From the Guidelines
The trial using eszopiclone for CPAP adherence is a clinical study investigating whether eszopiclone can improve adherence to continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea, with two published RCTs showing statistically significant and clinically relevant improvements in CPAP adherence associated with eszopiclone compared with placebo 1.
Key Points
- The typical dosage of eszopiclone used in the trial was 3mg taken orally before bedtime for the first 14 days of CPAP therapy.
- The medication works by enhancing the activity of GABA, an inhibitory neurotransmitter in the brain, which promotes sleep.
- Patients should be aware that common side effects include unpleasant taste, headache, and drowsiness the following day.
- This intervention specifically targets the critical initial adaptation period to CPAP, which is when many patients abandon therapy due to discomfort or difficulty falling asleep with the device.
Evidence
The evidence from the studies 1 suggests that eszopiclone can improve CPAP adherence in patients with obstructive sleep apnea. However, it is essential to consider the potential side effects and the individual patient's response to the medication.
Recommendations
Based on the available evidence, eszopiclone may be considered as an option to improve CPAP adherence in patients with obstructive sleep apnea, particularly during the initial adaptation period 1.
From the Research
Trial Using Eszopiclone for CPAP Adherence
- The study 2 investigated the effects of eszopiclone on continuous positive airway pressure (CPAP) adherence in adults with obstructive sleep apnea.
- The trial found that patients in the eszopiclone group used CPAP for 20.8% more nights and 1.3 more hours per night compared to the placebo group.
- The hazard ratio for discontinuation of CPAP was 1.90 times higher in the placebo group, indicating that eszopiclone improved CPAP adherence.
Mechanism of Action
- Another study 3 found that eszopiclone increased the respiratory arousal threshold and lowered the apnoea/hypopnoea index in obstructive sleep apnea patients with a low arousal threshold.
- This suggests that eszopiclone may improve CPAP adherence by increasing the patient's ability to tolerate the treatment and reducing the number of apnoea and hypopnoea events.
Comparison with Other Treatments
- A study 4 compared the combination of eszopiclone with brief behavioral therapy for insomnia (BBTI) to BBTI alone in patients with comorbid insomnia and obstructive sleep apnea.
- The results showed that both treatments improved sleep quality, but there was no significant difference in CPAP adherence between the two groups.
Safety and Efficacy of Eszopiclone
- A review of eszopiclone for the treatment of insomnia 5 found that it was effective in improving sleep onset and maintenance, with moderate effects on sleep efficacy outcomes.
- The review also found that eszopiclone was generally well-tolerated, with common adverse events including unpleasant taste, dry mouth, somnolence, and dizziness.
- Another study 6 found that eszopiclone was effective in improving sleep parameters and daytime functioning in patients with primary insomnia, with no evidence of tolerance or rebound insomnia.