Night-time Medication Research Articles

Demonstrating the Benefits of Antihypertensive Nighttime Dosing and Indapamide Usage in Hypertension Management.

Background: Uncontrolled hypertension, specifically nocturnal hypertension, increases the risk for significant clinical outcomes. Evidence on the use of nighttime antihypertensives is scant and conflicting. In addition, hydrochlorothiazide continues to be the primary thiazide used despite being the least potent. Objective: The primary purpose of this study was to evaluate instituting nighttime dosing to control hypertension and compare the short-term effectiveness of blood pressure control with indapamide versus hydrochlorothiazide. Methods: This was a retrospective, observational study. Participant inclusion criteria consisted of patients 18 years of age or older, a current diagnosis of hypertension, and hypertension that required medical therapy. The investigator documented whether a patient was taking at least one antihypertensive at night versus all morning medications, as well as the use of indapamide versus hydrochlorothiazide. The patient's baseline and first follow-up blood pressure readings were documented. The primary outcome was to determine whether including nighttime dosing in antihypertensive regimens is more effective than all morning antihypertensive regimens. The secondary outcome was to determine whether indapamide was more effective than hydrochlorothiazide. Results: A total of 64 patients were included in the study. Twenty-eight patients were taking >1 nighttime antihypertensives versus 32 patients on all morning medications. Patients on at least one nighttime medication demonstrated greater systolic blood pressure reduction. There was no difference in blood pressure reduction between indapamide and hydrochlorothiazide. Conclusion: The study findings support the use of nighttime dosing to improve blood pressure management. The results on the effectiveness of indapamide versus hydrochlorothiazide conflict with previous research.

Nighttime medication administration and patient perception of sleep in the intensive care unit

AbstractIntroductionEnvironmental, patient, disease, and care‐related factors can lead to sleep disruption in the intensive care unit (ICU). Medication administration is a potentially modifiable factor in this setting that has not been well described as a target for sleep improvement.ObjectivesTo determine characteristics of nighttime medication administration practices in the ICU, evaluate the effect on patient perceived sleep, and assess the opportunity for pharmacist‐led nighttime medication administration stewardship.MethodsThis was a multicenter, retrospective, observational cohort study. Patients included for chart review had perceived sleep measured using the Richards‐Campbell Sleep Questionnaire (RCSQ). Data were collected on patient characteristics, ICU exposures, and nighttime medications administered. Four RCSQ groups defined for comparison were RCSQ 0–25 indicating “very poor” sleep, 26–50 “poor” sleep, 51–75 “good” sleep, and 76–100 “very good” sleep.ResultsOverall, 115 patients with RCSQ assessments and 435 nighttime medication administrations were included. Nighttime medications were most commonly cardiovascular (28.9%) and central nervous system (21.4%) agents, administered via intravenous (54.5%) and oral (22.7%) routes. Patient characteristics were comparable between the four groups except for history of head trauma. Patients reporting very poor sleep had a significantly higher median number of nighttime medications administered as compared to patients reporting very good sleep (4.0 [interquartile range (IQR) (2, 6)] vs. 2.5 [IQR 1, 4], adjusted p = 0.048). Approximately three‐quarters of nighttime medications occurred between the hours of 22:00–0:59 and 5:00–5:59. Nearly 40% of nighttime medications could have been retimed for daytime administration.ConclusionsUnnecessary nighttime medication administration is common and associated with poor patient perceived sleep in the ICU. Pharmacists are well‐positioned to evaluate timing of medication administration and cluster medication‐related care for daytime hours, when appropriate. Nighttime medication stewardship optimization by pharmacists is an opportunity to improve patient perceived sleep in the ICU.

Sleep disturbance and psychological distress among hospitalized children in India: Parental perceptions on pediatric inpatient experiences.

