정신신체의학 (Korean Journal of Psychosomatic Medicine)

한국정신신체의학회 (Korean Psychosomatic Society)
권호 표지
DOI QR코드

DOI QR Code

입원 환자에게서 졸피뎀 사용 후 나타나는 수면 연관 행동의 위험 요소

Risk Factors for Zolpidem Induced Sleep-Related Behavior in Inpatients

  • 김형인 (인하대학교 의과대학 정신건강의학교실) ;
  • 이정섭 (인하대학교 의과대학 정신건강의학교실) ;
  • 김원형 (인하대학교 의과대학 정신건강의학교실) ;
  • 김혜영 (인하대학교 의과대학 정신건강의학교실) ;
  • 맹세리 (인하대학교 의과대학 정신건강의학교실) ;
  • 배재남 (인하대학교 의과대학 정신건강의학교실)
  • Hyung-Inn, Kim (Department of Psychiatry, Inha University College of Medicine) ;
  • Jeong-Seop, Lee (Department of Psychiatry, Inha University College of Medicine) ;
  • Won-Hyoung, Kim (Department of Psychiatry, Inha University College of Medicine) ;
  • Hye-Young, Kim (Department of Psychiatry, Inha University College of Medicine) ;
  • Se-ri, Maeng (Department of Psychiatry, Inha University College of Medicine) ;
  • Jae-Nam, Bae (Department of Psychiatry, Inha University College of Medicine)
  • 투고 : 2022.06.13
  • 심사 : 2022.09.26
  • 발행 : 2022.12.31
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

연구목적 졸피뎀은 세계적으로 불면증에서 널리 쓰이고 있는 약물이다. 그러나 졸피뎀을 복용한 환자에게서 중추 신경계 부작용이나 수면 연관 행동을 보인다는 여러 보고가 있다. 본 연구는 입원 환자를 대상으로 졸피뎀 복용 후 나타나는 수면 연관 행동에 영향을 미치는 위험요인을 조사하기 위해 시행되었다. 방 법 2019년 1월 1일부터 2019년 12월 31일까지 인하대학교 병원에 입원한 졸피뎀을 복용한 환자들의 의무기록을 후향적으로 검토하였다. 졸피뎀 사용 후 나타나는 수면 연관 행동의 유무, 나이, 성별, 기저 질환, 투약력, 졸피뎀의 용량, 졸피뎀의 종류를 조사하였다. 결 과 졸피뎀을 복용한 907명의 환자 중 수면 연관 행동을 보인 환자는 102명(11.2%)이고, 65세 이상(OR 2.681, 95% CI 1.677-4.287, p<0.001), 남성(OR 1.556, 95% CI 1.007-2.404, p=0.046), 항정신병제 복용(OR 3.305, 95% CI 1.577-6.925, p=0.002), 항정신병제와 벤조디아제핀 동시 복용(OR 3.792, 95% CI 1.677-8.572, p=0.001)한 경우 수면 연관 행동이 발생할 확률이 유의하게 높았다. 결 론 졸피뎀 사용 후 생기는 수면 연관 행동의 위험 요소는 성별, 고령, 항정신병제 병용 투약, 항정신병제와 벤조디아제핀 동시 병용 투약 여부로 추정된다.

Objectives : Zolpidem is a common drug used in insomnia. However, there are several reports of side effects of the central nervous system or sleep related behavior in patients who took zolpidem. This study was conducted to investigate risk factors affecting sleep related behavior after taking zolpidem in inpatients. Methods : From January 1, 2019 to December 31, 2019, medical records of patients who took zolpidem hospitalized at Inha University Hospital were reviewed retrospectively. Results : 907 patients who took Zolpidem, 102 (11.2%) showed sleep related behavior, and if they were 65 years of age or older, men, taking antipsychotics, and taking antipsychotics and benzodiazepines at the same time, they were significantly more likely to show sleep related behavior. Conclusions : Risk factors for sleep-related behavior after use of zolpidem are estimated gender, elderly, antipsychotics, and combination of antipsychotics and benzodiazepines.

