The effect of zolpidem on sleep efficiency and obstructive sleep apnea severity in OSA patients: A systematic review...

Insomnia and obstructive sleep apnea (OSA) comorbidity is prevalent and leads to worse outcomes. While zolpidem may improve sleep in OSA, existing trials report inconsistent results on safety and efficacy. We aimed to perform a meta-analysis to systematically evaluate the effect of zolpidem in OSA patients.

We systematically searched PubMed, Medline, Embase, Cochrane's Library, Web of Science, and other online sources for related trials. Data were pooled using a random-effects model, and mean differences with 95% confidence intervals were calculated. The effects of zolpidem on sleep efficiency and severity of sleep apnea were analyzed.

5 controlled trials (4 randomized and 1 nonrandomized) were included. All studies claimed all participants were diagnosed with OSA. Treatment with zolpidem significantly improved total sleep time compared to placebo or no-drug (MD: 0.78, 95% confidence interval: 0.19-1.37, P = .009; I2 = 38%). However, zolpidem did not alter OSA severity as shown by no systematic changes in the Apnea-Hypopnea Index (AHI). Total AHI, supine AHI, and AHI during non-rapid eye movement sleep or rapid eye movement sleep were unaltered on the drug night compared to the control group. Next-day sleepiness was measured in 4 studies, and the results showed no statistical difference, indicating that zolpidem was generally well tolerated with no major adverse events.

Zolpidem can substantially increase sleep duration in OSA patients without worsening AHI or overnight hypoxemia, and appears well-tolerated without a next-day hangover. These findings are limited by the small number of studies, small sample sizes, and short-term nature of interventions. Further large-scale RCTs are warranted to confirm long-term safety and efficacy.