Association between chronic use of benzodiazepines and the severity of Obstructive Sleep Apnea syndrome and changes in sleep parameters

Abstract

Introduction: Obstructive Sleep Apnea Syndrome (OSAS) is characterized by partial or complete obstruction of the upper airway, intermittently and recurrently. It results from collapses of the pharyngeal region, providing a substantial reduction in airflow, determining apnea or hypopnea. It is associated with several symptoms and comorbidities, such as excessive daytime sleepiness, cognitive impairment, depression, obesity, reduced quality of life, increased risk of occupational and traffic accidents, and risk of cardiovascular disease, among others. Affected patients complain of poor sleep quality, making them candidates for the use of hypnotic drugs, benzodiazepines. These drugs typically have ansiolitic and hypnotic effect but also behave as anticonvulsivants and muscle relaxants. Therefore, in patients presenting OSAS, the negative effect of benzodiazepines in the ventilatory control during sleep has been questioned. The goals of the present study is to associate the chronic use of benzodiazepines with the severity of OSAS and changes in sleep parameters in adult patients diagnosed by Polysomnography.

Materials and Methods: This is a cross-sectional study, consisting of 525 patients over the age of 18 of a private clinic in Belo Horizonte, Brazil, between April and July of 2022. The patients underwent Polysomnography aiming the assessment of the presence and degree of apnea/hypopnea and responded to a questionnaire beforehand considering comorbities and chronic use of medications. Were excluded from this study in use of any other medications that affect the central nervous system, insufficient data of the Polyssomnography, patients diagnosed with any other sleep syndrome, neuromuscular syndromes, neurologic syndromes that have impact on the OSAS, cranial malformation or any genetic syndrome that has impact on respiratory sleep syndromes. The data obtained by both the test and questionare revealed a number of 33 chronic users of benzodiazepines. The association between these patients, the severity of the Obstructive Sleep Apnea Syndrome and the changes in sleep parameters was calculated using the Chi-Square test.

Results: Chronic benzodiazepine use and the diagnose of OSAS was not associated (p = 0.078). As for the polysomnographic variables analyzed, there is a statistical association between the use of the medication and changes in sleep patterns, such as increase of REM latency (p=0,000) and N2 stage(p=0,003) and decrease of N1 (p=0,022), and REM (p=0,001) stages.

Conclusions: Benzodiazepine chronic use demonstrated no difference in the severity of OSAS but presented changes in the parameters of sleep.