Chlormezanone in the treatment of insomnia due to rheumatic stiffness

Zopiclone as night medication in rheumatoid arthritis

Sleep disturbances and related daytime complaints are frequent in rheumatoid arthritis (RA). The aim of the current study was therefore to evaluate the effect of a newer hypnotic on sleep structure and clinical parameters in RA. Forty outpatients were randomized to a two week treatment regimen with either 7.5 mg zopiclone or placebo at bedtime. Clinical examinations were performed before and after treatment and the degree of pain, fatigue, sleepiness, morning stiffness, and activities of daily living were assessed. Two sleep questionnaires were also completed weekly. Polysomnography was performed before the study and after 14 days of treatment. Recordings were evaluated using conventional sleep scoring as well as frequency analysis of the electroencephalography (EEG). Patients in the zopiclone group had subjective improvement of sleep, but otherwise no differences in pain score or the other clinical parameters were found. Conventional sleep assessments showed only minor changes during treatment, but frequency analysis demonstrated a shift from the lower towards the higher EEG frequencies in the active treatment group. Although the modulation of the EEG can represent a non-specific pharmacologic epiphenomenon, it might also reflect a disturbance of sleep microstructure. In conclusion, treatment with zopiclone may be of value for subjective sleep complaints in selected patients with RA, but it is doubtful whether hypnotics improve daytime symptoms in this patient group.

The evaluation of a nonsteroidal anti-inflammatory drug (tenoxicam) in the treatment of sleep disturbance in osteoarthritic patients

The effects of a nocturnal nonsteroidal anti-inflammatory drug (tenoxicam) on twelve male osteoarthritic patients were investigated in a randomised, double-blind, placebo-controlled, cross-over study. Tenoxicam produced no significant changes in any of the areas evaluated which included electroencephalographic (EEG) sleep, subjective sleep, pain and early morning stiffness. The selection of patients may have contributed to this unexpected result. There was no evidence to suggest that tenoxicam caused any unwanted side-effects or affected early morning psychomotor performance. The use of the sleep EEG as an objective pain measure is discussed.

Measurement of nocturnal body motility: behaviour of osteoarthritic patients and healthy controls

Nocturnal body motility has been compared in a sleep laboratory between patients with osteoarthritis and healthy age-, sex- and weight-matched controls using a Bio-medical timer and bedleg force transducers connected to a Disa polygraph. Four motility variables were derived (duration of movement; duration adjusted for sensitivity; number of movements; number of 30-s epochs containing movements) enabling an assessment of nocturnal body motility in the two groups. There was a trend for osteoarthritic patients to move more than controls during sleep on all variables measured, although this did not reach statistical significance. Temazepam elixir (0.4 mg/kg body weight/night) reduced all four motility variables in both osteoarthritic patients and controls, although only the reduction of the number of 30-s epochs containing movements (P less than 0.05) in the control group attained statistical significance.

Comparison of sleep in osteoarthritic patients and age and sex matched healthy controls

A sleep laboratory comparison of the sleep of 14 osteoarthritic patients with that of 16 age and sex matched healthy controls was undertaken. After three nights of adaptation continuous recordings of electroencephalographic (EEG), electro-oculographic (EOG), and electromyographic (EMG) activity were obtained for the next two nights. A comparison of EEG sleep variables during this baseline period showed that osteoarthritic patients had a significantly greater percentage of stage 1 and significantly smaller percentage of stage 2 sleep than control subjects. These findings indicate sleep disturbance in osteoarthritic patients. The limited degree of disturbance observed in these patients may be due to the fact that they were allowed to continue with their normal anti-inflammatory and analgesic medication for the course of the study.