키워드

참고문헌

  1. Chung S, Park B, Yi K, Lee J. Pattern of hypnotic drug prescription in South Korea: Health insurance review and assessment service-national patients sample. Sleep Medicine Research 2013;4;51-55.  https://doi.org/10.17241/smr.2013.4.2.51
  2. Hwang TJ, Ni HC, Chen HC, Lin YT, Liao SC. Risk predictors for hypnosedative-related complex sleep behaviors: a retrospective, cross-sectional pilot study. The Journal of Clinical Psychiatry 2010;71;18455. 
  3. Toner LC, Tsambiras BM, Catalano G, Catalano MC, Cooper DS. Central nervous system side effects associated with zolpidem treatment. Clinical Neuropharmacology 2000;23;54-58.  https://doi.org/10.1097/00002826-200001000-00011
  4. Brodeur MR, Stirling AL. Delirium associated with zolpidem. Annals of Pharmacotherapy 2001;35;1562-1564.  https://doi.org/10.1345/aph.10385
  5. Freudenreich O, Menza M. Zolpidem-related delirium: a case report. The Journal of Clinical Psychiatry 2000;61;22623. 
  6. Sharma A. A case report of zolpidem-induced somnambulism. The Primary Care Companion for CNS Disorders 2005;7;24200. 
  7. Yang W, Dollear M, Muthukrishnan SR. One rare side effect of zolpidem-sleepwalking: a case report. Archives of Physical Medicine and Rehabilitation 2005;86;1265-1266.  https://doi.org/10.1016/j.apmr.2004.11.022
  8. Morgenthaler TI, Silber MH. Amnestic sleep-related eating disorder associated with zolpidem. Sleep Medicine 2002;3;323-327.  https://doi.org/10.1016/S1389-9457(02)00007-2
  9. Kintz P, Villain M, Dumestre-Toulet V, Ludes B. Drug-facilitated sexual assault and analytical toxicology: the role of LC-MS/MS: a case involving zolpidem. Journal of Clinical Forensic Medicine 2005;12;36-41.  https://doi.org/10.1016/j.jcfm.2004.08.005
  10. Chen CS, Huang MF, Hwang TJ, Chen ST, Ko CH, Yen CN, Chen TT, SU PW, Yeh YC, Lin JJ, Yen, CF. Clinical correlates of zolpidem-associated complex sleep-related behaviors: age effect. The Journal of Clinical Psychiatry 2014;75;2723. 
  11. Dolder CR, Nelson MH. Hypnosedative-induced complex behaviours. CNS Drugs 2008;22;1021-1036.  https://doi.org/10.2165/0023210-200822120-00005
  12. Olubodun JO, Ochs HR, Von Moltke LL, Roubenoff R, Hesse LM, Harmatz JS, Shader RI, Greenblatt DJ. Pharmacokinetic properties of zolpidem in elderly and young adults: possible modulation by testosterone in men. British Journal of Clinical Pharmacology 2003;56;297-304.  https://doi.org/10.1046/j.0306-5251.2003.01852.x
  13. Kim YM, Lee S, Jung JY, Shin KH, Kim DH, Kim JH, Jee YK. Incidence of and risk ractors for zolpidem-induced delirium. Korean Journal of Medicine 2013;804-809.  https://doi.org/10.3904/kjm.2013.84.6.804
  14. Elie M, Cole MG, Primeau FJ, Bellavance, F. Delirium risk factors in elderly hospitalized patients. Journal of General Internal Medicine 1998;13;204-212.  https://doi.org/10.1046/j.1525-1497.1998.00047.x
  15. Lee JM, Jang SM. Zolpidem-induced complex sleep-related behavior. J Korean Soc Biol Ther Psychiatry 2021;27;89-96.  https://doi.org/10.22802/JKSBTP.2021.27.2.89
  16. Mallampalli MP, Carter CL. Exploring sex and gender differences in sleep health: a society for women's health research report. Journal of Women's Health 2014;23;553-562.  https://doi.org/10.1089/jwh.2014.4816
  17. Cubala WJ, Wiglusz M, Burkiewicz A, Galuszko-Wegielnik M. Zolpidem pharmacokinetics and pharmacodynamics in metabolic interactions involving CYP3A: sex as a differentiating factor. European Journal of Clinical Pharmacology 2010;66:955-955.  https://doi.org/10.1007/s00228-010-0854-x
  18. Kito S, Koga Y. Visual hallucinations and amnesia associated with zolpidem triggered by fluvoxamine: a possible interaction. International Psychogeriatrics 2006;18;749-751.  https://doi.org/10.1017/S1041610206214418
  19. McKernan RM, Rosahl TW, Reynolds DS, Sur C , Wafford KA, Atack JR, Farrar S, Myers J, Cook G, Ferris P, Garrett L, Bristow L, Marshall G, Brown N, Howell O, Moore KW, Carling RW, Street LJ, Castro JL, Ragan CI, Dawson GR, Whiting PJ. Sedative but not anxiolytic properties of benzodiazepines are mediated by the GABAA receptor α1 subtype. Nature Neuroscience 2000;3;587-592.  https://doi.org/10.1038/75761
  20. Chiang A, Krystal A. Report of two cases where sleep related eating behavior occurred with the extended-release formulation but not the immediate-release formulation of a sedative-hypnotic agent. Journal of Clinical Sleep Medicine 2008;4;155-156.  https://doi.org/10.5664/jcsm.27132
  21. Monti JM, Spence DW, Pandi-Perumal SR, Langer SZ, Hardeland R. Pharmacotherapy of insomnia: focus on zolpidem extended release. Clinical medicine. Therapeutics 2009;1:CMT-S2040.