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Published in: Journal of Neurology 7/2017

01-07-2017 | Original Communication

Effects of different doses of triazolam in the middle-of-the-night insomnia: a double-blind, randomized, parallel group study

Authors: Luigi Ferini Strambi, Sara Marelli, Marco Zucconi, Andrea Galbiati, Giovanni Biggio

Published in: Journal of Neurology | Issue 7/2017

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Abstract

It has been reported that insomnia characterized by difficulty returning to sleep following a nocturnal awakening, otherwise defined as the middle-of-the-night (MOTN) insomnia, is a common form of insomnia in adults with growing prevalence by increasing age. The aim of this study is to evaluate the efficacy and safety of different dosages of triazolam in insomnia patients when taken after a MOTN awakening with difficulty returning to sleep. In this double-blind, randomized, parallel group study, 24 patients (mean age 41.00 ± 10.40, 10 female and 14 male) affected by MOTN insomnia were enrolled and randomized into three groups according to different dosages of triazolam: group A (0.0625 mg), group B (0.125 mg), and group C (0.250 mg). A significant increment of total sleep time, sleep efficiency and a reduction of wake after sleep onset, number of awakening and non-REM sleep stage 1 was observed in T1 (triazolam) in comparison to T0 (placebo) by means of polysomnographic recording, irrespective of dosage. After 2 weeks of the treatment, insomnia severity significantly improved in all three groups in comparison to baseline without diurnal residual effects. This study demonstrates that low dose of triazolam objectively and subjectively improves the sleep of patients having MOTN insomnia.
Literature
1.
go back to reference Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6:97–111CrossRefPubMed Ohayon MM (2002) Epidemiology of insomnia: what we know and what we still need to learn. Sleep Med Rev 6:97–111CrossRefPubMed
2.
go back to reference Riemann D, Nissen C, Palagini L, Otte A, Perlis ML, Spiegelhalder K (2015) The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol 14:547–558CrossRefPubMed Riemann D, Nissen C, Palagini L, Otte A, Perlis ML, Spiegelhalder K (2015) The neurobiology, investigation, and treatment of chronic insomnia. Lancet Neurol 14:547–558CrossRefPubMed
3.
go back to reference Ohayon MM, Roth T (2001) What are the contributing factors for insomnia in the general population? J Psychosom Res 51:745–755CrossRefPubMed Ohayon MM, Roth T (2001) What are the contributing factors for insomnia in the general population? J Psychosom Res 51:745–755CrossRefPubMed
4.
go back to reference Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC (2006) Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry 60:1364–1371CrossRefPubMedPubMedCentral Roth T, Jaeger S, Jin R, Kalsekar A, Stang PE, Kessler RC (2006) Sleep problems, comorbid mental disorders, and role functioning in the national comorbidity survey replication. Biol Psychiatry 60:1364–1371CrossRefPubMedPubMedCentral
5.
go back to reference Walsh JK, Coulouvrat C, Hajak G, Lakoma MD, Petukhova M, Roth T, Sampson NA, Shahly V, Shillington A, Stephenson JJ, Kessler RC (2001) Nighttime insomnia symptoms and perceived health in the America insomnia survey (AIS). Sleep 34:997–1011CrossRef Walsh JK, Coulouvrat C, Hajak G, Lakoma MD, Petukhova M, Roth T, Sampson NA, Shahly V, Shillington A, Stephenson JJ, Kessler RC (2001) Nighttime insomnia symptoms and perceived health in the America insomnia survey (AIS). Sleep 34:997–1011CrossRef
6.
go back to reference Ohayon MM (2009) Difficulty in resuming or inability to resume sleep and the links to daytime impairment: definition, prevalence and comorbidity. J Psychiatr Res 43:934–940CrossRefPubMedPubMedCentral Ohayon MM (2009) Difficulty in resuming or inability to resume sleep and the links to daytime impairment: definition, prevalence and comorbidity. J Psychiatr Res 43:934–940CrossRefPubMedPubMedCentral
