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Li X, Jin Y. Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report. BMC Cardiovasc Disord 2024; 24:339. [PMID: 38965461 PMCID: PMC11225507 DOI: 10.1186/s12872-024-04016-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 06/26/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. CASE PRESENTATION A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected. CONCLUSIONS This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.
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Affiliation(s)
- Xiaolin Li
- Department of Nutrition, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine, International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China
| | - Yunpeng Jin
- Department of Cardiology, The Fourth Affiliated Hospital of School of Medicine, International School of Medicine , International Institutes of Medicine, Zhejiang University, Yiwu, 322000, China.
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Chen SY, Lin TA, Sun CK, Chang R. Correspondence to "association of sleep patterns and cardiovascular disease risk is modified by glucose tolerance status". Diabetes Metab Res Rev 2024; 40:e3808. [PMID: 38711301 DOI: 10.1002/dmrr.3808] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/08/2024]
Abstract
After reading the article written by Wang et al., we have encountered several concerns that may compromise the credibility of the article. There are some factors, such as changes in sleep patterns, glucose tolerance status, and the use of hypnotics, which may interfere with the research results. Additionally, the design of the sleep pattern could lead to biased outcomes. Therefore, we are writing this letter to recommend that further research should take these concerns into consideration.
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Affiliation(s)
- Ssu-Yu Chen
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Ting-An Lin
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheuk-Kwan Sun
- Department of Emergency Medicine, E-Da Dachang Hospital, I-Shou University, Kaohsiung, Taiwan
- School of Medicine for International Students, College of Medicine, I-Shou University, Kaohsiung, Taiwan
| | - Renin Chang
- Department of Emergency Medicine, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Medical Education and Research, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Joung KI. Gender differences in spontaneous adverse event reports associated with zolpidem in South Korea, 2015-2019. Front Pharmacol 2023; 14:1256245. [PMID: 38026947 PMCID: PMC10665515 DOI: 10.3389/fphar.2023.1256245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 10/03/2023] [Indexed: 12/01/2023] Open
Abstract
Study objectives: While zolpidem is considered as an example of a gender effect on drug response, there is insufficient evidence to reach a consensus. This study aimed to investigate gender differences in adverse events (AEs) of zolpidem. Methods: We estimated the difference between the reporting odds ratios (RORs) calculated in gender subgroups for the AEs signals detected in data mining using 2015-2019 Korea voluntary adverse drug events reporting system (KAERS) data. Different reporting risk by gender was evaluated by using the log RORs being significantly different by gender at the 5% significance level and the 95% confidence intervals of the gender ROR. Results: A total of 94 AE signals were detected. Among these, 35 signals showed significant disparities by gender at the 5% level or were detected only in one gender. When categorized by similarity of AEs, parasomnia including somnambulism and paroniria, and cardiovascular disorders including coronary thrombosis had higher reporting risks in women. Men were more likely to report cognitive disorders such as delirium, insomnia related disorders, and movement disorders. Among all AEs with gender differences in reporting risk, the difference in somnambulism was the most consistent and substantial. Conclusion: For several AEs associated with zolpidem, gender-based reporting disparities were evident. Notably, women exhibited a higher susbeptibility to somnambulism, potentially serious adverse effects of zolpidem. This underscores the need for further investigation into the underlying factors influencing these gender-specific reporting patterns.
