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Background: The interaction between smoking and sleep seems appears to be bidirectional, but few studies evaluated the impact of smoking and its cessation on objective sleep parameters. In this context, this new study aimed to assess the impact of smoking and its cessation on sleep architecture and on ventilatory sleep parameters, particularly the presence of sleep apnea syndrome (apnea-hypopnea index (AHI)≥15). Methods: Patients hospitalized for polysomnographic sleep exploration were compared according to their smoking status: active smokers (AS), former smokers (FS), non-smokers (NoNi). Psychiatric and non-psychiatric co-morbidities and treatment or substance use were taken into account in the analyses. Results: A total of 170 participants were included (N = 37 FS, 39 AS, 86 NoNi). A significant decrease in the mean nocturnal O2 saturation was observed for FS and AS compared to NoNi. No differences were found regarding AHI. Regarding sleep architecture, we observed a significant decrease in the slow wave sleep duration for AS compared to NoNi, and interestingly not between FS and NoNi. Conclusion: This study suggests that current smokers suffer from alterations in both sleep architecture and ventilatory parameters, the later appears to persist even after smoking cessation.
RESUMO
INTRODUCTION: Varenicline (Champix) was approved in France in 2006 as an aid to smoking cessation treatment. Although there is a consensus on its efficacy, its tolerability is debatable. This article sought to clarify its tolerability profile in current medical practice. MATERIALS AND METHODS: This retrospective study examined tolerance of varenicline prescribed to smokers who wanted to quit smoking in 10 "Stop-Smoking" consultation centers around France. It included all patients who used varenicline during the one-year (February 12, 2007, to February 12, 2008) study period. RESULTS: At least one adverse event (AE) was reported by 45.9% of the 338 patients, with a total of 343. AE incidence was higher among women (51.5%) than men (40.5%) (OR=1.56, 95% CI: 0.99-2.47, p=0.026). There were 32 unexpected AEs, that is, not listed in the initial new drug application, reported by 23 patients, including 19 psychiatric AEs. Of the 8 serious AEs, 3 were of neurological origin. CONCLUSION: This retrospective study confirmed the tolerability issues for varenicline, identified during the phase II-phase III development program and confirmed afterwards. It raises the following questions: Should varenicline be prescribed as a second-line therapy? Is there a patient type for which varenicline would be more - or less - appropriate? Can the tolerability profile be improved by reducing dosage while maintaining the level of efficacy or by co-administering symptomatic treatment more systematically? These are questions that new studies evaluating varenicline tolerability should answer.
