![]() ![]() The GABA A receptor expressing the α 1 subunit corresponds to the benzodiazepine ω 1 receptor. Benzodiazepines bind to synaptic GABA A receptors containing α 1, α 2, α 3, or α 5 subunits with comparable affinity. 6 GABA A receptor sensitivity to benzodiazepines is mediated through α subunits. ![]() Synaptic GABA A receptors are responsible for modulating benzodiazepine sensitivity and typically contain α 1, 2, 3, or 5, β 2 or 3, and the γ 2 subunits. GABA A receptors exist as pentameric protein complexes, assembled from a combination of at least 19 subunits from 7 distinct gene families (α, β, γ, δ, ϵ, θ, and π). GABA is the main inhibitory neurotransmitters in the mammalian central nervous system (CNS). Benzodiazepines and benzodiazepine receptor agonists like zolpidem bind to the GABA A receptor at sites that are distinct from the GABA binding site, thereby allosterically affecting the activity of the ligand-operated chloride channel. 5 Though considered a non-benzodiazepine since its imidazopyridine structure differs from benzodiazepine fusion of benzene and diazepine, zolpidem is a benzodiazepine receptor agonist with high binding affinity for the GABA A (gamma-amino butyric acid type A) receptor expressing the α 1 subunit. Zolpidem is an imidazopyridine drug indicated for short-term insomnia at a dosage usually ranging from 5 to 10 mg per day. After her evaluation, the patient's zolpidem was gradually withdrawn all sleep related activities immediately ceased and have not recurred during 6 months of follow-up. She had a vague recollection of this event, but thought that she was dreaming. ![]() Other reported events included one occasion of urination in the hallway, and one episode when the patient drove her automobile 10 miles from her home and was found asleep behind the wheel by police. As a preventive measure, she installed nocturnal alarms on her doors to wake her or her family from sleep if she opened one. ![]() The patient would also leave her home and walk on her front porch or on her front lawn. The following morning she would have abdominal fullness, find her kitchen messy, and have complete amnesia for the event. She would also leave her bedroom to go to her kitchen where she would eat a loaf of bread, cold cereal, or leftover food. The patient would speak incoherently using short phrases with her eyes closed and would then open her eyes when questioned by her husband. she began sleep related walking, eating, and one episode of driving.Įpisodes of sleepwalking, SRED, and sleeptalking occurred 3 nights per week, 1-2 h after sleep onset. At age 44 the patient was started on non-extended release zolpidem 10 mg at bedtime for insomnia. The patient did not have a history of daytime eating disorder. The patient reported no personal or family history of sleepwalking or other parasomnias. History for alcohol, tobacco, or illicit drug use was negative. Medications included paroxetine 20 mg once a day, extended release metoprolol 25 mg twice per day, and simvastatin 40 mg once a day. Previous diagnostic polysomnogram revealed an apnea-hypopnea index of 10 events/h. The patient is a 51-year-old African American woman with past medical history of hypertension, mild obstructive sleep apnea, hyperlipidemia, and depression. We also review the literature regarding unintended effects of zolpidem use. The cerebral glucose metabolism rates of the 2 studies were then compared, using statistical parametric mapping analysis. A second 18F-FDG-PET was acquired the following day, 1 h after oral administration of zolpidem 10 mg ( Figure 1). A fluorine-18-flourodeoxyglucose positron emission tomography (18F-FDG-PET) was obtained one month after discontinuation of zolpidem. 4 We present a patient with zolpidem-induced sleepwalking, SRED, and sleep-driving. 2 Two post-marketing studies of zolpidem reported sleepwalking incidences of 7 of 1972 patients (0.3%) 3 and 1 of 96 patients (1%). In a 2005 National Institutes of Health consensus statement for the treatment of chronic insomnia in adults zolpidem was considered a hypnotic with limited risk. 1 Parasomnias such as sleepwalking, SRED, and sleep-driving can coexist and are rare side effects of zolpidem. 1 Sleep related eating disorder (SRED) consists of recurrent episodes of involuntary eating during arousals from sleep. Sleepwalking or somnambulism, is a parasomnia consisting of a series of complex behaviors usually initiated during arousals from slow wave sleep and commonly culminate in walking with an altered state of consciousness and impaired judgment. ![]()
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