title: A randomized trial of temazepam versus acetazolamide in high altitude sleep disturbance.
abstract: This study is the first comparative trial of sleep medications at high altitude. We performed a randomized, double-blind trial of temazepam and acetazolamide at an altitude of 3540 meters. 34 healthy trekkers with self-reports of high-altitude sleep disturbance were randomized to temazepam 7.5 mg or acetazolamide 125 mg taken at bedtime for one night. The primary outcome was sleep quality on a 100 mm visual analog scale. Additional measurements were obtained with actigraphy; pulse oximetry; and questionnaire evaluation of sleep, daytime drowsiness, daytime sleepiness, and acute mountain sickness. Sixteen subjects were randomized to temazepam and 18 to acetazolamide. Sleep quality on the 100 mm visual analog scale was higher for temazepam (59.6, SD 20.1) than acetazolamide (46.2, SD 20.2; p=0.048). Temazepam also demonstrated higher subjective sleep quality on the Groningen Sleep Quality Scale (3.5 vs. 6.8, p=0.009) and sleep depth visual analog scale (60.3 vs. 41.4, p=0.028). The acetazolamide group reported significantly more awakenings to urinate (1.8 vs. 0.5, p=0.007). No difference was found with regards to mean nocturnal oxygen saturation (84.1 vs. 84.4, p=0.57), proportion of the night spent in periodic breathing, relative desaturations, sleep onset latency, awakenings, wake after sleep onset, sleep efficiency, Stanford Sleepiness Scale scores, daytime drowsiness, or change in self-reported Lake Louise Acute Mountain Sickness scores. We conclude that, at current recommended dosing, treatment of high-altitude sleep disturbance with temazepam is associated with increased subjective sleep quality compared to acetazolamide.
authors.affiliation: 1 Division of Wilderness Medicine, Department of Emergency Medicine, Massachusetts General Hospital , Boston, Massachusetts.
authors.forename: John B
authors.initials: JB
authors.lastname: Tanner
authors.forename: Sarah M E
authors.initials: SM
authors.lastname: Tanner
authors.forename: Ghan Bahadur
authors.initials: GB
authors.lastname: Thapa
authors.forename: Yuchiao
authors.initials: Y
authors.lastname: Chang
authors.forename: Kirsty L M
authors.initials: KL
authors.lastname: Watson
authors.forename: Eamon
authors.initials: E
authors.lastname: Staunton
authors.forename: Claire
authors.initials: C
authors.lastname: Howarth
authors.forename: Buddha
authors.initials: B
authors.lastname: Basnyat
authors.forename: N Stuart
authors.initials: NS
authors.lastname: Harris
mesh_terms: D000086:Acetazolamide / Q000627:therapeutic use*; D056044:Actigraphy; D000328:Adult; D000531:Altitude; D002257:Carbonic Anhydrase Inhibitors / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood; D020919:Sleep Disorders, Intrinsic / Q000097:blood / Q000188:drug therapy*; D012894:Sleep Stages / Q000187:drug effects; D011795:Surveys and Questionnaires; D013693:Temazepam / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D006993:Hypnotics and Sedatives; D013693:Temazepam; D000086:Acetazolamide; D010100:Oxygen
references.citation: Am J Med. 1987 Dec;83(6):1024-30
references.pmid: 3332564
references.citation: Psychophysiology. 1973 Jul;10(4):431-6
references.pmid: 4719486
references.citation: Am J Respir Crit Care Med. 1996 Jun;153(6 Pt 1):1864-9
references.pmid: 8665047
references.citation: Sleep. 1988 Aug;11(4):354-61
references.pmid: 2905069
references.citation: Behav Sleep Med. 2004;2(1):24-40
references.pmid: 15600222
references.citation: Sleep. 2007 Nov;30(11):1527-33
references.pmid: 18041485
references.citation: Eur Respir J. 2004 Jan;23(1):47-52
references.pmid: 14738230
references.citation: High Alt Med Biol. 2004 Summer;5(2):180-9
references.pmid: 15265339
references.citation: Sleep. 2003 Feb 1;26(1):81-5
references.pmid: 12627737
references.citation: J Sleep Res. 2013 Jun;22(3):322-30
references.pmid: 23294420
references.citation: Am Rev Respir Dis. 1987 Apr;135(4):896-8
references.pmid: 3565935
references.citation: High Alt Med Biol. 2008 Winter;9(4):281-7
references.pmid: 19115911
references.citation: Sleep Med. 2008 May;9(4):446-9
references.pmid: 17869574
references.citation: Sleep Med Rev. 2011 Aug;15(4):259-67
references.pmid: 21237680
references.citation: Sleep. 1992 Oct;15(5):461-9
references.pmid: 1455130
references.citation: Neuropsychobiology. 2004;49(3):154-62
references.pmid: 15034230
references.citation: Sleep. 2012 Mar 01;35(3):419-23
references.pmid: 22379248
references.citation: Sleep. 1980;3(3-4):455-64
references.pmid: 7221351
references.citation: N Engl J Med. 1979 Dec 13;301(24):1329-31
references.pmid: 503151
references.citation: High Alt Med Biol. 2011 Fall;12(3):229-36
references.pmid: 21962066
references.citation: High Alt Med Biol. 2008 Fall;9(3):195-8
references.pmid: 18800955
references.citation: BMJ. 1998 Feb 21;316(7131):587-9
references.pmid: 9518909
references.citation: Acta Psychiatr Scand Suppl. 1986;332:55-9
references.pmid: 2883829
references.citation: N Engl J Med. 1968 Oct 17;279(16):839-45
references.pmid: 4877992
references.citation: Chest. 2012 Jan;141(1):131-138
references.pmid: 21659435
references.citation: JAMA. 1982 Jul 16;248(3):328-32
references.pmid: 7045433
references.citation: J Sleep Res. 2006 Dec;15(4):445-54
references.pmid: 17118102