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Premedication with zolpidem may reduce poor quality polysomnography
  1. P Bhatia
  1. SpR Respiratory Medicine, Wythenshawe Hospital, Manchester, UK;

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The increasing awareness of sleep disordered breathing has resulted in an increased demand for polysomnography (PSG). A number of factors may lead to poor quality studies requiring repeat studies; these factors can prolong waiting times.

Zolpidem is a non-benzodiazepine sedative which has been shown to decrease sleep latency and increase sleep efficiency with minimal side effects on sleep architecture and respiratory events. The authors hypothesised that premedication with zolpidem before PSG might therefore result in a higher diagnostic yield.

They retrospectively reviewed 203 PSGs performed in adults. Two were excluded because they were given 5 mg zolpidem and one was excluded because he was on long term zolpidem treatment. Zolpidem premedication was not standardised and was prescribed at the discretion of the consulting sleep physicians who were unaware of the study. Of the remaining 200 patients, 54 (27%) received 10 mg zolpidem before the PSG. This resulted in a significant reduction in sleep latency (11.8 minutes v 26.0 minutes, p = 0.002) and sleep efficiency was also improved with zolpidem (p<0.0001). There was no difference in the mean (SD) apnoea-hypopnoea index with or without zolpidem (32.4 (12.7) v 30.1 (11.9), p = 0.28). Without zolpidem 33.6% studies were of poor quality compared with 7.4% with zolpidem. Thirty of the 49 PSGs of poor quality were repeated during the study period, 21 with zolpidem premedication all of which were of good quality and nine without zolpidem of which five remained of poor quality.

The authors conclude that premedication with 10 mg zolpidem will enhance the diagnostic yield of PSG, thus saving costs and time. However, this study does not conclusively exclude any effect of zolpidem on the PSG itself. A prospective study is required before this can be generally recommended.

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