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Affiliation(s)
- Kyung-In Joung
- School of AI Healthcare, College of Integrated Health Science, CHA University, Pocheon, Republic of Korea
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Arora N, Bhatta L, Skarpsno ES, Dalen H, Åsvold BO, Brumpton BM, Richmond RC, Strand LB. Investigating the causal interplay between sleep traits and risk of acute myocardial infarction: a Mendelian randomization study. BMC Med 2023; 21:385. [PMID: 37798698 PMCID: PMC10557341 DOI: 10.1186/s12916-023-03078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND Few studies have investigated the joint effects of sleep traits on the risk of acute myocardial infarction (AMI). No previous study has used factorial Mendelian randomization (MR) which may reduce confounding, reverse causation, and measurement error. Thus, it is prudent to study joint effects using robust methods to propose sleep-targeted interventions which lower the risk of AMI. METHODS The causal interplay between combinations of two sleep traits (including insomnia symptoms, sleep duration, or chronotype) on the risk of AMI was investigated using factorial MR. Genetic risk scores for each sleep trait were dichotomized at their median in UK Biobank (UKBB) and the second survey of the Trøndelag Health Study (HUNT2). A combination of two sleep traits constituting 4 groups were analyzed to estimate the risk of AMI in each group using a 2×2 factorial MR design. RESULTS In UKBB, participants with high genetic risk for both insomnia symptoms and short sleep had the highest risk of AMI (hazard ratio (HR) 1.10; 95% confidence interval (CI) 1.03, 1.18), although there was no evidence of interaction (relative excess risk due to interaction (RERI) 0.03; 95% CI -0.07, 0.12). These estimates were less precise in HUNT2 (HR 1.02; 95% CI 0.93, 1.13), possibly due to weak instruments and/or small sample size. Participants with high genetic risk for both a morning chronotype and insomnia symptoms (HR 1.09; 95% CI 1.03, 1.17) and a morning chronotype and short sleep (HR 1.11; 95% CI 1.04, 1.19) had the highest risk of AMI in UKBB, although there was no evidence of interaction (RERI 0.03; 95% CI -0.06, 0.12; and RERI 0.05; 95% CI -0.05, 0.14, respectively). Chronotype was not available in HUNT2. CONCLUSIONS This study reveals no interaction effects between sleep traits on the risk of AMI, but all combinations of sleep traits increased the risk of AMI except those with long sleep. This indicates that the main effects of sleep traits on AMI are likely to be independent of each other.
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Affiliation(s)
- Nikhil Arora
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Laxmi Bhatta
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Division of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Institute for Molecular Bioscience, University of Queensland, Brisbane, Australia
| | - Eivind Schjelderup Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Neurology and Clinical Neurophysiology, St. Olavs Hospital, Trondheim, Norway
| | - Håvard Dalen
- Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Trondheim, Norway
- Department of Medicine, Levanger Hospital, Nord-Trøndelag Hospital Trust, Levanger, Norway
- Clinic of Cardiology, St. Olavs Hospital, Trondheim, Norway
| | - Bjørn Olav Åsvold
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Department of Endocrinology, Clinic of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Ben Michael Brumpton
- K.G. Jebsen Center for Genetic Epidemiology, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
- HUNT Research Centre, Department of Public Health and Nursing, Norwegian University of Science and Technology, Levanger, Norway
- Department of Medicine, St. Olavs Hospital, Trondheim, Norway
| | - Rebecca Claire Richmond
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Linn Beate Strand
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
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Ezekekwu E, Johnson C, Karimi S, Antimisiaris D, Lorenz D. Examining the relationship between long working hours and the use of prescription sedatives among U.S. workers. Sleep Med 2023; 109:226-239. [PMID: 37478659 DOI: 10.1016/j.sleep.2023.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 06/11/2023] [Accepted: 06/27/2023] [Indexed: 07/23/2023]
Abstract
OBJECTIVES The prevalence of long working hours has been accompanied by a corresponding rise in sleep disorders. Sedative-hypnotic agents (SHAs), have been reported as the second most commonly misused drug class in the U.S. The key objective of this study was to examine the relationship between working hours on the use of sleep aids and medications with sedative properties. METHODS The 2010-2019 Medical Expenditure Panel Survey data was utilized. SHAs and medications with sedative related properties (MSRPs) were identified. Furthermore, we employed different regression models ranging from multivariable linear regression, Tobit regression, Heckman regression, and multivariable logistic regression, to ensure consistency, robustness, and reliability of associations. RESULTS Overall, a sample of 81,518 observations of full-time workers was analyzed. Working 56hours or more per week was significantly associated (p < 0.05) with an increased odds of using SHAs and MSRPs by 13% (Adjusted Odds Ratio, aOR =1.13, 95% Confidence Interval, CI=1.01:1.26) and 9% (aOR=1.09, 95% CI=1.03:1.16), respectively more than that among those who worked fewer hours. Females in our study had a higher likelihood (aOR=1.11, 95% CI=1.05:1.19) of using SHAs when compared to males. Also, professional services had the highest likelihood (aOR=1.31, 95% CI=1.14:1.50) of using SHAs. CONCLUSION We found that long working hours were significantly associated with an elevated use of SHAs and MSRPs among U.S. workers. Specifically, female workers and individuals working in professional services had the highest likelihood of using sleep medications.
