title: Middle-of-the-night administration of sleep medication: a critical review of the effects on next morning driving ability.
abstract: OBJECTIVE
  Sleep maintenance problems are common, hence treatments enabling patients to fall asleep more rapidly after middle-of-the-night (MOTN) awakenings, without impairing next morning alertness, are needed. This literature review compares the effects of MOTN administration of various hypnotics on morning driving ability, a potentially dangerous daily activity under conditions of impairment.
  
  
  METHODS
  A literature search was conducted identifying on-the-road driving studies examining the effects of MOTN administration of hypnotics on morning driving performance. In a standardized 100-km highway driving test in normal traffic, subjects were instructed to drive with a steady lateral position and constant speed of 95 km/h. The primary outcome measure of the driving test is the Standard Deviation of Lateral Position (SDLP, cm), i.e. weaving of the car.
  
  
  RESULTS
  Four driving studies were identified. Driving performance after MOTN administration of traditional benzodiazepine hypnotics was not examined. Zolpidem (10 mg and 20 mg, oral immediate release tablets) significantly impaired driving in a dose-dependent manner, when tested 4 hours after MOTN administration. Also, gaboxadol (15 mg) and zopiclone (7.5 mg) significantly impaired next-morning driving after MOTN administration. In contrast, sublingual zolpidem (3.5 mg) and zaleplon (10 mg and 20 mg) did not significantly affect driving 4 hours after MOTN administration.
  
  
  CONCLUSIONS
  Driving was not affected 4 hours after MOTN administration of sublingual zolpidem (3.5 mg) or zaleplon (10 mg and 20 mg). Significant driving impairment was found after MOTN administration of zolpidem (10 and 20 mg), gaboxadol (15 mg), and zopiclone (7.5 mg).
authors.forename: Joris C
authors.initials: JC
authors.lastname: Verster
authors.forename: Aurora J A E
authors.initials: AJ
authors.lastname: van de Loo
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Moline
authors.affiliation: Utrecht Institute for Pharmaceutical Sciences, Division of Pharmacology, Utrecht University, Universiteitsweg 99, 3584 CG, Utrecht, The Netherlands. j.c.verster@uu.nl.
authors.forename: Thomas
authors.initials: T
authors.lastname: Roth
mesh_terms: D001334:Automobile Driving; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D012727:Sex Characteristics; D013997:Time Factors
chemical_list: D006993:Hypnotics and Sedatives