Investigate parental perceptions of children's sleep disturbance and psychological distress associated with an inpatient stay in a low-resource hospital setting. Demographic and validated survey instruments were adapted for administration to parents of children in the medical wards of a tertiary hospital in India. Parents proficient in English, Hindi, Tamil, or Telugu with a child age 4-12 years admitted for at least 48 h were eligible to participate. All respondents completed the Factors Affecting Sleep Disturbance Scale, Sleep Duration Questionnaire, Sleep Disturbance Scale, and Kessler Psychological Distress Scale. Data analysis entailed descriptive statistics, correlations, and multivariate regressions to analyze relationships across responses on demographics, sleep disturbance, and psychological distress. Among 105 parents with hospitalized children, most had children 4-6 years old (54%), including 65% boys and 35% girls. Parents reported that their children slept overnight in the hospital for a mean of 8.3 ± 1.6 h. Children 4-6 year old (relative risk ratio [RRR] = 0.63, p = .004), dyspnea (RRR = 8.73, p = .04), previous hospitalization (RRR = 9.17, p = .03), nighttime procedures (RRR = 2.97, p = .03, and missing home (RRR = 6.78, p < .001) were the factors affecting sleep. Factors affecting psychological distress was nighttime medication administration (RRR = 4.92, p = .01). Sleep disturbances correlated with psychological distress (r = 0.56; p < .01). Sleep disturbance and associated psychological distress in hospitalized children were widely reported by parents queried in this low-resource hospital setting. Nurses can lead efforts in ameliorating sleep in hospitalized children, including partnering with stakeholders on measures to reduce sleep disruption. Child-centered interventions may improve sleep hygiene and decrease psychological distress among children.

Restless legs syndrome in Parkinson's disease: relationship with quality of life and medication.

We aimed to disclose the relationship between restless leg syndrome (RLS) and antiparkinsonian treatment, and its effect on quality of life (QoL) in patients with Parkinson's disease (PD). Previous studies documented the prevalence of RLS among patients with PD to be higher than in the general population, but conclusions regarding the aetiology and impact were contradictory. We examined 101 patients with idiopathic PD. All participants completed the five-dimension/five-level-EuroQoL questionnaire (EQ-5D-5L) and the International Restless-Legs-syndrome-study-group rating Scale (IRLS). The prevalence of RLS was 22.77 %. There were no statistically significant differences in levodopa or dopamine agonists (DA) doses between RLS-positive and negative participants. However, the use of levodopa as the last night-time medication was connected with a higher risk of RLS (OR=2.049, p=0.041). There was significantly lower prevalence of RLS in patients after surgical treatment for PD (p=0.024). Participants with RLS were at a greater risk for sleep disturbances (OR=3.866, p=0.023) and excessive daytime sleepiness (OR=7.202, p<0.001). Greater RLS symptoms were associated with worse QoL (higher IRLS score predicted higher EQ5D5L score, p=0.023). RLS is prevalent among PD patients and night-time dopaminergic over-excitation with levodopa plays an important role in its pathogenesis. Since the symptoms of RLS are associated with decreased QoL, early accurate diagnosis and appropriate adjustment of dopaminergic therapy can lead to immediate relief from RLS symptoms and to QoL improvement (Tab. 4, Fig. 1, Ref. 34).

Time And Dose Of Blood Pressure Medication Improves Hidden Hypertension Risk In A Firefighter

Most firefighters (FF) are unaware of their BP levels, which increases their risk of undiagnosed hypertension. According to a recent study, BP medication taken at bedtime lowers levels more effectively and leads to a 66% decrease in the risk of fatal cardiac incidents. Using ambulatory BP (ABP) monitoring to measure BP over time is a recommended way to assess risk. PURPOSE: To provide evidence that time and dosage of BP medication can improve hypertension risk in FF. METHODS: We included 43 FF in an ongoing clinical trial. FF wore an ABP cuff for a period, and the overall average BP, daytime BP and nighttime BP levels were examined. FF also came to the lab for a clinical fasted visit including BP, body fat, and vascular health measures. For this sub-analysis, we report data from 1 FF who was found to have nocturnal hypertension and morning BP surge. RESULTS: Overall the entire group of FF were hypertensive with clinic BP of 128.7 ± 1.7/ 81.8 ± 1.2 mmHg, had high central BP measured by SphygmoCor® XCEL (121.8 ± 2.7/ 84 ± 1.5 mmHg), and had high average SBP measured by ABP (130.9 ± 1.5 mmHg). We identified several FF with nocturnal hypertension and high morning BP surge levels, and here we report on data on one. He was 53 yr old, weighed 226 lbs, had 36.1% body fat, was an uncontrolled hypertensive (140.5/84.5 mmHg), and had high central BP levels (134/81 mmHg). During the initial ABP monitoring, his daytime BP was 160.2/86.9 and nighttime BP was 178.9/87.1 mmHg. His BP rose in the morning to 203/104 mmHg and remained that level for 2hrs. The FF self-reported feeling headaches and a ‘rushing sensation’ during fire calls, so he took his ABP data to a clinician. Initially, he was prescribed BP med in AM. The doctor increased dosage and switched to nighttime medication. During follow-up ABP monitoring, the FF’s BP was much more controlled. His average daytime BP was 145.1/82.6, nighttime BP was 114.8/66.2, and morning BP was only 125/69 mmHg. CONCLUSION: With this case-study data from one FF in a larger clinical trial, we confirmed that timing and dosage of medication leads to improved BP levels. This further confirms that overall health awareness in FF is important. Fire chiefs and the firehouse medical director should encourage and increase BP monitoring. This one example proves to be a valuable anecdote when we enter firehouses and discuss our clinical trial.