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Affiliation(s)
- Emmanuel Ezekekwu
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Christopher Johnson
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Seyed Karimi
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Demetra Antimisiaris
- Department of Health Management and Systems Sciences School of Public Health and Information Sciences, University of Louisville 485 E. Gray Street Louisville, KY 40202, USA.
| | - Doug Lorenz
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Sciences, University of Louisville, 485 E. Gray Street, Louisville, KY 40202, USA.
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Hu X, Jong GP, Wang L, Lin MC, Gong SQ, Zhang XH, Lin JJ, Adeniran E, Liu YL, Chen HY, Yang B. Hypnotics Use Is Associated with Elevated Incident Atrial Fibrillation: A Propensity-Score Matched Analysis of Cohort Study. J Pers Med 2022; 12:jpm12101645. [PMID: 36294784 PMCID: PMC9605069 DOI: 10.3390/jpm12101645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 07/27/2022] [Accepted: 07/29/2022] [Indexed: 11/30/2022] Open
Abstract
We aimed to investigate the association between either or both of benzodiazepines (BZDs) and non-BZDs and the incidence of atrial fibrillation (AF) in the Taiwan National Health Insurance Database. The participants with at least two prescriptions of BZDs and/or non-BZDs were identified as hypnotics users, whereas those without any prescription of hypnotics were non-hypnotics users. The hypnotics and non-hypnotics cohorts were 1:1 matched on their propensity scores. A total of 109,704 AF-free individuals were included; 610 AF cases occurred in the 54,852 hypnotics users and 166 in the 54,852 non-hypnotics users during the 602,470 person-years of follow-up, with a higher risk of new-onset AF in the users than the non-users (hazard ratio (HR): 3.61, 95% confidence interval [CI]: 3.04−4.28). The users at the highest tertiles of the estimated defined daily doses per one year (DDD) had a greater risk for AF than the non-users, with the risk increasing by 7.13-fold (95% CI: 5.86−8.67) for >0.74-DDD BZDs, 10.68-fold (95% CI: 6.13−18.62) for >4.72-DDD non-BZDs, and 3.26-fold (95% CI: 2.38−4.47) for > 1.65-DDD combinations of BZDs with non-BZDs, respectively. In conclusion, hypnotics use was associated with elevated incidence of AF in the Taiwanese population, which highlighted that the high-dose usage of hypnotics needs more caution in clinical cardiological practice.
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Affiliation(s)
- Xiang Hu
- Department of Endocrine and Metabolic Diseases, Key Laboratory of Clinical Laboratory Diagnosis and Translational Research of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
| | - Gwo-Ping Jong
- Division of Cardiology, Department of Medicine, Chung Shan Medical University Hospital, Chung Shan Medical University, Taichung 402, Taiwan
| | - Liang Wang
- Department of Public Health, Robbins College of Health and Human Sciences, Baylor University, Waco, TX 76798, USA
| | - Mei-Chen Lin
- Management Office for Health Data, China Medical University Hospital, Taichung 404, Taiwan
- College of Medicine, China Medical University, Taichung 404, Taiwan
| | - Shao-Qing Gong
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an 710049, China
| | - Xue-Hong Zhang
- Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA
| | - Jiun-Jie Lin
- Department of Pharmacy, Feng-Yuan Hospital, Ministry of Health Welfare, Taichung 420, Taiwan
| | - Esther Adeniran
- Department of Biostatistics and Epidemiology, College of Public Health, East Tennessee State University, Johnson City, TN 37614, USA
| | - Yan-Long Liu
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
| | - Hung-Yi Chen
- Department of Pharmacy, China Medical University, Taichung 404, Taiwan
- Department of Pharmacy, China Medical University Beigang Hospital, Yunlin 651, Taiwan
- Correspondence: (H.-Y.C.); (B.Y.); Tel./Fax: +86-577-86687632 (B.Y.)
| | - Bo Yang
- School of Public Health and Management, Wenzhou Medical University, Wenzhou 325035, China
- Department of Pharmacy, China Medical University, Taichung 404, Taiwan
- Correspondence: (H.-Y.C.); (B.Y.); Tel./Fax: +86-577-86687632 (B.Y.)
