title: Eszopiclone and Zolpidem Do Not Affect the Prevalence of the Low Arousal Threshold Phenotype.
abstract: We sought to determine whether non benzodiazepine sedative hypnotics (NBSH) reduce the occurrence of the low arousal threshold (LAT) phenotype.
  
  
  
  Consecutive patients with suspected obstructive sleep apnea (OSA) referred for polysomnography (PSG) had demographic and PSG data abstracted. LAT was estimated using PSG criteria. After adjusting for pretest probability (PTP) for OSA, we calculated the effect that premedication with NBSHs has on LAT prevalence.
  
  
  
  Five hundred seventy-nine patients with a mean age and body mass index of 42.2 ± 10.1 y and 28.9 ± 4.5 kg/m2, respectively, had data available for analysis. Most patients (444, or 80.9%) had a LAT, and administering a NBSH (zolpidem or eszopiclone) on the same night as the PSG did not change LAT prevalence (NBSH: 339 (83.3%) versus no drug: 100 (80.6%); p = 0.50). Adjusting for PTP, neither administration of eszopiclone (odds ratio 0.80 (95% confidence interval: 0.33-2.0); 0.69) nor zolpidem (odds ratio 1.65 (95% confidence interval: 0.8-3.5); p = 0.19) reduced the odds that a patient had a LAT. NBSHs did not change the mean SpO2nadir, percentage hypopneas, or apnea-hypopnea index. There was no association between zolpidem or eszopiclone dosing and SpO2nadir (zolpidem: β = -0.69, p = 0.80; eszopiclone: β = -1.53, p = 0.68), percentage hypopneas (zolpidem: β = 2.2, p = 0.43; eszopiclone β = -6.2, p = 0.46), or apnea-hypopnea index (zolpidem: β = 3.1, p = 0.22; eszopiclone: β = 2.6, p = 0.39).
  
  
  
  The LAT is common in our population and NBSH premedication does not alter its occurrence. Further studies are needed to determine how the LAT can be optimally managed to improve OSA treatment.
authors: Department of Pulmonary, Critical Care, and Sleep Medicine Walter Reed National Military Medical Center Bethesda, MD.
authors: Patrick R
authors: PR
authors: Smith
authors: Respira Medical, Inc, Walter Reed National Military Medical Center.
authors: Karen L
authors: KL
authors: Sheikh
authors: Department of Pulmonary, Critical Care, and Sleep Medicine, Walter Reed National Military Medical Center.
authors: Camille
authors: C
authors: Costan-Toth
authors: Department of Pulmonary, Critical Care, and Sleep Medicine Walter Reed National Military Medical Center Bethesda, MD.
authors: Derek
authors: D
authors: Forsthoefel
authors: Department of Pulmonary, Critical Care, and Sleep Medicine Walter Reed National Military Medical Center Bethesda, MD.
authors: Edward
authors: E
authors: Bridges
authors: Department of Pulmonary, Critical Care, and Sleep Medicine Walter Reed National Military Medical Center Bethesda, MD.
authors: Teotimo F
authors: TF
authors: Andrada
authors: Department of Pulmonary, Critical Care, and Sleep Medicine Walter Reed National Military Medical Center Bethesda, MD.
authors: Aaron B
authors: AB
authors: Holley
mesh_terms: D000328:Adult; D001143:Arousal; D000069582:Eszopiclone / Q000494:pharmacology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000494:pharmacology*; D008297:Male; D008875:Middle Aged; D010641:Phenotype; D017286:Polysomnography; D015995:Prevalence; D011725:Pyridines / Q000494:pharmacology*; D012189:Retrospective Studies; D020181:Sleep Apnea, Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem; D000069582:Eszopiclone
keywords: arousal threshold; non benzodiazepine sedative hypnotics; sleep apnea