Treatment of Depressive Disorders: Opipramol As Nighttime Medication

The CME article addresses primarily general practitioners and family doctors. As a specialist physician in private practice with many years’ experience in collaborating with referring colleagues I wish to draw attention to an for initial treatment that has been tried and tested in the general practice setting. No mention was made of prescribing the sedative antidepressant opipramol, especially as nighttime medication. This drug can be used even today, and at very low dosage, to treat early awakening, the particularly tormenting symptom of most forms of depression, with few side effects. Another tricyclic option that should have a place in general practice is trimipramine; the fact that it comes in the form of drops makes it particularly suitable when starting treatment. Following the authors’ recommendations would mean that the only antidepressant with the desired sedative effect is the modern drug mirtazapine, although this often causes restless leg syndrome in elderly patients. The highlighted nonresponder rate of 30–50% applies for this drug too. There are more than enough patients nowadays—even those of an advanced age—for whom the absolute contraindications of antidepressants do not apply and in whom the undesired side effects are limited. Supported by such medication, even the general practitioner or, in more severe cases, the psychiatrist can prescribe a stimulating antidepressant without having to fear sleep deprivation and inner unrest. The antidepressants and the art of differential therapy should not be altogether sacrificed on the altar of guideline conform medicine (1). This is even more so because in the near future, pharmacogenetics will enable us to predict desirable and undesirable effects even in antidepressants.

The effects of differing pharmaceutical preparations of indomethacin on night pain and morning stiffness in patients with rheumatoid arthritis

A study was carried out in 18 patients with rheumatoid arthritis to compare the effects of two different preparations of indomethacin with placebo on night pain, sleep and duration of morning stiffness. Patients were treated for 1 night each, in random order, with identical capsules containing 75 mg indomethacin, either as 'Indomod' (all sustained-release form) or 'Indocid' R (25 mg normal, 50 mg sustained-release form), or placebo as a substitute for their usual night-time medication. The results of visual analogue scale scores and a standard sleep assessment questionnaire score indicated the same order of effectiveness for each of the three parameters, with 'Indomod' best, 'Indocid' R intermediate and placebo worst, but only the difference in sleep was statistically significant. 'Indomod', therefore, might offer a slight advantage over the same dose of indomethacin as 'Indocid' R given at night. Less side-effects were produced by active treatment than by placebo and none was severe.

Temazepam and the perceptual-motor performance of professional footballers.

The use of benzodiazepines to overcome the possible debilitating effects of travel on football performance is a recent phenomenon and indicative of current usage of such drugs. Contemporary psychological theory is critical of many of the measures used to monitor such drugs. This study has created a battery of tests which include some measures which are deemed more ecologically valid and, for purposes of comparison, some traditional indices. On a sample of First Division professional Association footballers temazepam (40 mg) was compared with placebo on these measures and testing occurred on the afternoon following night time medication. The findings suggest that on such a protocol, perceptual-motor performance is not impaired.

Night medication in rheumatoid arthritis. III. The use of sulindac

A double-blind controlled trial was carried out in 18 in-patients with classical or definite rheumatoid arthritis to assess the effectiveness of night-time medication with 100 mg indomethacin plus 10 mg diazepam, 200 mg sulindac, and 200 mg sulindac plus 10 mg diazepam in improving sleep and reducing night pain and the duration of morning stiffness. Patients received each treatment regimen for 1 night. The results from the 17 patients completing the full trial protocol indicated that indomethacin plus diazepam was the most effective of the three regimens, although the differences did not reach conventional statistical significance. It is suggested that in further such studies with sulindac a larger dose and a longer duration of treatment should be used.