BENZODIAZEPINES IN CONGESTIVE-HEART-FAILURE - EFFECTS OF TEMAZEPAM ONAROUSABILITY AND CHEYNE-STOKES RESPIRATION

We studied seven male patients with moderate to severe congestive hear t failure (CHF) [left ventricular ejection fraction (LVEF) = 22.4 +/- 6.7; mean +/- SD] in a double-blind crossover trial to determine the e ffects of temazepam 15 mg on arousability, sleep architecture, Cheyne- Stokes respiration (CSR) and nighttime oxygen saturation. Sleep archit ecture was not markedly improved with temazepam. There was no signific ant change in total sleep time (TST) (383.1 +/- 14.1 minutes to 396.6 +/- 15.4 minutes, p = ns) (mean +/- SE, placebo vs. temazepam) or tota l wake time (TWT) (96.9 +/- 14.0 vs. 81.4 +/- 14.0 minutes, p = ns). S leep stage proportions did not change appreciably except for a reducti on in stage 1 sleep (6.7 +/- 1.2% vs. 4.0 +/-1.0%, p < 0.05). Microaro usals per hour of sleep decreased with temazepam (21.1 +/- 2.7/hour vs . 13.9 +/- 2.1/hour placebo, p < 0.05), with the largest change occurr ing in stage 2 (24.9 +/- 5.4/hour vs. 15.0 +/- 3. 1 /hour, p < 0.05). Wake time during sleep (WDS) was reduced from 82.5 +/- 11.7 minutes to 54.5 +/- 9.4 minutes, p < 0.03. Daytime alertness was improved with t emazepam as was indicated by an increase in mean latency to sleep [mul tiple sleep latency test (MSLT) = 7.1 +/- 2.4 vs. 5.7 +/- 2.0 minutes, p < 0.04) on days following treatment with temazepam. There was no si gnificant change in CSR as a percentage of TST (38.7 =/- 13.6% vs. 32. 5 +/- 11.8%, p = ns). However, the apnea/hypopnea index (AHI) (10% fil ter) was decreased in stage 1 (28.1 +/- 9.7/hour vs. 15.6 +/- 8.2/hour ). Overnight oxygen saturation did not change with temazepam (95.1 +/- 0.6% both nights) and the percentage of TST spent below 90% oxygen sa turation was minimal for both conditions (1.5 +/- 1.1% vs. 2.2 +/- 1.7 %, p = ns). We conclude that CHF patients with CSR experience frequent arousals and that these arousals can be reduced with temazepam. There was an improvement in daytime somnolence. There was no worsening of n ighttime oxygen saturation.