Source: Nephron  |  Posted 8 years ago

The new nonbenzodiazepine hypnotic drug zaleplon (ZAL) appears to improve sleep quality in patients undergoing maintenance haemodialysis (MHD), according to the findings of new research.

The majority of patients on MHD have difficulty sleeping, which can severely affect quality of life. Furthermore, impaired sleep may worsen the cardiovascular profile and decrease immune system function in these patients.

The clinical benefit of benzodiazepines for insomnia has been demonstrated, but adverse reactions include rebound insomnia, withdrawal effects, and residual sedation. Zaleplon is a new nonbenzodiazepine pyrazolopyrimidine hypnotic with rapid onset of action and a very short half-life. In addition, the pharmacokinetic properties of this drug are not altered by renal impairment.

Using the Pittsburgh questionnaire, Massimo Sabbatini, MD, with the Department of Nephrology at the University Federico II, Naples, Italy, and colleagues assessed the sleep quality of 10 patients on MHD with insomnia. Patients underwent a randomised double-blind crossover study versus placebo.

Compared to placebo, ZAL significantly improved the total score of sleep quality (p<0.03), the researchers found. In addition, treatment with ZAL was associated with a higher subjective sleep quality (p<0.01) and a reduced sleep latency (p<0.01) compared to placebo.

ZAL did not modify the duration of sleep, but habitual sleep efficacy (p<0.05) appeared to improve. No adverse effects were observed.

According to the researchers, the results demonstrate "a significantly better sleep quality as compared with placebo, with a very scarce incidence of adverse effects and no modification in dialysis parameters."

"The absence of side effects and its pharmacodynamic properties make ZAL a useful drug in uraemic patients," they conclude.

However, Dr Sabbatini and colleagues note that before starting pharmacological treatment for sleep disorders, other clinical problems potentially leading to insomnia must be excluded, and they add that "sleeping pills, in fact, could dangerously mask the symptoms of serious diseases such as sleep apnoea or periodic limb movements."