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Kuo CL, Chien IC, Lin CH. Trends, correlates, and disease patterns of sedative-hypnotic use among elderly persons in Taiwan. BMC Psychiatry 2022; 22:316. [PMID: 35508990 PMCID: PMC9066755 DOI: 10.1186/s12888-022-03964-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE The population-based National Health Insurance database was adopted to investigate the prevalence, correlates, and disease patterns of sedative-hypnotic use in elderly persons in Taiwan. METHODS The National Health Research Institutes provided a database of 1,000,000 random subjects in the National Health Insurance program. We adopted this sample of subjects who were older than 65 years from 1997 to 2005 and examined the proportions of psychiatric and nonpsychiatric disorders with regard to sedative-hypnotic use. RESULTS The 1-year prevalence of sedative-hypnotic use in elderly individuals increased from 1.7% in 1997 to 5.5% in 2005. The 1-year prevalence rates of benzodiazepine (BZD) and non-BZD hypnotics were 3.2 and 3.1%, respectively, in 2005. The overall hypnotic use was highest in ≥85-year-olds, males, those with lower amounts of insurance or higher Charlson Comorbidity Index scores and those living in eastern Taiwan. Both BZD and non-BZD hypnotic use were most commonly used in nonpsychiatric disorders instead of psychiatric disorders. Among the psychiatric disorders, the disorders that accounted for higher BZD and non-BZD hypnotic use were senile and presenile organic psychotic conditions (3.4 and 3.4%, respectively). Higher BZD and non-BZD use was for diseases of the respiratory system (30.4 and 17.8%, respectively), the circulatory system (20.4 and 22.4%, respectively), and neoplasms (12.6 and 13.8%, respectively). CONCLUSION The prevalence rates of both BZD and non-BZD sedative-hypnotic use increased from 1997 to 2005 in the elderly. The risk factors for sedative-hypnotic use were aging, male sex, lower insurance amount, and higher Charlson Comorbidity Index scores. Most BZD and non-BZD sedative-hypnotic users were persons with nonpsychiatric disorders.
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Affiliation(s)
- Chia-Lun Kuo
- grid.454740.6Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan ,grid.64523.360000 0004 0532 3255Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - I-Chia Chien
- Bali Psychiatric Center, Ministry of Health and Welfare, No. 33, HuaFuShan Rd, Bali District, New Taipei City, 249, Taiwan. .,National Yang-Ming University, Taipei, Taiwan.
| | - Ching-Heng Lin
- grid.410764.00000 0004 0573 0731Taichung Veterans General Hospital, Taichung, Taiwan ,grid.412146.40000 0004 0573 0416National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
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Basu A, Joshi T, Pal A, Gupta R. Management of chronic insomnia using hypnotics: a friend or a foe? Sleep Biol Rhythms 2022; 20:39-46. [PMID: 38469060 PMCID: PMC10900020 DOI: 10.1007/s41105-021-00363-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 11/28/2021] [Indexed: 10/19/2022]
Abstract
Epidemiological studies suggest that 10-15% adults meet the present criteria for the diagnosis of insomnia disorder; however, there may be geographical variations. Untreated insomnia disorders have a number of adverse health consequences in addition to economic burden caused by it. Available guidelines mention that CBT-I should be preferred over hypnotics. However, several patients of chronic insomnia are not candidate for CBT-I and for them, hypnotics are the only answer. This paper reviews the literature to answer following questions: What is the current understanding regarding place of hypnotics for in management of insomnia disorder? How many patients misuse or abuse hypnotics, especially benzodiazepines, as commonly believed? Do we have data from human studies regarding low-dose benzodiazepine dependence? What does hypnotics produce-withdrawal insomnia, rebound insomnia or end of dose phenomenon? Are adverse effects of benzodiazepines worse than other psychotropic medications? Is prescription of hypnotics more troublesome than untreated insomnia disorder? Available literature suggests that there is an unreasonable negative bias attached to the use of hypnotics. Only a sub-set of patients who are prescribed hypnotics, meet the criteria for "dependence" in long term. Other patients either discontinue it (as insomnia remits) or change to occasional use (since insomnia may be relapsing remitting disorder), or continue using it in low dose (since insomnia reappears as hypnotics are discontinued, similar to increase in blood sugar after hypoglycemics are discontinued). Meta-analysis shows that adverse effects of hypnotics are comparable to that of other psychotropic medications. Considering the consequences and risks associated with untreated insomnia disorder, even long-term use of hypnotics is justified, however with the careful watch that patients are not increasing the dose. This approach is especially important in geographical areas where trained CBT-I therapists are not available.
