Abstract
1 Midazolam in doses of 0.21-0.46 mg/kg was given to four insomniacs for 27 days, and to a fifth insomniac for an additional 124 days, to assess its short, intermediate, long-term and long-standing efficacy.
2 Automatic analysis of the polygraphic sleep recordings was carried out employing real-time signal processing (based on linear prediction), and an off-line sequential fuzzy clustering.
3 Total sleep length did not vary significantly during medication, whereas other efficacy parameters such as sleep onset latency, wake time after sleep onset and number of nightly awakenings decreased significantly throughout the period of active medication. In one patient, midazolam was still effective after 151 days of administration.
4 The ultrashort action (probably 3-4 h) of midazolam could be demonstrated by the distribution of the efficacy parameters, dividing the night into 2-h periods, by the unchanged total sleep length during medication compared with baseline and by the lack of any subjective clinical symptoms of hangover.
5 The quantitative analysis of the signals showed that, although a decrease in the total amount of slow-wave sleep during long-term medication and withdrawal was detected, the total relative power in the delta band increased during drug administration. This was interpreted as redistribution of the delta activity during active medication.
6 A lengthening of REM sleep was found during active medication probably attributable to intranight rebound. This was not followed by any clinical symptom of clinical REM rebound.
7 Midazolam would thus be indicated mainly in insomnic patients with difficulties in falling asleep, or having a pathological sleep pattern during the first half of the night.
Full text
PDF
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Church M. W. Changes in frequency and amplitude of delta activity during sleep. Electroencephalogr Clin Neurophysiol. 1975 Jul;39(1):1–7. doi: 10.1016/0013-4694(75)90121-2. [DOI] [PubMed] [Google Scholar]
- Conner J. T., Katz R. L., Pagano R. R., Graham C. W. RO 21-3981 for intravenous surgical premedication and induction of anesthesia. Anesth Analg. 1978 Jan-Feb;57(1):1–5. doi: 10.1213/00000539-197801000-00001. [DOI] [PubMed] [Google Scholar]
- Fragen R. J., Gahl F., Caldwell N. A water-soluble benzodiazepine, RO21-3981, for induction of anesthesia. Anesthesiology. 1978 Jul;49(1):41–43. doi: 10.1097/00000542-197807000-00012. [DOI] [PubMed] [Google Scholar]
- Gaillard J. M., Simmen A. E., Tissot R. Analyse automatique des enregistrements polygraphiques de sommeil. Electroencephalogr Clin Neurophysiol. 1971 Jun;30(6):557–561. doi: 10.1016/0013-4694(71)90153-2. [DOI] [PubMed] [Google Scholar]
- Gath I., Bar-On E., Rogowski Z., Bental E. Computerized analysis of sleep recordings applied to drug evaluation: midazolam in normal subjects. Clin Pharmacol Ther. 1981 Apr;29(4):533–541. doi: 10.1038/clpt.1981.75. [DOI] [PubMed] [Google Scholar]
- Gath I., Bar-on E. Computerized method for scoring of polygraphic sleep recordings. Comput Programs Biomed. 1980 Jun;11(3):217–223. doi: 10.1016/0010-468x(80)90083-5. [DOI] [PubMed] [Google Scholar]
- Kales A., Kales J. D., Bixler E. O., Scharf M. B., Russek E. Hypnotic efficacy of triazolam: sleep laboratory evaluation of intermediate-term effectiveness. J Clin Pharmacol. 1976 Aug-Sep;16(8-9):399–406. doi: 10.1002/j.1552-4604.1976.tb02414.x. [DOI] [PubMed] [Google Scholar]
- Martin W. B., Johnson L. C., Viglione S. S., Naitoh P., Joseph R. D., Moses J. D. Pattern recognition of EEG-EOG as a technique for all-night sleep stage scoring. Electroencephalogr Clin Neurophysiol. 1972 Apr;32(4):417–427. doi: 10.1016/0013-4694(72)90009-0. [DOI] [PubMed] [Google Scholar]
- Monti J. M., Debellis J., Alterwain P., D'Angelo L. Midazolam and sleep in insomniac patients. Br J Clin Pharmacol. 1983;16 (Suppl 1):87S–88S. doi: 10.1111/j.1365-2125.1983.tb02276.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Reves J. G., Corssen G., Holcomb C. Comparison of two benzodiazepines for anaesthesia induction: midazolam and diazepam. Can Anaesth Soc J. 1978 May;25(3):211–214. doi: 10.1007/BF03004881. [DOI] [PubMed] [Google Scholar]
- Roth T., Kramer M., Schwartz J. L. Triazolam: a sleep laboratory study of a new benzodiazepine hypnotic. Curr Ther Res Clin Exp. 1974 Feb;16(2):117–123. [PubMed] [Google Scholar]
- Smith J. R., Karacan I. EEG sleep stage scoring by an automatic hybrid system. Electroencephalogr Clin Neurophysiol. 1971 Sep;31(3):231–237. doi: 10.1016/0013-4694(71)90092-7. [DOI] [PubMed] [Google Scholar]
- Vogel G. W., Vogel F. Effect of midazolam on sleep of insomniacs. Br J Clin Pharmacol. 1983;16 (Suppl 1):103S–108S. doi: 10.1111/j.1365-2125.1983.tb02279.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Vogel G., Thurmond A., Gibbons P., Edwards K., Sloan K. B., Sexton K. The effect of triazolam on the sleep of insomniacs. Psychopharmacologia. 1975;41(1):65–69. doi: 10.1007/BF00421308. [DOI] [PubMed] [Google Scholar]