Temazepam at high altitude reduces periodic breathing without impairing next-day performance: a randomized cross-over double-blind study

A. H. Nickol, J. Leverment, P. Richards, P. Seal, G. A. Harris, Jennifer Cleland, G. Dubowitz, D. J. Collier, J. Milledge, J. R. Stradling, M. J. Morrell

Research output: Contribution to journalArticle

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Abstract

The aim of the study was to examine the efficacy and safety of temazepam on nocturnal oxygenation and next-day performance at altitude. A double-blind, randomized, cross-over trial was performed in Thirty-three healthy volunteers. Volunteers took 10 mg of temazepam and placebo in random order on two successive nights soon after arrival at 5000 m, following a 17-day trek from 410 m. Overnight SaO(2) and body movements, and next-day reaction time, maintenance of wakefulness and cognition were assessed. Compared with placebo, temazepam resulted in a reduction in periodic breathing from a median (range) of 16 (0-81.3)% of the night to 9.4 (0-79.6)% (P = 0.016, Wilcoxon's signed-rank test), associated with a small but significant decrease in mean nocturnal SaO(2) from 78 (65-84)% to 76 (64-83)% (P = 0.013). There was no change in sleep latency (P = 0.40) or restlessness (P = 0.30). Temazepam had no adverse effect on next-day reaction time [241 (201-380) ms postplacebo and 242 (204-386) ms post-temazepam], maintenance of wakefulness (seven trekkers failed to maintain 40 min of wakefulness postplacebo, and four post-temazepam), cognition or acute mountain sickness. At high altitude temazepam reduces periodic breathing during sleep without an adverse effect on next-day reaction time, maintenance of wakefulness or cognition. The 2% reduction in mean SaO(2) post-temazepam is likely to be predominantly because of acclimatization, as by chance more trekkers took temazepam on the first night (19 versus 14). We conclude that at high altitude temazepam is effective in reducing periodic breathing, and is safe to use, without any adverse effect upon next-day performance.

Original languageEnglish
Pages (from-to)445-454
Number of pages9
JournalJournal of Sleep Research
Volume15
Issue number4
Early online date17 Nov 2006
DOIs
Publication statusPublished - Dec 2006

Keywords

  • high altitude
  • maintenance of wakefulness
  • periodic breathing
  • reaction time
  • sleep
  • temazepam
  • computerized cognitive assessment
  • hypoxic ventilatory response
  • obstructive sleep-apnea
  • simulated altitude
  • oxygen-saturation
  • extreme altititude
  • arousal
  • benzodiazepines
  • respiration
  • disruption

Cite this

Temazepam at high altitude reduces periodic breathing without impairing next-day performance : a randomized cross-over double-blind study. / Nickol, A. H.; Leverment, J.; Richards, P.; Seal, P.; Harris, G. A.; Cleland, Jennifer; Dubowitz, G.; Collier, D. J.; Milledge, J.; Stradling, J. R.; Morrell, M. J.

In: Journal of Sleep Research, Vol. 15, No. 4, 12.2006, p. 445-454.

Research output: Contribution to journalArticle

Nickol, AH, Leverment, J, Richards, P, Seal, P, Harris, GA, Cleland, J, Dubowitz, G, Collier, DJ, Milledge, J, Stradling, JR & Morrell, MJ 2006, 'Temazepam at high altitude reduces periodic breathing without impairing next-day performance: a randomized cross-over double-blind study', Journal of Sleep Research, vol. 15, no. 4, pp. 445-454. https://doi.org/10.1111/j.1365-2869.2006.00558.x
Nickol, A. H. ; Leverment, J. ; Richards, P. ; Seal, P. ; Harris, G. A. ; Cleland, Jennifer ; Dubowitz, G. ; Collier, D. J. ; Milledge, J. ; Stradling, J. R. ; Morrell, M. J. / Temazepam at high altitude reduces periodic breathing without impairing next-day performance : a randomized cross-over double-blind study. In: Journal of Sleep Research. 2006 ; Vol. 15, No. 4. pp. 445-454.
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AU - Nickol, A. H.

