THE EFFECT OF TRIAZOLAM AND FLUNITRAZEPAM - 2 BENZODIAZEPINES WITH DIFFERENT HALF-LIVES - ON BREATHING DURING SLEEP

We performed a double-blind single-dose placebo/hypnotics crossover st udy randomized within groups to test the potential problems that a gro up of normal subjects, including subjects who snore, may face using hy pnotic medications. Two benzodiazepine hypnotics-triazolam, 0.25 mg, a nd flunitrazepam, 2 mg tablets-were considered. Subjects were monitore d with nocturnal polysomnography, including esophageal pressure (Pes) monitoring as a measure of respiratory efforts, and were given daytime performance tests. Results were analyzed for the total nocturnal slee p period and also by thirds of the night in consideration of the diffe rent half-lives of the studied drugs. Three specific respiratory varia bles were evaluated: mean breathing frequency for selected unit of tim e, ''Delta Pes'' (esophageal pressure at peak end-expiration minus Pes at peak end-inspiration) expressed in cm H2O, and the ratio of Delta Pes/Delta TI (inspiratory time), taken as an index of respiratory driv e calculated for each respiratory cycle, There was no significant incr ease in either the respiratory disturbance index or the oxygen desatur ation index (number of drops in arterial oxygen saturation of 4% or mo re per hour of sleep, as measured by pulse oximetry). There was a sign ificant increase in mean breathing frequency with flunitrazepam compar ed with placebo, as well as a significantly larger percentage of time during sleep with Delta Pes above 10 cm H2O (taken as a cutoff point f or normal respiratory effort) with both triazolam and flunitrazepam co mpared with placebo. These respiratory changes, even if significant, w ere minor but may become a liability in association with specific abno rmalities.