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Affiliation(s)
- Aniruddha Basu
- Department of Psychiatry, All India Institute of Medical Sciences, Kalyani, 741245 India
| | - Tanmay Joshi
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, 249203 India
| | - Arghya Pal
- Department of Psychiatry, All India Institute of Medical Sciences, Raibareli, 229405 India
| | - Ravi Gupta
- Department of Psychiatry and Division of Sleep Medicine, All India Institute of Medical Sciences, Rishikesh, 249203 India
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Maher LLM, Coke LA. Diagnosis and treatment of obstructive sleep apnea and its impact on cardiovascular disease. J Am Assoc Nurse Pract 2021; 34:389-396. [PMID: 34172628 DOI: 10.1097/jxx.0000000000000632] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/19/2021] [Indexed: 10/21/2022]
Abstract
ABSTRACT Obstructive sleep apnea (OSA) is a prevalent disorder that has direct correlation to cardiovascular disease. Understanding the etiology and symptoms of this condition as it relates to cardiovascular disease can improve comprehensive health assessments and determine the use of appropriate screening tools. This case-based approach follows a patient through assessment, diagnosis, and treatment options. Although lifestyle behavior changes are recommended for all patients, other options, such as positive airway pressure therapy, oral appliances, implantable therapy, surgery, and pharmacological and oxygen therapies, exist and should be explored as treatment options. Yearly follow-up provides the best method for long-term treatment success. Treatment of OSA reduces the incidence of cardiac comorbidities and improves cardiovascular health.
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Affiliation(s)
- Lisa L M Maher
- Cedar Valley Medical Specialists PC, Cedar Valley Cardiovascular Center, Waterloo, Iowa
| | - Lola A Coke
- Wesorick Center for Healthcare Transformation, Kirkhof College of Nursing, Grand Valley State University, Allendale, Michigan
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Manolis TA, Manolis AA, Apostolopoulos EJ, Melita H, Manolis AS. Cardiovascular Complications of Sleep Disorders: A Better Night's Sleep for a Healthier Heart / From Bench to Bedside. Curr Vasc Pharmacol 2021; 19:210-232. [PMID: 32209044 DOI: 10.2174/1570161118666200325102411] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 02/26/2020] [Accepted: 02/26/2020] [Indexed: 12/27/2022]
Abstract
Sleep is essential to and an integral part of life and when lacking or disrupted, a multitude of mental and physical pathologies ensue, including cardiovascular (CV) disease, which increases health care costs. Several prospective studies and meta-analyses show that insomnia, short (<7h) or long (>9h) sleep and other sleep disorders are associated with an increased risk of hypertension, metabolic syndrome, myocardial infarction, heart failure, arrhythmias, CV disease risk and/or mortality. The mechanisms by which insomnia and other sleep disorders lead to increased CV risk may encompass inflammatory, immunological, neuro-autonomic, endocrinological, genetic and microbiome perturbations. Guidelines are emerging that recommend a target of >7 h of sleep for all adults >18 years for optimal CV health. Treatment of sleep disorders includes cognitive-behavioral therapy considered the mainstay of non-pharmacologic management of chronic insomnia, and drug treatment with benzodiazepine receptor agonists binding to gamma aminobutyric acid type A (benzodiazepine and non-benzodiazepine agents) and some antidepressants. However, observational studies and meta-analyses indicate an increased mortality risk of anxiolytics and hypnotics, although bias may be involved due to confounding and high heterogeneity in these studies. Nevertheless, it seems that the risk incurred by the non-benzodiazepine hypnotic agents (Z drugs) may be relatively less than the risk of anxiolytics, with evidence indicating that at least one of these agents, zolpidem, may even confer a lower risk of mortality in adjusted models. All these issues are herein reviewed.