AU - Leverment, J.

AU - Richards, P.

AU - Seal, P.

AU - Harris, G. A.

AU - Cleland, Jennifer

AU - Dubowitz, G.

AU - Collier, D. J.

AU - Milledge, J.

AU - Stradling, J. R.

AU - Morrell, M. J.

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N2 - The aim of the study was to examine the efficacy and safety of temazepam on nocturnal oxygenation and next-day performance at altitude. A double-blind, randomized, cross-over trial was performed in Thirty-three healthy volunteers. Volunteers took 10 mg of temazepam and placebo in random order on two successive nights soon after arrival at 5000 m, following a 17-day trek from 410 m. Overnight SaO(2) and body movements, and next-day reaction time, maintenance of wakefulness and cognition were assessed. Compared with placebo, temazepam resulted in a reduction in periodic breathing from a median (range) of 16 (0-81.3)% of the night to 9.4 (0-79.6)% (P = 0.016, Wilcoxon's signed-rank test), associated with a small but significant decrease in mean nocturnal SaO(2) from 78 (65-84)% to 76 (64-83)% (P = 0.013). There was no change in sleep latency (P = 0.40) or restlessness (P = 0.30). Temazepam had no adverse effect on next-day reaction time [241 (201-380) ms postplacebo and 242 (204-386) ms post-temazepam], maintenance of wakefulness (seven trekkers failed to maintain 40 min of wakefulness postplacebo, and four post-temazepam), cognition or acute mountain sickness. At high altitude temazepam reduces periodic breathing during sleep without an adverse effect on next-day reaction time, maintenance of wakefulness or cognition. The 2% reduction in mean SaO(2) post-temazepam is likely to be predominantly because of acclimatization, as by chance more trekkers took temazepam on the first night (19 versus 14). We conclude that at high altitude temazepam is effective in reducing periodic breathing, and is safe to use, without any adverse effect upon next-day performance.

AB - The aim of the study was to examine the efficacy and safety of temazepam on nocturnal oxygenation and next-day performance at altitude. A double-blind, randomized, cross-over trial was performed in Thirty-three healthy volunteers. Volunteers took 10 mg of temazepam and placebo in random order on two successive nights soon after arrival at 5000 m, following a 17-day trek from 410 m. Overnight SaO(2) and body movements, and next-day reaction time, maintenance of wakefulness and cognition were assessed. Compared with placebo, temazepam resulted in a reduction in periodic breathing from a median (range) of 16 (0-81.3)% of the night to 9.4 (0-79.6)% (P = 0.016, Wilcoxon's signed-rank test), associated with a small but significant decrease in mean nocturnal SaO(2) from 78 (65-84)% to 76 (64-83)% (P = 0.013). There was no change in sleep latency (P = 0.40) or restlessness (P = 0.30). Temazepam had no adverse effect on next-day reaction time [241 (201-380) ms postplacebo and 242 (204-386) ms post-temazepam], maintenance of wakefulness (seven trekkers failed to maintain 40 min of wakefulness postplacebo, and four post-temazepam), cognition or acute mountain sickness. At high altitude temazepam reduces periodic breathing during sleep without an adverse effect on next-day reaction time, maintenance of wakefulness or cognition. The 2% reduction in mean SaO(2) post-temazepam is likely to be predominantly because of acclimatization, as by chance more trekkers took temazepam on the first night (19 versus 14). We conclude that at high altitude temazepam is effective in reducing periodic breathing, and is safe to use, without any adverse effect upon next-day performance.

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KW - computerized cognitive assessment

KW - hypoxic ventilatory response

KW - obstructive sleep-apnea

KW - simulated altitude

KW - oxygen-saturation

KW - extreme altititude

KW - arousal

KW - benzodiazepines

KW - respiration

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JO - Journal of Sleep Research

JF - Journal of Sleep Research

SN - 0962-1105

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