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de Mendonça FMR, de Mendonça GPRR, Souza LC, Galvão LP, Paiva HS, de Azevedo Marques Périco C, Torales J, Ventriglio A, Castaldelli-Maia JM, Sousa Martins Silva A. Benzodiazepines and Sleep Architecture: A Systematic Review. CNS & NEUROLOGICAL DISORDERS DRUG TARGETS 2023; 22:172-179. [PMID: 34145997 DOI: 10.2174/1871527320666210618103344] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 11/18/2020] [Accepted: 01/20/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Insomnia, defined as a difficulty in initiating or maintaining sleep, is a relevant medical issue. Benzodiazepines (BZDs) are commonly prescribed to treat insomnia. Two phases characterize human sleep structure: sleep with Non-Rapid Eye Movement (NREM) and sleep with Rapid Eye Movement (REM). Physiological sleep includes NREM and REM phases in a continuous cycle known as "Sleep Architecture." OBJECTIVE This systematic review summarizes the studies that have investigated effects of BZDs on Sleep Architecture. METHODS The articles selection included human clinical trials (in English, Portuguese, or Spanish) only, specifically focused on BZDs effects on sleep architecture. PubMed, BVS, and Google Scholar databases were searched. RESULTS Findings on BZDs effects on sleep architecture confirm an increase in stage 2 of NREM sleep and a decrease in time of stages 3 and 4 of NREM sleep with a reduction in time of REM sleep during the nocturnal sleep. CONCLUSION Variations in NREM and REM sleep may lead to deficits in concentration and working memory and weight gain. The increase in stage 2 of NREM sleep may lead to a subjective improvement of sleep quality with no awakenings. BZDz should be prescribed with zeal and professional judgment. These patients should be closely monitored for possible long-term side effects.
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Affiliation(s)
| | | | - Laura Costa Souza
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
| | | | | | - Cintia de Azevedo Marques Périco
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Department of Neuroscience, Medical School, ABC Health University Center, Santo Andre, SP, Brazil
| | - Julio Torales
- Department of Psychiatry, School of Medical Sciences, National University of Asuncion, Asuncion, Paraguay
| | - Antonio Ventriglio
- Department of Clinical and Experimental Medicine, University of Foggia, Foggia, Italy
| | - Joao Maurício Castaldelli-Maia
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Otorhinus Clinica Medica, São Paulo, SP, Brazil
- Department of Neuroscience, Medical School, ABC Health University Center, Santo Andre, SP, Brazil
- Department of Psychiatry, Medical School, University of São Paulo, Sao Paulo, SP, Brazil
- Department of Epidemiology, Columbia Mailman School of Public Health, New York, NY, U.S
| | - Anderson Sousa Martins Silva
- Health Secretariat of São Bernardo do Campo, São Bernardo do Campo, SP, Brazil
- Medical School, Universidade Nove de Julho, Sao Paulo, SP, Brazil
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The effect of cognitive function and central nervous system depressant use on mortality—A prospective observational study of previously hospitalised older patients. PLoS One 2022; 17:e0263024. [PMID: 35239678 PMCID: PMC8893618 DOI: 10.1371/journal.pone.0263024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 01/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Older patients are often users of prolonged Central Nervous System Depressants (CNSD) (Z-hypnotics, benzodiazepines and opioids), which may be associated with reduced cognition. The long-term effects of CNSD use and reduced cognitive function in older patients are unclear. The aim of this study was to examine whether cognitive function and CNSD use at baseline hospitalisation were associated with all-cause mortality two years after discharge. Methods We conducted a prospective observational study, including baseline data (2017–2018) from previously hospitalised older patients (65–90 years), assessing all-cause mortality two years after discharge. We used logistic regression to assess the primary outcome, all-cause mortality two years after baseline hospitalisation. The primary predictors were cognitive function measured by The Mini Mental State Examination (MMSE) and prolonged CNSD use (continuous use ≥ 4 weeks). Adjustment variables: age, gender, education, the Hospital Anxiety and Depression Scale (HADS) and the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), using receiver operating characteristics (ROC) to compare the predictive power of the models. In a sub-analysis we used, the Neurobehavioural Cognitive State Examination (Cognistat) and the Clock Drawing Test. Results Two years after discharge, out of 246 baseline patients, 43 were deceased at follow-up, among these 27 (63%) were CNSD users, and 16 (36%) were non-users at baseline, (p = 0.002). In the multivariable models cognitive function (MMSE score) was a predictor of mortality (OR 0.81 (95% CI 0.69; 0.96), p = 0.014). CNSD use was associated with mortality (OR 2.71 (95% CI 1.06; 6.95), p = 0.038), with ROC AUC: 0.74–0.77 for these models. Results using Cognistat supported the findings. The Clock Drawing Test was not significant predictor of mortality. Conclusion Two years after discharge from the hospital, older patients with reduced cognitive function and CNSD use during hospital stay had higher mortality. This underlines that inappropriate (prolonged and concurrent) use of CNSDs should be avoided by older patients, particularly in patients with reduced cognitive function. Trial registration NCT03162081, 22 May 2017.
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Borda MG, Jaramillo-Jimenez A, Oesterhus R, Santacruz JM, Tovar-Rios DA, Soennesyn H, Cano-Gutierrez CA, Vik-Mo AO, Aarsland D. Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia. Int J Geriatr Psychiatry 2021; 36:917-925. [PMID: 33382911 DOI: 10.1002/gps.5494] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 10/13/2020] [Accepted: 12/27/2020] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5-year follow-up. METHODS This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway" (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD-ADep). Linear mixed-effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale-2, and cognition measured with the Mini-Mental State Examination. RESULTS Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD-ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. CONCLUSIONS BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.
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Affiliation(s)
- Miguel Germán Borda
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Alberto Jaramillo-Jimenez
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.,Grupo de Neurociencias de Antioquia, Medical School, Universidad de Antioquia, Medellin, Colombia
| | - Ragnhild Oesterhus
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jose Manuel Santacruz
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Cognition and Memory Center, Intellectus, Hospital Universitario San Ignacio, Bogotá, Colombia.,Psychiatry Department, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Diego Alejandro Tovar-Rios
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,School of Statistics, Faculty of Engineering, Universidad Del Valle, Santiago de Cali, Colombia.,Department of Mathematics and Statistics, Faculty of Basic Sciences, Universidad Autónoma de Occidente, Santiago de Cali, Colombia
| | - Hogne Soennesyn
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway
| | - Carlos Alberto Cano-Gutierrez
- Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana, Bogotá, Colombia.,Geriatric Unit, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - Audun Osland Vik-Mo
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Dag Aarsland
- Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway.,Department of Old Age Psychiatry, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
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