Comparable Effects Seen With Zolpidem, Eszopiclone in PAP Titration
SEATTLE, WA—When eszopiclone was given instead of zolpidem, no difference was observed on the polysomnogram diagnostic and positive airway pressure (PAP)-titration portions, according to data reported at SLEEP 2015.
In addition, “there was also no difference in PAP compliance at 30 days,” stated William A. Londeree, MD, of Walter Reed National Military Medical Center in Bethesda, MD.
Although several studies and a recent meta-analysis have shown that non-benzodiazepine sedative hypnotics such as eszopiclone and zolpidem do not alter the Apnea Hypopnea Index (AHI), the agents “have not been directly compared to each other,” he noted. “Our goal was to compare the effect that these two drugs have on PAP titration and subsequent compliance.”
The study was a retrospective analysis of titration and adherence data of 122 patients with split titration studies. Twenty-one patients (17.2%) were taking eszopiclone, 59 (48.4) were taking zolpidem, and 41 (33.6%) were not taking any drug. Of the total patients, 116 (99.1%) had obstructive sleep apnea (OSA). Thirty-day PAP compliance data was also collected. Results were compared by the medication they received during their polysomnogram
“During the diagnostic portion there was no significant difference in AHI, age, total sleep time, or sleep efficiency between groups,” Dr. Londeree stated.
In addition, during the PAP portion, no significant differences in total sleep time, sleep efficiency, percentage REM sleep or AHI in supine REM were observed. The 30-day post-PAP initiation data showed no difference in the percentage of days greater than four hours or hours per nights that PAP was used.
Regarding sleep efficiency, analysis of PSG variables of zolpidem vs. eszopiclone data yielded ANOVA of 0.03 and 0.07 at post-hoc analysis.
“The clinical implications are that either eszopiclone or zolpidem can be used for PAP titration and as a pharmacological tool,” Dr. Londeree said. He added that Zolpidem may be preferable, given lower cost and equivalent efficacy.