Vol. 8 •Issue 1 • Page 12
Drugs and Polysomnography
Prescription Medications Affect Sleep Studies
Drug effects on polysomnography and the patient are a primary concern to the acquiring and scoring technician, as well as the interpreting physician.
However, pharmacopoeias tend not to list sleep-related adverse drug effects other than perhaps insomnia and lethargy.
When a patient comes into the lab and presents a list of drugs that he or she is using or has stopped using, the technician or physician may not understand the drug’s specific pharmacologic therapy effects on the polysomnogram or the patient’s sleep/wake status.
Specific drug effects are not the only aspect to consider. Often clinicians must determine if the drug causes the sleep-related effect, or if the effect is a consequence of either improved or further disturbed sleep.
Withdrawal effects are another aspect to consider with pharmacologic therapies.
Often clinicians find a rebound effect during evaluation, such as the drug suppresses rapid eye movement (REM) when taken. Withdrawing the drug is likely to increase the patient’s REM periods, REM time and REM onset. However, tapering the doses may help resolve these issues.
In addition to sleep/wake related drug side effects, clinicians see drugs that suppress slow wave sleep (SWS) during polysomnography. These drugs can have a serious effect on a child’s growth because SWS affects growth hormone amounts.
Clinicians must also evaluate pharmacologic therapies for patients who state they are not well rested and are taking a drug that suppresses SWS. Prescribing a drug that promotes SWS will counter this effect.
For instance, drugs that relieve pain may contribute to a better night’s sleep, while drugs that cause depression may lead to insomnia.
The chart that accompanies this article is designed for those involved in sleep study acquisition, scoring and interpretation. It characterizes drug effects as either polysomnographic or physiological.
Poloysomnographic changes refer to drug effects visible on the test data, whereas physiological changes refer to the action of drug use on the patient.
A clinician or technician looking at the raw data would be more interested in the polysomnographic effects. However, the scoring technician would consider both polysomnographic and physiological effects.
To determine how the patient presents at testing and his or her ability to sleep or not sleep, the acquisition technician would look at the physiological effects of drugs. Although, as the study progresses, the interest may lie more in the polysomnographic effects.
On the other hand, the interpreting physician may look at either polysomnographic or physiological effects.
While the drug effects chart is by no means complete, it will aid in the polysomnogram interpretation and overall patient sleep/wake status evaluation. Clinicians can often order other medications to replace the drugs in question.
CHART SOURCES
• Cender D, Gelhot A, Phillips B, Anstead M, Khawaja I, Pinto J. Daytime drowsiness: Is a drug to blame? J Resp Dis 1998;19(8):617-629.
• Dietrich B. Polysomnography in drug development. J Clin Pharmacol 1997;37(suppl):70s-78s.
• Idzikowski C, Shapiro C. Non-psychotropic drugs and sleep. BMJ 1993; 306:1118-1121.
• Nicholson AN, Bradley CM, Pascoe PA. Medications: Effect on sleep and wakefulness. In: Kryger M, Roth T, Dement W, eds. Principles and Practice of Sleep Medicine. 2nd ed. Philadelphia: W.B. Saunders Co.; 1994:364-372.
• Novak M, Shapiro C. Drug-induced sleep disturbances focus on nonpsychotropic medications. Drug Safety 1997;2:133-149.
William Eckhardt is manager of the sleep laboratory at Lowell General Hospital in Lowell, Mass.
