Evaluation of sleep pattern in insomnia in benzodiazepine users and analysis of trazodone as a substitute medication

ABSTRACT Objective To know the modifications of the sleep pattern in chronic benzodiazepine users after the introduction of trazodone. Methods In a group of 11 patients, a gradual withdrawal of benzodiazepine (BZD) was introduced with progressive introduction of trazodone. Two polysomnograms were performed, the first with BZD usual dose of the patient and the second after BZD suppression and with 150 mg of prolonged release trazodone. Sleep quality questionnaires (Pittsburgh), daytime sleepiness (Epworth) and depressive (Hamilton) and anxious (Beck) symptoms were applied. Results Five subjects completed the study and were followed up for at least six weeks. In these patients, trazodone significantly increased sleep efficiency and REM sleep and decreased wakefulness after sleep onset. There was an improvement in sleep quality, but there was no change in depressive and anxious symptoms. Conclusion Prolonged release trazodone has been shown to be a therapeutic option for chronic insomnia patients with benzodiazepines with effective withdrawal of the anxiolytic drug. There was improvement in sleep quality by questionnaire and polysomnography. More patients will be needed to determine the benefits of trazodone in this type of intervention.摘要 目的 明确慢性苯二氮䓬类药物（benzodiazepine, BZD）使用者在引入曲唑酮后睡眠模式的变化情况。方法 本研究纳入11例患者，采用逐步引入曲唑酮的方案完成苯二氮䓬类药物的逐渐减量停药。共完成两次多导睡眠图（polysomnogram）检测：首次检测在患者维持常规苯二氮䓬类药物剂量时进行，第二次检测则在停用苯二氮䓬类药物并服用150mg缓释型曲唑酮（prolonged release trazodone）后完成。同时采用匹兹堡睡眠质量问卷（Pittsburgh）、爱泼沃斯嗜睡量表（Epworth）、汉密尔顿抑郁量表（Hamilton）与贝克焦虑量表（Beck），分别评估受试者的睡眠质量、日间嗜睡程度、抑郁症状与焦虑症状。结果 共有5例受试者完成本研究并接受至少6周的随访。在该部分患者中，缓释型曲唑酮可显著提升睡眠效率与快速眼动（REM）睡眠时长，并缩短入睡后觉醒时长。受试者的睡眠质量得到改善，但抑郁与焦虑症状未出现显著变化。结论 研究证实，缓释型曲唑酮可作为慢性失眠且长期使用苯二氮䓬类药物、需有效戒断该抗焦虑药物患者的治疗选择。通过量表与多导睡眠图检测均证实患者睡眠质量得到改善，且可实现抗焦虑药物的有效戒断。未来需纳入更多受试者，以明确缓释型曲唑酮在该类干预方案中的临床获益。