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Tang IT, Hsu NW, Chou P, Chen HC. The association between various characteristics of hypnotics and cardiac autonomic control in community-dwelling older adults: the Yilan Study, Taiwan. Sleep Med 2020; 71:77-82. [PMID: 32502853 DOI: 10.1016/j.sleep.2020.03.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 03/23/2020] [Accepted: 03/26/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Alteration of cardiac autonomic function may underlie the link between hypnotics use and the risk for cardiovascular morbidity and mortality. This study aimed to examine the relationship between the various characteristics of benzodiazepine receptor agonists (BzRAs) and heart rate variability (HRV). METHODS A community-based survey using the cohort from the Yilan Study, Taiwan was conducted. Older adults aged 65 and older were randomly selected to participate from August 2013 to November 2016. Cardiac autonomic function was evaluated using HRV, and the lowest quartiles of HRV parameters were defined as unhealthy. Those who used BzRAs as a sleep aid were defined as BzRA hypnotic users. The characteristics of BzRA use were further detailed and included the half-life, drug compound, frequency of use, and cumulative daily equivalent dosage. RESULTS Of all participants, 379 (14.5%) were BzRA hypnotic users. After controlling for covariates, BzRA hypnotic users had a higher risk for unhealthier HRV than non-users. Among all BzRA hypnotic users, those who only used benzodiazepines (BZDs), used short half-life BzRAs, and used the middle tertile of daily cumulative BZD equivalent had a higher risk for poor total power (odds ratio [OR]: 2.11, 95% confidence interval [CI]: 1.07-4.16), high frequency (OR: 3.43, 95% CI: 1.07-10.97), and high frequency (OR: 2.94, 95% CI: 1.35-6.42), respectively, than their counterparts. CONCLUSIONS BzRA hypnotics are linked with poor cardiac autonomic function. Various characteristics of BzRA hypnotics showed an independent pattern of association with cardiac autonomic function.
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Affiliation(s)
- I-Tien Tang
- Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Division of Clinical Toxicology and Occupational Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Nai-Wei Hsu
- Division of Cardiology, Department of Internal Medicine & Community Medicine Center, National Yang-Ming University Hospital, Yilan, Taiwan; Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan; Public Health Bureau, Yilan County, Taiwan
| | - Pesus Chou
- Community Medicine Research Center & Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Hsi-Chung Chen
- Department of Psychiatry & Center of Sleep Disorders, National Taiwan University Hospital, Taipei, Taiwan.
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Bragg S, Benich JJ, Christian N, Visserman J, Freedy J. Updates in insomnia diagnosis and treatment. Int J Psychiatry Med 2019; 54:275-289. [PMID: 31269837 DOI: 10.1177/0091217419860716] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Insomnia is the most commonly reported sleep disorder and remains undertreated in many patients. New changes to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, have changed the way insomnia is diagnosed. In patients who suffer from insomnia, a number of available treatment options exist including both behavioral therapy and medications. Literature Review: First line therapy for insomnia should always include behavioral modifications such as sleep hygiene and insomnia-oriented cognitive behavioral therapy. In patients deemed to need pharmacotherapy, first line medications include nonbenzodiazepine hypnotics (i.e., z-drugs) and antidepressants depending on the patients’ needs and comorbidities. The risk of next day impairment, parasomnias, and central nervous system depression are some of the most feared side effects with z-drugs. Second line drug therapy includes melatonin and suvorexant. Several concerns exist for suvorexant similar to other insomnia medications, but melatonin remains one of the safest medication alternatives. Other medication options such as benzodiazepines, antihistamines, and antipsychotics should rarely be used because of weak effectiveness data or serious safety concerns. Discussion The most appropriate treatment plan needs to be tailored to meet the needs of individual patients. Many patient factors (e.g., age, other comorbidities, specific problems with sleep) need to be considered before prescribing drug therapy for patients suffering from insomnia. Medications with the best evidence and fewest safety concerns should be prioritized when clinicians work with patients to determine the most appropriate treatment plan. Conclusions Nondrug treatment should be the emphasis for managing insomnia, but several options exist for patients needing multimodal therapy to improve their symptoms and maximize their quality of life. Z-drugs and antidepressants are first line medications options, but other options may be considered when tailored to individual patients. Medications should only be used intermittently and short term until nondrug treatments help to change a patient’s sleep routine.
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Affiliation(s)
- Scott Bragg
- 1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | | | - Natalie Christian
- 1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Josh Visserman
- 1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - John Freedy
- 1 Department of Family Medicine, Medical University of South Carolina, Charleston, SC, USA
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