Eszopiclone and Inflammatory Mediators in Patients With Acute Coronary Syndrome
Abnormalities of sleep are common in hospitalized patients, but the mechanisms and
consequences are not well understood. In many of these patients, sleep is very disrupted,
occurs during the daytime, and circadian rhythm is diminished or lost. Hospitalized
patients experience more frequent arousals and awakenings than is normal and show decreases
in rapid eye movement and slow wave sleep. The degree of sleep fragmentation is at least
equivalent to that seen in patients with obstructive sleep apnea. About 20% of arousals and
awakenings are related to noise, 10% are related to health care personnel and care-related
activities, and the cause for the remainder is not known, although severity of underlying
disease is likely an important factor.
In studies of sleep following acute myocardial infarction, marked disturbances have been
found in patients, whether in the ICU and on the wards. These disturbances include long
periods of wakefulness; poor sleep efficiency, and disruption of REM sleep. The fact that
there is also a loss in circadian rhythm in these patients may indicate a widespread
disruption of bodily homeostasis which, in turn, may be related to the infarct itself, to a
more generalized physiological response to stress or to other factors. Sleep disruption can
induce sympathetic activation and elevation of blood pressure, which may contribute to
It has been shown that there is an increased level of some inflammatory and coagulation
factors in the recovery period following an acute myocardial infarction (MI). Post MI
patients have higher levels of TNF-α, IL-6 and tissue plasminogen activator as well as lower
levels of antithrombin III and protein C.
The aim of this study is to determine whether the sleep-aid Eszopiclone can improve sleep,
decrease inflammation, and decrease pro-coagulation factors in patients who have recently
suffered myocardial infarction when compared with a control group without sleep aids.
Eszopiclone is a benzodiazepine receptor agonist which improves sleep quality by reducing
the time to sleep onset and reduces wakefulness during the sleep period. Unlike
benzodiazepines, it does not affect the deeper stage 3 and 4 sleep. The result is that it
provides a more nearly normal night sleep than other sleep aids. It is hoped that improved
sleep patterns will result in more rapid normalization of inflammatory and coagulation
factors and perhaps more rapid recovery.
Allocation: Randomized, Endpoint Classification: Efficacy Study, Intervention Model: Parallel Assignment, Masking: Double Blind (Subject, Investigator), Primary Purpose: Supportive Care
Changes in circulating inflammatory cytokines (Interleukin [IL]-1B, IL-6, IL-10, and Tumor Necrosis Alpha [TNF-α]) and pro-coagulant mediators (soluble P-selectin and CD40 ligand).
Sairam Parthasarathy, MD
Southern Arizona VA Health Care System
United States: Institutional Review Board
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