7.
go back to reference Moline M, DiBonaventura Md, Shah D, Ben-Joseph R (2014) Impact of middle-of-the-night awakenings on health status, activity impairment, and costs. Nat Sci Sleep 6:101–111PubMedPubMedCentral Moline M, DiBonaventura Md, Shah D, Ben-Joseph R (2014) Impact of middle-of-the-night awakenings on health status, activity impairment, and costs. Nat Sci Sleep 6:101–111PubMedPubMedCentral
8.
go back to reference Roth T, Eklov SD, Drake CL, Verster JC (2014) Meta-analysis of on-the-road experimental studies of hypnotics: effects of time after intake, dose, and half-life. Traffic Inj Prev 15:439–445CrossRefPubMed Roth T, Eklov SD, Drake CL, Verster JC (2014) Meta-analysis of on-the-road experimental studies of hypnotics: effects of time after intake, dose, and half-life. Traffic Inj Prev 15:439–445CrossRefPubMed
9.
go back to reference Lieberman JA (2007) Update on the safety considerations in the management of insomnia with hypnotics: incorporating modified-release formulations into primary care. Prim Care Companion J Clin Psychiatry 9:25–31CrossRefPubMedPubMedCentral Lieberman JA (2007) Update on the safety considerations in the management of insomnia with hypnotics: incorporating modified-release formulations into primary care. Prim Care Companion J Clin Psychiatry 9:25–31CrossRefPubMedPubMedCentral
10.
go back to reference Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M (2007) The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med 22:1335–1350CrossRefPubMedPubMedCentral Buscemi N, Vandermeer B, Friesen C, Bialy L, Tubman M, Ospina M, Klassen TP, Witmans M (2007) The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. J Gen Intern Med 22:1335–1350CrossRefPubMedPubMedCentral
11.
go back to reference Asnis GM, Thomas M, Henderson MA (2016) Pharmacotherapy treatment options for insomnia: a primer for clinicians. Int J Mol Sci 17:50CrossRef Asnis GM, Thomas M, Henderson MA (2016) Pharmacotherapy treatment options for insomnia: a primer for clinicians. Int J Mol Sci 17:50CrossRef
12.
go back to reference Matarazzo JD, Herman DO (1984) Base rate data for the WAIS-R: test–retest stability and VIQ-PIQ differences. J Clin Neuropsychol 6:351–366CrossRefPubMed Matarazzo JD, Herman DO (1984) Base rate data for the WAIS-R: test–retest stability and VIQ-PIQ differences. J Clin Neuropsychol 6:351–366CrossRefPubMed
13.
go back to reference Castronovo V, Galbiati A, Marelli S, Brombin C, Cugnata F, Giarolli L, Anelli MM, Rinaldi F, Ferini-Strambi L (2016) Validation study of the Italian version of the insomnia severity index (ISI). Neurol Sci 37:1517–1524CrossRefPubMed Castronovo V, Galbiati A, Marelli S, Brombin C, Cugnata F, Giarolli L, Anelli MM, Rinaldi F, Ferini-Strambi L (2016) Validation study of the Italian version of the insomnia severity index (ISI). Neurol Sci 37:1517–1524CrossRefPubMed
14.
go back to reference Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMed Johns MW (1991) A new method for measuring daytime sleepiness: the Epworth sleepiness scale. Sleep 14:540–545CrossRefPubMed
15.
go back to reference Hays RD, Stewart AL (1992) Sleep measures. In: Stewart AL, Ware JEJ (eds) Measuring functioning and well-being; the medical outcomes study approach Duke edition. Duke University Press, Durham, pp 235–259 Hays RD, Stewart AL (1992) Sleep measures. In: Stewart AL, Ware JEJ (eds) Measuring functioning and well-being; the medical outcomes study approach Duke edition. Duke University Press, Durham, pp 235–259
16.
go back to reference Ware JE, Kosinski M, Keller SD (1994) SF-36 Physical and mental health summary scales: a users’ manual. The Health Institute, Boston Ware JE, Kosinski M, Keller SD (1994) SF-36 Physical and mental health summary scales: a users’ manual. The Health Institute, Boston
