From the Guidelines
Yes, obese individuals can develop atelectasis (lung collapse) during sleep due to the extra weight on their chest restricting full lung expansion, and this condition can lead to increased morbidity and mortality if not properly managed. Symptoms may include shortness of breath upon waking, morning headaches, excessive daytime sleepiness, and poor sleep quality. However, atelectasis alone is not an absolute contraindication to benzodiazepines. Rather, it's obesity-related sleep apnea that raises concerns with benzodiazepine use, as these medications can further relax airway muscles and depress respiratory drive, potentially worsening breathing problems during sleep, and increasing the risk of respiratory failure and other complications 1.
Key Considerations
- Benzodiazepines should be used with extreme caution in obese patients with suspected or confirmed sleep-disordered breathing, as they can exacerbate respiratory problems and worsen outcomes 1.
- If benzodiazepines are necessary, they should be prescribed at the lowest effective dose for the shortest duration possible, with close monitoring for worsening respiratory symptoms, to minimize the risk of adverse effects and optimize patient outcomes.
- Alternative medications like non-benzodiazepine sleep aids (such as ramelteon) or non-pharmacological approaches like cognitive behavioral therapy for insomnia may be safer options for obese patients with breathing concerns during sleep, and can help improve sleep quality and reduce symptoms of insomnia and sleep apnea 1.
- Weight loss, positional therapy (sleeping on one's side), and treatment of any underlying sleep apnea with CPAP therapy would also be important management strategies, as they can help reduce the risk of atelectasis and other respiratory complications, and improve overall health outcomes 1.
Management Strategies
- Weight loss can help reduce the risk of atelectasis and other respiratory complications, and improve overall health outcomes, by reducing the amount of weight on the chest and improving lung function 1.
- Positional therapy, such as sleeping on one's side, can help reduce the risk of atelectasis and other respiratory complications, by improving lung expansion and reducing the amount of weight on the chest.
- Treatment of any underlying sleep apnea with CPAP therapy can help improve sleep quality and reduce symptoms of insomnia and sleep apnea, and can also help reduce the risk of atelectasis and other respiratory complications, by keeping the airway open and improving lung function 1.
From the FDA Drug Label
CONTRAINDICATIONS SECTION Diazepam tablets are contraindicated in patients with a known hypersensitivity to diazepam and, because of the lack of sufficient clinical experience, in pediatric patients under 6 months of age. Diazepam is also contraindicated in patients with myasthenia gravis, severe respiratory insufficiency, severe hepatic insufficiency, and sleep apnea syndrome. The FDA drug label does not answer the question.
From the Research
Atelectasis in Obese Individuals
- Atelectasis, a state of collapsed and non-aerated lung parenchyma, can occur in obese individuals due to various factors such as airway obstruction, compression of parenchyma, and increased surface tension in alveoli and bronchioli 2.
- Obese individuals may experience atelectasis while sleeping, particularly if they have underlying respiratory conditions such as obstructive sleep apnea or obesity-hypoventilation syndrome 3.
Symptoms of Atelectasis
- Symptoms of atelectasis may include respiratory distress, cough, chest pain, and fever 2.
- In severe cases, atelectasis can lead to respiratory failure, which may require mechanical ventilation 4.
Benzodiazepines and Atelectasis
- Benzodiazepines, commonly used for their sedative effects, can exacerbate respiratory problems in individuals with atelectasis or other respiratory conditions 5.
- The use of benzodiazepines in individuals with atelectasis or respiratory failure may be contraindicated due to the risk of worsening respiratory function 5.
- However, there is no absolute contraindication to benzodiazepines in individuals with atelectasis, and the decision to use these medications should be made on a case-by-case basis, taking into account the individual's overall medical condition and the potential risks and benefits of treatment.
Treatment of Atelectasis
- Treatment of atelectasis depends on the underlying cause and severity of the condition, and may include chest physiotherapy, postural drainage, bronchodilator and anti-inflammatory therapy, and removal of mucous plugs by bronchoscopy 2.
- Non-invasive mechanical ventilation (NIMV) may be useful in the treatment of atelectasis in some critical patients, particularly those who are unable to undergo bronchoscopy 4.