title: Polysomnographic findings in a cohort of chronic insomnia patients with benzodiazepine abuse.
abstract: OBJECTIVE
  To evaluate sleep modifications induced by chronic benzodiazepine (BDZ) abuse.
  
  
  METHODS
  Cohort study, comparison of sleep measures between BDZs abusers and controls. Drug Addiction Unit (Institute of Psychiatry) and Unit of Sleep Disorders (Institute of Neurology) of the Catholic University in Rome. Six outpatients affected by chronic BDZ abuse were enrolled, (4 men, 2 women, mean age 53.3 ± 14.8, range: 34-70 years); 55 healthy controls were also enrolled (23 men, 32 women, mean age 54.2 ± 13.0, range: 27-76 years). All patients underwent clinical evaluation, psychometric measures, ambulatory polysomnography, scoring of sleep macrostructure and microstructure (power spectral fast-frequency EEG arousal, cyclic alternating pattern [CAP]), and heart rate variability.
  
  
  RESULTS
  BDZ abusers had relevant modification of sleep macrostructure and a marked reduction of fast-frequency EEG arousal in NREM (patients: 6.6 ± 3.7 events/h, controls 13.7 ± 4.9 events/h, U-test: 294, p = 0.002) and REM (patients: 8.4 ± 2.4 events/h, controls 13.3 ± 5.1 events/h, U-test: 264, p = 0.016), and of CAP rate (patients: 15.0 ± 8.6%, controls: 51.2% ± 12.1%, U-test: 325, p < 0.001).
  
  
  CONCLUSIONS
  BDZ abusers have reduction of arousals associated with increased number of nocturnal awakenings and severe impairment of sleep architecture. The effect of chronic BDZ abuse on sleep may be described as a severe impairment of arousal dynamics; the result is the inability to modulate levels of vigilance.
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Marianna
authors.initials: M
authors.lastname: Mazza
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Anna
authors.initials: A
authors.lastname: Losurdo
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Elisa
authors.initials: E
authors.lastname: Testani
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marano
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Di Nicola
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Serena
authors.initials: S
authors.lastname: Dittoni
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Valentina
authors.initials: V
authors.lastname: Gnoni
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Di Blasi
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Nadia Mariagrazia
authors.initials: NM
authors.lastname: Giannantoni
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Lapenta
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Brunetti
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Pietro
authors.initials: P
authors.lastname: Bria
authors.affiliation: Institute of Psychiatry, Catholic University, Rome, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Janiri
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Salvatore
authors.initials: S
authors.lastname: Mazza
authors.affiliation: Institute of Neurology, Catholic University, Rome, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Della Marca
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000494:pharmacology*; D002908:Chronic Disease; D015331:Cohort Studies; D004569:Electroencephalography / Q000187:drug effects; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography / Q000187:drug effects* / Q000379:methods / Q000706:statistics & numerical data; D011594:Psychometrics; D012384:Rome; D007319:Sleep Initiation and Maintenance Disorders / Q000139:chemically induced* / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications*
chemical_list: D001569:Benzodiazepines
keywords: Abuse; arousal; benzodiazepines; cyclic alternating pattern; polysomnography; sleep