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Relationship between zolpidem concentrations and sleep parameters in pediatric burn patients

Chris Stockmann1, Michele M Gottschlich, Daniel Healy

  • 1From the *Division of Clinical Pharmacology, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City; †The Shriners Hospitals for Children, Cincinnati, Ohio; ‡Department of Surgery, University of Cincinnati, Ohio; §Department of Pharmacy Practice and Administrative Sciences, James L. Winkle College of Pharmacy, University of Cincinnati, Ohio; and the Departments of ‖Biostatistics and ¶Nutrition Services, Cincinnati Children's Hospital Medical Center, Ohio.

Journal of Burn Care & Research : Official Publication of the American Burn Association
|September 5, 2014
PubMed

Insights

Zolpidem improved stage 2 sleep in pediatric burn patients but did not restore slow-wave or REM sleep. Alternative hypnotics may be needed for better sleep architecture in these children.

Area of Science:

  • Pediatric critical care
  • Sleep medicine
  • Pharmacology

Background:

  • Severe burn injuries disrupt sleep architecture in children.
  • Zolpidem, a non-benzodiazepine hypnotic, is used to manage insomnia.
  • Its effect on sleep parameters in pediatric burn patients requires further investigation.

Purpose of the Study:

  • To evaluate the relationship between zolpidem serum concentrations and sleep parameters in pediatric burn patients.
  • To assess the impact of zolpidem on sleep architecture, including total sleep time, slow-wave sleep, REM sleep, and sleep stage transitions.

Main Methods:

  • A cohort of 10 pediatric burn patients received standard age-based zolpidem dosing.
  • Polysomnography data were collected throughout the night.
  • Serum zolpidem concentrations were measured at multiple time points post-administration.
  • Markov mixed-effects pharmacodynamic models were used to analyze the data.

Main Results:

  • Zolpidem administration resulted in total sleep time of approximately 65% of normal values.
  • Slow-wave and REM sleep were significantly reduced (18-37% of normal).
  • Stage 2 sleep was preserved at 99% of normal levels, with higher zolpidem concentrations correlating with increased stage 2 sleep (r = .54; P = .04).
  • Patients experienced a median of 120 sleep stage transitions and 55 night awakenings.

Conclusions:

  • Higher zolpidem serum concentrations in pediatric burn patients are associated with normal stage 2 sleep.
  • However, zolpidem profoundly depresses slow-wave and REM sleep, leading to frequent sleep stage transitions and awakenings.
  • Alternative hypnotic agents may be necessary to fully restore normal sleep architecture in this population.

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