[Prevalence of sleep disorders in Madrid, Spain]. / Prevalencia de los trastornos del sueño en la ciudad de Madrid.

INTRODUCTION: Sleep disorders are among the clinical entities with a great health and socioeconomic impact. So far, in Spain there are isolated epidemiologic data, lacking from studies that cover the full spectrum of sleep disorders in the general adult population. METHODS: A sample of 1,500 adult subjects from Madrid were interviewed during the first semester of 1990, using a clinical questionnaire including sociodemographic data, habits, sleep disorders, and information regarding somatic and psychiatric pathology. A detailed analysis of the influence of sex, age and occupational status on the prevalence of the different disorders is presented. RESULTS: 1,131 persons (75.4%) completed the interview. 22.8% (95% confidence interval, CI: 20.4-25.4) referred at least one sleep difficulty, 11.3% (9.5-13.3) of the sample complained of insomnia, this being more common in women, older individuals and unemployed. Daytime sleepiness was reported by 11.6% (9.8-13.7) of the sample, and 3.2% (2.2-4.4) referred hypersomnia, with sleep attacks and sleep paralysis being rarely found. Regarding parasomnias, 12.3% (10.4-14.4) had nightmares, with the prevalence of sonambulism, night terrors and enuresis being near 1%. Daily snoring was present in 11.9% (10.1-14.0) of the sample, whereas 1.1% (0.6-2.0) reported respiratory pauses during the night. CONCLUSIONS: A high prevalence of sleep disorders is estimated in the adult population of the city of Madrid, Spain. Our data are in general similar to those found in other countries, and differences found are discussed.

Benzodiazepine types in high versus therapeutic dose dependence.

Two types of benzodiazepine dependence have been described: high vs. therapeutic dose dependence. So far, no systematic research has been conducted regarding the frequency with which the various benzodiazepines are represented in one type or the other. In this study, 153 dependent patients using 14 different benzodiazepines were evaluated to assess the prevalence of their use among high vs. therapeutic dose dependents. Triazolam was the single drug most frequently used by high-dose dependents, followed by Lorazepam. No significant differences were found among benzodiazepines regarding their use by therapeutic dose dependents. Our data shows that pharmacokinetic and pharmacodynamic factors appear to be related to the frequency with which the different benzodiazepines are used by high and therapeutic dose dependents.

Benzodiazepine withdrawal syndrome seizures.

In this study, we present five cases of seizures following withdrawal of flunitrazepam, lorazepam, or triazolam, representing 3% of a sample consisting of 153 patients dependent on benzodiazepines. Both abrupt cessation of benzodiazepine intake and high-dose use seem to be critical for the appearance of seizures. Pharmacological features, such as short elimination half-life and high potency, might explain the higher risk of seizures observed in these patients.