Mauro Manconi1, Raffaele Ferri2, Silvia Miano3, Michelangelo Maestri4, Valentina Bottasini5, Marco Zucconi5, Luigi Ferini-Strambi5. 1. Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland. Electronic address: mauro.manconi@eoc.ch. 2. Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging, Troina, Italy. 3. Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland. 4. Sleep and Epilepsy Center, Neurocenter of the Southern Switzerland, Civic Hospital of Lugano, Lugano, Switzerland; Department of Neurosciences, Neurological Clinic, University of Pisa, Italy. 5. Sleep Disorders Center, Vita-Salute San Raffaele University, Milan, Italy.
Abstract
OBJECTIVE: Benzodiazepines (BZDs) are the most commonly prescribed compounds in insomnia. A long-term of BZDs use may cause dependence and abuse. The aim of this study was to evaluate sleep architecture and microstructure (in terms of cyclic alternating pattern - CAP - analysis and of sleep EEG power spectral analysis) in a group of long-term users of high doses of BZDs for their primary chronic insomnia. METHODS: Twenty patients consecutively admitted at the Sleep Centre for drug discontinuation and 13 matched healthy controls underwent a full nocturnal video-polysomnographic recording, after one adaptation night. RESULTS: Significant differences were found in time in bed, REM sleep latency and sleep stage 1% which were increased in patients compared to controls, while CAP rate was dramatically decreased. During NREM sleep, patients showed a clear decrease in the relative power of delta band. CONCLUSIONS: Our data demonstrate that in adults with chronic insomnia, long-term use of high doses of BZDs induces a severe disruption of sleep microstructure, while sleep architecture seems to be much less affected. SIGNIFICANCE: The long term use of high doses of BZDs for chronic insomnia induces a marked depression of slow wave activity and of its physiological instability.
OBJECTIVE:Benzodiazepines (BZDs) are the most commonly prescribed compounds in insomnia. A long-term of BZDs use may cause dependence and abuse. The aim of this study was to evaluate sleep architecture and microstructure (in terms of cyclic alternating pattern - CAP - analysis and of sleep EEG power spectral analysis) in a group of long-term users of high doses of BZDs for their primary chronic insomnia. METHODS: Twenty patients consecutively admitted at the Sleep Centre for drug discontinuation and 13 matched healthy controls underwent a full nocturnal video-polysomnographic recording, after one adaptation night. RESULTS: Significant differences were found in time in bed, REM sleep latency and sleep stage 1% which were increased in patients compared to controls, while CAP rate was dramatically decreased. During NREM sleep, patients showed a clear decrease in the relative power of delta band. CONCLUSIONS: Our data demonstrate that in adults with chronic insomnia, long-term use of high doses of BZDs induces a severe disruption of sleep microstructure, while sleep architecture seems to be much less affected. SIGNIFICANCE: The long term use of high doses of BZDs for chronic insomnia induces a marked depression of slow wave activity and of its physiological instability.