Benzodiazepines apnea with

Side effects associated with benzodiazepines in PD patients are similar to those observed in other disorders. Sedation, fatigue, and cognitive impairment are the most commonly reported side effects.49 Benzodiazepines should be avoided in patients with current substance abuse, a history of such, dependence, or sleep apnea. Additionally, caution should be used in older adults because they have more pronounced psychomotor and cognitive effects. 

Side effects of benzodiazepines include sedation, dizziness, poor coordination, and, at higher doses, amnesia. Benzodiazepines also increase the effects of alcohol therefore, alcohol use should be avoided or markedly curtailed. Benzodiazepines can also exacerbate the breathing problems of patients with sleep apnea and other respiratory disorders such as emphysema. Like the barbiturates, long-term use of benzodiazepines can lead to physical dependence, and abrupt discontinuation can produce an unpleasant, or even dangerous, withdrawal syndrome. 

In 10 stable patients maintained on methadone (50-120 mg/day) and nine healthy subjects assessed using polysomnography, the methadone-maintained patients had more abnormalities of sleep architecture, with a higher prevalence of central sleep apnea (23). Methadone depresses respiration, probably by acting on p opioid receptors in the ventral surface of the medulla and possibly on other receptor sites in the lung and spinal cord. All the patients taking methadone also used benzodiazepines and cannabis, which may have influenced the above findings. 

Although injectable phenobarbital contains propylene glycol, it can be given more rapidly than phenytoin (see Table 55-3). Phenobarbital can be given intramuscularly, but its rate of absorption is too slow to be effective in GCSE. Phenobarbital may cause depression of consciousness and respiration. The risk of apnea and hypopnea may be more profound in patients treated initially with benzodiazepines." Medical personnel should be ready to provide respiratory support whenever the two agents are used concurrently. If significant hypotension develops, the infusion should be slowed or stopped. ... 

Benzodiazepine hypnotics should not be prescribed for individuals with sleep apnea, a history of substance abuse, or during pregnancy. Patients should be instructed to avoid alcohol even taking alcohol on the day after ingestion of a benzodiazepine with a long elimination half-life can result in additive CNS impairment. Prescriptions for benzodiazepine hypnotics should be accompanied by printed information and verbal counseling on precautions. 

In contrast, hypnotic doses of benzodiazepines may worsen sleep-related breathing disorders by adversely affecting control of the upper airway muscles or by decreasing the ventilatory response to CO2. The latter effect may cause hypoventilation and hypoxemia in some patients with severe COPD, although benzodiazepines may improve sleep and sleep structure in some instances. In patients with obstructive sleep apnea (OSA), hypnotic doses of benzodiazepines may exaggerate the impact of apneic episodes on alveolar hypoxia, pulmonary hypertension, and cardiac ventricular load. Caution should be exercised with patients who snore regularly partial airway obstruction may be converted to OSA under the influence of these drugs. 

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