BENZODIAZEPINE USE IN PATIENTS WITH OBSTRUCTIVE SLEEP APNEA: PATHOPHYSIOLOGICAL EFFECTS AND CLINICAL IMPLICATIONS — AN INTEGRATIVE REVIEW

Abstract

Obstructive sleep apnea (OSA) is characterized by recurrent episodes of upper airway obstruction during sleep, associated with impaired oxygenation and recurrent arousals. Benzodiazepine use in this population remains controversial because of its potential effects on ventilatory control, respiratory arousal threshold, and upper airway patency. This study aimed to analyze the pathophysiological effects and clinical implications of benzodiazepine use in patients with OSA. An integrative literature review was conducted using PubMed/MEDLINE, LILACS, SciELO, and Google Scholar, including studies addressing the respiratory and polysomnographic effects of benzodiazepines. The analyzed studies showed heterogeneous findings. Nitrazepam and temazepam did not consistently worsen the apnea-hypopnea index or other respiratory parameters in the populations evaluated. In contrast, triazolam was associated with an increased respiratory arousal threshold, longer respiratory events, and a lower oxygen saturation nadir. Studies involving flurazepam also reported an increased number of respiratory events and greater oxygen desaturation during sleep. Additionally, observational evidence identified an association between benzodiazepine use and adverse respiratory outcomes, including acute respiratory failure. In conclusion, the respiratory effects of benzodiazepines in patients with OSA are not uniform, and the absence of a significant increase in the apnea-hypopnea index does not exclude other respiratory consequences. Clinical assessment should therefore consider the specific benzodiazepine, dose, OSA severity, individual patient characteristics, and respiratory parameters beyond the frequency of obstructive events.