17.
go back to reference American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRef American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. American Psychiatric Publishing, ArlingtonCrossRef
18.
go back to reference Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system of sleep stages in human subjects. Brain Information Service/Brain Research Institute, University of California, Los Angeles Rechtschaffen A, Kales A (eds) (1968) A manual of standardized terminology, techniques and scoring system of sleep stages in human subjects. Brain Information Service/Brain Research Institute, University of California, Los Angeles
19.
go back to reference Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester Iber C, Ancoli-Israel S, Chesson A, Quan S (2007) The AASM manual for the scoring of sleep and associated events: rules, terminology and technical specifications, 1st edn. American Academy of Sleep Medicine, Westchester
20.
go back to reference Roth T, Berglund P, Shahly V, Shillington AC, Stephenson JJ, Kessler RC (2013) Middle-of-the-night hypnotic use in a large national health plan. J Clin Sleep Med 9:661–668PubMedPubMedCentral Roth T, Berglund P, Shahly V, Shillington AC, Stephenson JJ, Kessler RC (2013) Middle-of-the-night hypnotic use in a large national health plan. J Clin Sleep Med 9:661–668PubMedPubMedCentral
22.
go back to reference Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017) Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13:307–349CrossRefPubMed Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL (2017) Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American academy of sleep medicine clinical practice guideline. J Clin Sleep Med 13:307–349CrossRefPubMed
23.
go back to reference Vermeeren A (2004) Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs 18:297–328CrossRefPubMed Vermeeren A (2004) Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs 18:297–328CrossRefPubMed
24.
go back to reference Hajak G, Cluydts R, Allain H, Estivill E, Parrino L, Terzano MG, Walsh JK (2003) The challenge of chronic insomnia: is non-nightly hypnotic treatment a feasible alternative? Eur Psychiatry 18:201–208CrossRefPubMed Hajak G, Cluydts R, Allain H, Estivill E, Parrino L, Terzano MG, Walsh JK (2003) The challenge of chronic insomnia: is non-nightly hypnotic treatment a feasible alternative? Eur Psychiatry 18:201–208CrossRefPubMed
25.
go back to reference Roth T, Franklin M, Bramley TJ (2007) The state of insomnia and emerging trends. Am J Manag Care 13(5 Suppl):S117–S120PubMed Roth T, Franklin M, Bramley TJ (2007) The state of insomnia and emerging trends. Am J Manag Care 13(5 Suppl):S117–S120PubMed
26.
go back to reference Kanno O, Sasaki T, Watanabe H, Takazawa S, Nakagome K, Nakajima T, Ichikawa I, Akaho R, Suzuki M (2000) Comparison of the effects of zolpidem and triazolam on nocturnal sleep and sleep latency in the morning: a cross-over study in healthy young volunteers. Prog Neuropsychopharmacol Biol Psychiatry 24:897–910CrossRefPubMed Kanno O, Sasaki T, Watanabe H, Takazawa S, Nakagome K, Nakajima T, Ichikawa I, Akaho R, Suzuki M (2000) Comparison of the effects of zolpidem and triazolam on nocturnal sleep and sleep latency in the morning: a cross-over study in healthy young volunteers. Prog Neuropsychopharmacol Biol Psychiatry 24:897–910CrossRefPubMed
Metadata
Title
Effects of different doses of triazolam in the middle-of-the-night insomnia: a double-blind, randomized, parallel group study
Authors
Luigi Ferini Strambi
Sara Marelli
Marco Zucconi
Andrea Galbiati
Giovanni Biggio
Publication date
01-07-2017
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 7/2017
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-017-8530-z

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