Some Sedative Hypnotics Not Ideal for Predicting Low-Arousal Threshold

Some Sedative Hypnotics Not Ideal for Predicting Low-Arousal Threshold
Some Sedative Hypnotics Not Ideal for Predicting Low-Arousal Threshold

SEATTLE, WA—Administration of a non-benzodiazepine sedative hypnotic (NBSH) does not increase the likelihood of having a low arousal phenotype for obstructive sleep apnea (OSA), a study presented at SLEEP 2015 has concluded.

Previously, it has been established that NBSHs do not impact the apnea-hypopnea index (AHI) in unselected patients undergoing polysomnography, noted CPT Patrick Smith, DO, of Walter Reed National Military Medical Center in Bethesda, MD. However, the impact of these agents on patients with the low arousal threshold phenotype of OSA had not yet been studied.

To investigate whether NBSHs reduce the prevalence of low arousal threshold OSA phenotype, Dr. Smith and colleagues abstracted data from 529 patients with OSA who underwent polysomnography. They used a recently defined clinical definition to identify this phenotype: >58.3% hypopneas, SpO2 nadir >82.5%, and mild-to-moderate OSA on polysomnography. In this study, 86.2% of patients met all three criteria.

When predictors for low arousal were examined, statistical significance was not observed for pretest probability tools (P=0.60), witnessed apneas (P=0.43), or hypertension (P=0.18).

Although there was a high prevalence of low arousal threshold phenotype, the NBSHs did not affect prevalence, he reported, adding that the phenotype is “difficult to predict.”

“Our data do not support using NHSHs to increase the arousal threshold,” he said. “Better pretest probability tools are needed to predict a low-arousal threshold phenotype.”

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