title: Use of computerized dynamic posturography to assess balance in older adults after nighttime awakenings using zolpidem as a reference.
abstract: BACKGROUND
  Computerized dynamic posturography (CDP) has been used to detect balance and stability impairments in adults of all ages. The goal of the current pilot study was to evaluate balance in healthy older adults after a middle-of-the-night awakening and to assess the ability of CDP to measure effects of bedtime zolpidem administration.
  
  
  METHODS
  Two studies used CDP to evaluate balance in healthy older adults (> or = 65 years) during middle-of-the-night awakenings. The first study used a drug-free, single-period, within-subject, repeated measures study design. Subjects were evaluated during the day, pre-sleep, and 2 hours after bedtime for dynamic standing balance using the NeuroCom EquiTest Sensory Organization Test (SOT). Pairwise comparisons were made using one-way ANOVA. The second study was a single-blind, randomized, placebo-controlled, crossover study evaluating the ability of the SOT to measure medication-induced dynamic standing balance impairments using the commonly prescribed sleep medication, zolpidem 10 mg, as a test medication. Assessments were performed at night before zolpidem administration and then again 2 hours after bedtime. Comparisons were made between the 2 groups using an ANCOVA model.
  
  
  RESULTS
  Twelve older adults (mean age 68.4 years) were evaluated in the first study. There was no significant difference between pre-sleep and middle-of-the-night assessments for the SOT composite score (P = 0.439). Eleven older adults (mean age 68.9 years) were evaluated in the second study. Zolpidem administration significantly decreased the SOT composite score after a middle-of-the-night awakening compared with placebo (P < 0.001).
  
  
  CONCLUSIONS
  In healthy older adults, getting up in the middle of the night did not have a significant effect on dynamic standing balance; however, bedtime administration of zolpidem 10 mg did lead to significant impairments. Thus, the SOT was able to measure medication-induced dynamic standing balance impairments and may be useful for future studies comparing balance effects of medications.
authors.affiliation: Clinilabs and the Columbia University College of Physicians and Surgeons, New York, NY, USA. gzammit@clinilabs.com
authors.forename: Gary
authors.initials: G
authors.lastname: Zammit
authors.forename: Sherry
authors.initials: S
authors.lastname: Wang-Weigand
authors.forename: Xuejun
authors.initials: X
authors.lastname: Peng
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003201:Computers; D018592:Cross-Over Studies; D005260:Female; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D004856:Postural Balance / Q000187:drug effects*; D011725:Pyridines / Q000494:pharmacology*; D014851:Wakefulness / Q000502:physiology; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem