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Effect of Long-Term Benzodiazepines for Chronic Insomnia on Cognitive Function and Waking Electroencephalography: A Case-Control Study

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Objective The relationship between benzodiazepine use and cognitive decline in insomnia patients has been reported, but still conflicting. Thus, we tried to determine whether long-term exposure of benzodiazepine might be associated with changes of cognition and electroencephalography (EEG) findings in patients with chronic insomnia.Methods Insomniacs using benzodiazepines (n=29), drug-free insomniacs (n=27), and age- and sex-matched controls (n=28) were recruited. Neurocognitive function tested with Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet Neuropsychological Assessment Battery, quantitative EEG in awake state, and information of benzodiazepine usage were obtained.Results Drug-free insomniacs reported more severe symptoms than insomniacs using benzodiazepine (p<0.001). Insomniacs using benzodiazepine showed a decrease of executive function in Trail Making Test A than drug-free insomniacs and controls (0.73±0.66 vs. 1.27±0.38 vs. 1.09±0.47, p<0.001) and in categorical fluency than drug-free insomniacs (-0.01±0.99 vs. 1.26±0.97, p=0.002). However, such decrease of executive function was not proportional to daily dose or cumulative dose of benzodiazepine. The EEG was not significantly different between insomniacs using benzodiazepine and drug-free insomniacs, while EEG of insomniacs showed low relative theta power in frontal and parietal regions but high relative beta power in frontal region than that of controls.Conclusion Benzodiazepine users with chronic insomnia showed an impairment of executive function compared to drug-free insomniacs and controls although they showed relatively decreased severity of insomnia symptoms. Chronic insomniacs showed a hyper-arousal manifestation in front-parietal region of brain regardless of benzodiazepine exposure.

Abstract

Objective The relationship between benzodiazepine use and cognitive decline in insomnia patients has been reported, but still conflicting. Thus, we tried to determine whether long-term exposure of benzodiazepine might be associated with changes of cognition and electroencephalography (EEG) findings in patients with chronic insomnia.Methods Insomniacs using benzodiazepines (n=29), drug-free insomniacs (n=27), and age- and sex-matched controls (n=28) were recruited. Neurocognitive function tested with Korean version of the Consortium to Establish a Registry for Alzheimer’s Disease Assessment Packet Neuropsychological Assessment Battery, quantitative EEG in awake state, and information of benzodiazepine usage were obtained.Results Drug-free insomniacs reported more severe symptoms than insomniacs using benzodiazepine (p<0.001). Insomniacs using benzodiazepine showed a decrease of executive function in Trail Making Test A than drug-free insomniacs and controls (0.73±0.66 vs. 1.27±0.38 vs. 1.09±0.47, p<0.001) and in categorical fluency than drug-free insomniacs (-0.01±0.99 vs. 1.26±0.97, p=0.002). However, such decrease of executive function was not proportional to daily dose or cumulative dose of benzodiazepine. The EEG was not significantly different between insomniacs using benzodiazepine and drug-free insomniacs, while EEG of insomniacs showed low relative theta power in frontal and parietal regions but high relative beta power in frontal region than that of controls.Conclusion Benzodiazepine users with chronic insomnia showed an impairment of executive function compared to drug-free insomniacs and controls although they showed relatively decreased severity of insomnia symptoms. Chronic insomniacs showed a hyper-arousal manifestation in front-parietal region of brain regardless of benzodiazepine exposure.

참고문헌 (55)

  1. Ohayon MM, "Epidemiology of insomnia: what we know and what we still need to learn", Sleep Med Rev, 6, pp.97~111 (2002)
  2. Laugsand LE, "Insomnia and the risk of acute myocardial infarction: a population study", Circulation, 124, pp.2073~2081 (2011)
  3. Troxel WM, "Sleep symptoms predict the development of the metabolic syndrome", Sleep, 33, pp.1633~1640 (2010)
  4. Baglioni C, "Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies", J Affect Disord, 135, pp.10~19 (2001)
  5. Bjørngaard JH, "Sleeping problems and suicide in 75,000 Norwegian adults: a 20 year follow-up of the HUNT I study", Sleep, 34, pp.1155~1159 (2011)
  6. Paller KA, "Memory and sleep: how sleep cognition can change the waking mind for the better", Annu Rev Psychol, 72, pp.123~150 (2021)
  7. Yaffe K, "Connections between sleep and cognition in older adults", Lancet Neurol, 13, pp.1017~1028 (2014)
  8. Sateia MJ, "Clinical practice guideline for the pharmacologic treatment of chronic insomnia in adults: an American Academy of Sleep Medicine clinical practice guideline", J Clin Sleep Med, 13, pp.307~349 (2017)
  9. Roth T, "Insomnia: definition, prevalence, etiology, and consequences", J Clin Sleep Med, 3, pp.S7~S10 (2007)
  10. "Br J Gen Pract", 2017, e609~e613
  11. Barker MJ, "Cognitive effects of long-term benzodiazepine use: a meta-analysis", CNS Drugs, 18, pp.37~48 (2004)
  12. Riemann D, "European guideline for the diagnosis and treatment of insomnia", J Sleep Res, 26, pp.675~700 (2017)
  13. Hauk L, "Treatment of chronic insomnia in adults: ACP guideline", Am Fam Physician, 95, pp.669~670 (2017)
  14. Ohayon MM, "Psychotropic medication and insomnia complaints in two epidemiological studies", Can J Psychiatry, 41, pp.457~464 (1996)
  15. Neutel CI, "The epidemiology of long-term benzodiazepine use", Int Rev Psychiatry, 17, pp.189~197 (2005)
  16. Morin CM, "Correlates of benzodiazepine use in individuals with insomnia", Sleep Med, 5, pp.457~462 (2004)
  17. Stewart SA, "The effects of benzodiazepines on cognition", J Clin Psychiatry, 66(Suppl 2), pp.9~13 (2005)
  18. 노현진, "The Relationship between Hippocampal Volume and Cognition in Patients with Chronic Primary Insomnia", Journal of Clinical Neurology, 8(2), pp.130~138 (2012), 대한신경과학회[DOI]
  19. Coutin-Churchman P, "Quantitative spectral analysis of EEG in psychiatry revisited:drawing signs out of numbers in a clinical setting", Clin Neurophysiol, 114, pp.2294~2306 (2003)
  20. Kesebir S, "QEEG in affective disorder: about to be a biomarker, endophenotype and predictor of treatment response", Heliyon, 4, pp.e00741~ (2018)
  21. Perlis ML, "Beta EEG activity and insomnia", Sleep Med Rev, 5, pp.363~374 (2001)
  22. Perlis ML, "Beta", Gamma EEG activity in patients with primary and secondary insomnia and good sleeper controls, 2001, pp.24, 110~117
  23. Wolynczyk-Gmaj D, "Waking EEG in primary insomnia", Acta Neurobiol Exp (Wars), 71, pp.387~392 (2011)
  24. Hamida ST, "EEG time and frequency domain analyses of primary insomnia", Annu Int Conf IEEE Eng Med Biol Soc, 2015, pp.6206~6209 (2015)
  25. American Academy of Sleep Medicine, "International classification of sleep disorders (3rd ed)", American Academy of Sleep Medicine, 21~22 (2014)
  26. Morin CM, "The insomnia severity index: psychometric indicators to detect insomnia cases and evaluate treatment response", Sleep, 34, pp.601~608 (2011)
  27. Johns MW, "A new method for measuring daytime sleepiness: the Epworth sleepiness scale", Sleep, 14, pp.540~545 (1991)
  28. Beck AT, "Beck depression inventory" (1996), The Psychological Corporation
  29. Lee DY, "A normative study of the CERAD neuropsychological assessment battery in the Korean elderly", J Int Neuropsychol Soc, 10, pp.72~81 (2004)
  30. Petersen RC, "Mild cognitive impairment as a diagnostic entity", J Intern Med, 256, pp.183~194 (2004)
  31. Wu CS, "The association between dementia and long-term use of benzodiazepine in the elderly: nested case-control study using claims data", Am J Geriatr Psychiatry, 17, pp.614~620 (2009)
  32. Wu CS, "Effect of benzodiazepine discontinuation on dementia risk", Am J Geriatr Psychiatry, 19, pp.151~159 (2011)
  33. World Health Organization, "WHO collaborating centre for drug statistics methodology: guidelines for ATC classification and DDD assignment", World Health Organization, ~ (2009)
  34. Crowe SF, "The residual medium and long-term cognitive effects of benzodiazepine use: an updated meta-analysis", Arch Clin Neuropsychol, 33, pp.901~911 (2018)
  35. Liu L, "The Effects of benzodiazepine use and abuse on cognition in the elders: a systematic review and meta-analysis of comparative studies", Front Psychiatry, 11, pp.00755~ (2020)
  36. Mura T, "Chronic use of benzodiazepines and latent cognitive decline in the elderly: results from the three-city study", Eur Neuropsychopharmacol, 23, pp.212~223 (2013)
  37. Del Ser T, "Effects of commonly prescribed drugs on cognition and mild cognitive impairment in healthy elderly people", J Psychopharmacol, 33, pp.965~974 (2019)
  38. Helmes E, "Associations between benzodiazepine use and neuropsychological test scores in older adults", Can J Aging, 34, pp.207~214 (2015)
  39. Quaranta D, "Semantic relations in a categorical verbal fluency test: an exploratory investigation in mild cognitive impairment", Front Psychol, 10, pp.2797~ (2019)
  40. Budson AE, "The handbook of Alzheimer’s disease and other dementias" (2014), Wiley-Blackwell
  41. Kehagia AA, "Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson’s disease", Lancet Neurol, 9, pp.1200~1213 (2010)
  42. Pillai V, "Effectiveness of benzodiazepine receptor agonists in the treatment of insomnia:an examination of response and remission rates", Sleep, 40, pp.zsw044~ (2017)
  43. Mendelsohn AR, "Sleep facilitates clearance of metabolites from the brain: glymphatic function in aging and neurodegenerative diseases", Rejuvenation Res, 16, pp.518~523 (2013)
  44. Johann AF, "Insomnia with objective short sleep duration is associated with longer duration of insomnia in the Freiburg Insomnia Cohort compared to insomnia with normal sleep duration, but not with hypertension", PLoS One, 12, pp.e0180339~ (2017)
  45. Fan TT, "Objective sleep duration is associated with cognitive deficits in primary insomnia:BDNF may play a role", Sleep, 42, pp.zsy192~ (2019)
  46. Holanda FWN Júnior, "Sleep and executive functions in older adults: a systematic review", Dement Neuropsychol, 10, pp.185~197 (2016)
  47. Pariente A, "The benzodiazepine-dementia disorders link: current state of knowledge", CNS Drugs, 30, pp.1~7 (2016)
  48. Dingemanse J, "Pharmacokinetic-pharmacodynamic modelling of the EEG effects of Ro 48-6791, a new short-acting benzodiazepine, in young and elderly subjects", Br J Anaesth, 79, pp.567~574 (1997)
  49. Carskadon MA, "Self-reports versus sleep laboratory findings in 122 drugfree subjects with complaints of chronic insomnia", Am J Psychiatry, 133, pp.1382~1388 (1976)
  50. Baker FC, "A comparison of subjective estimates of sleep with objective polysomnographic data in healthy men and women", J Psychosom Res, 47, pp.335~341 (1999)
  51. Michail E, "Benzodiazepine administration effect on EEG fractal dimension: results and causalities", Annu Int Conf IEEE Eng Med Biol Soc, 2010, pp.2350~2353 (2010)
  52. Mazza M, "Polysomnographic findings in a cohort of chronic insomnia patients with benzodiazepine abuse", J Clin Sleep Med, 10, pp.35~42 (2014)
  53. Bastien CH, "Sleep EEG power spectra, insomnia, and chronic use of benzodiazepines", Sleep, 26, pp.313~317 (2003)
  54. Fernandez-Mendoza J, "Insomnia with objective short sleep duration is associated with cognitive impairment: a first look at cardiometabolic contributors to brain health", Sleep, 44, pp.zsaa150~ (2021)
  55. Perlis ML, "Response to “do increases in beta EEG activity uniquely reflect insomnia?” (C. H. Bastein and M. H. Bonnet)", Sleep Med Rev, 5, pp.379~383 (2001)

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