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Patients accurately self-identify middle-of-the-night insomnia; zolpidem improves insomnia in these patients, study data show

Wednesday, December 12 2007 | Comments
Evidence Grade 0 What's This?
Adult patients are capable of self-identifying their middle-of-the-night (MOTN) insomnia with great enough accuracy that subject sleep diaries can be used as diagnostic tools, study results indicate.

MOTN insomnia may occur in up to 20% of the U.S. population, according to the National Sleep Foundation's Sleep in America polls.

To determine the accuracy of self-identification and characterization of MOTN insomnia relative to polysomnographic (PSG) screening, 124 adults with primary insomnia and a history of prolonged MOTN awakenings completed a 10-day sleep diary to confirm MOTN insomnia before undergoing 2 nights of PSG screening. The PSG results, which included latency to persistent sleep (LPS), total sleep time (TST), and sleep efficiency (SE), were compared with subjective measures from the patients' sleep diaries.

The study authors found that the diary results were "highly consistent" (68%) with those of the PSG testing.

"This level of agreement between subjective patient reports and objective PSG measures suggests that patients can very accurately assess their MOTN insomnia," they wrote.

Following the screening phase, 83 patients who had confirmed MOTN insomnia entered into a double-blind, 3-period, crossover study in which they were awakened 4 hrs after lights-out and were administered sublingual zolpidem 1.75 mg, zolpidem 3.5 mg, or placebo. After being kept awake for 30 min, they were then allowed to return to bed for another 4 hrs. Each treatment period consisted of 2 consecutive nights of dosing, separated by a washout period of 5 to 12 days.

Patients who received either dose of zolpidem had significantly better sleep latency, TST, and SE than did patients who received placebo (P<.001 for all). Neither dose of zolpidem was associated with residual sedation or impaired next-day alertness, the authors noted.

"Sleep diaries can be used as a simple, inexpensive tool that is readily accessible to clinicians and nonintrusive for patients," the authors concluded. "Clinicians should have a high degree of confidence in patient reports of MOTN insomnia based on the apparent high degree of accuracy in patient self-reporting of this condition." (Vince BD, et al. Poster NR595.)

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