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Considerations regarding benzodiazepines (GABA receptor agonists) for sleep in children

Considerations regarding benzodiazepines (GABA receptor agonists) for sleep in children
Pros Cons
  • Half-lives vary; some appropriate for sleep-maintenance insomnia
  • Anticonvulsant, anxiolytic, myorelaxant properties
  • Decrease SOL, decrease WASO; increase TST, decrease arousals (depending on drug's duration of action)
  • Effects on sleep architecture: Most suppress SWS
  • Side effects:
    • Potential daytime sedation/cognitive impairment, rebound insomnia; anterograde amnesia, disinhibition
    • Respiratory depression; OSA is a relative contraindication
    • Ethanol use or CNS depressants may potentiate effects
  • Dependence/abuse potential
Bottom line – Limited utility in pediatric populations; other properties (eg, anxiolytic, long duration of action) may be useful in some patients.
GABA: gamma-aminobutyric acid; SOL: sleep onset latency; WASO: wake after sleep onset; TST: total sleep time; SWS: slow-wave sleep; OSA: obstructive sleep apnea; CNS: central nervous system.
Courtesy of Judith A Owens, MD, MPH.
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