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A protocol for a randomized controlled trial comparing Sleepwell, EMPOWER, and treatment-as-usual for benzodiazepine receptor agonist discontinuation in older adults: the your answers when needing sleep in New Brunswick (YAWNS NB) study. EXPLORATORY RESEARCH IN CLINICAL AND SOCIAL PHARMACY 2022; 7:100164. [PMID: 36045710 PMCID: PMC9420952 DOI: 10.1016/j.rcsop.2022.100164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 07/28/2022] [Indexed: 11/24/2022] Open
Abstract
Background Chronic benzodiazepine receptor agonist (BZRA) use among older adults is a public health concern given cognitive and physical risks. One in four older adults in New Brunswick, Canada, is a long-term user of BZRAs. Previous studies using a direct-to-patient approach as the primary intervention target have shown promise in reducing BZRA use. The Your Answers When Needing Sleep in New Brunswick (YAWNS NB) study aims to reduce the long-term use of BZRAs in older adults and increase the use of cognitive behavioural therapy for insomnia (CBTi), which is the recommended first line treatment. Methods The trial (ClinicalTrials.gov registration NCT04406103) is a three arm, open-label, parallel randomized controlled trial in NB, Canada. Eligible participants 65 years and older using BZRAs long-term will be randomly allocated to: the Eliminating Medications through Patient Ownership of End Results (EMPOWER) information package group; the Sleepwell information package group; or treatment-as-usual (TAU). Information packages will be mailed via Canada Post. The primary outcome of BZRA discontinuation at 6 months will be compared across groups. Secondary outcomes include participants with ≥25% BZRA dose reduction, and switching to newly prescribed alternate sedative-hypnotics. Several exploratory outcomes will also be examined. Discussion Targeting participants with information packages informing them of appropriate use, dangers, and approaches to reducing BZRA use and increasing CBTi use may be beneficial in a region of Canada with the highest rate of chronic BZRA use in older adults. Comparing information packages and TAU will provide insights into the effectiveness of direct-to-patient interventions for BZRA reduction.
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Short-Term Risk of Unintentional Poisoning After New Initiation of Central Nervous System Medications in Swedish Older Adults: A Register-Based Case-Crossover Study. Drug Saf 2022; 45:873-880. [PMID: 35788537 PMCID: PMC9360158 DOI: 10.1007/s40264-022-01197-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2022] [Indexed: 11/17/2022]
Abstract
Introduction Medications acting on the central nervous system (CNS) are common causes of medication-related unintentional poisoning. Little is known about the short-term effects of CNS medications on unintentional poisoning. Objective This study aims to determine the short-term association between newly prescribed CNS drugs and unintentional poisoning. Methods We conducted a register-based case-crossover study of 9354 patients (age ≥ 50 years) with first-time hospitalization for unintentional poisoning in Sweden between 1 July, 2006 and 30 September, 2018. Newly initiated CNS medication was identified based on dispensations from the Swedish Prescribed Drug Register during 28 days prior to the unintentional poisoning event and compared with dispensations during an equally long control period. Conditional logistic regression was used to estimate the odds ratio and 95% confidence intervals. Results After a newly initiated CNS treatment, we found an increased risk of unintentional poisoning during the following 2 weeks with an odds ratio (95%) being 2.52 (1.98–3.21) and 1.47 (1.08–2.00) for the first and second week, respectively. The risk was elevated in all sub-groups but to a different degree with odds ratio ranges of 1.73–2.47 by age, 1.91–2.21 by sex, 1.40–2.30 by Charlson Comorbidity Index, 2.00–2.07 by neuropsychiatric comorbidity, and 1.63–2.82 by number of other medications. Conclusions The risk of unintentional poisoning doubles in 2 weeks following a new initiation of CNS drugs and the risk is increased across a range of population groups. Clinicians should carefully monitor signs of poisoning after such initiation among not only multimorbid older adults but also those with less comorbidity and polypharmacy. Supplementary Information The online version contains supplementary material available at 10.1007/s40264-022-01197-w.
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Zitoun S, Baudouin E, Corruble E, Vidal JS, Becquemont L, Duron E. Use of potentially driver-impairing drugs among older drivers. BMC Geriatr 2022; 22:4. [PMID: 34979970 PMCID: PMC8722131 DOI: 10.1186/s12877-021-02726-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 12/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Road safety is a major issue among seniors. Potentially Driver-Impairing (PDI) drugs are known to increase the risk of car accident. The aim of this cross-sectional study was to describe PDI-drug consumption among older drivers and determine associated factors. Methods The S.AGES cohort is a French non-interventional real-life prospective study of 3700 community-dwelling participants aged ≥65 years old, suffering from type 2 diabetes (T2DM), chronic pain or atrial fibrillation (AF). Baseline data of drivers with known treatment (n = 1783) were used for the analyses. PDI drugs were defined according to the French classification. Results One thousand seven hundred eighty-three drivers were included (66% males; mean age 76 (Standard deviation = 5.78) years old). 21% (n = 373) took PDI drugs, 64% of which took only one (n = 239). The most frequent PDI drugs were: Zolpidem (11%; n = 60); Zopiclone (8%; n = 45); Bromazepam (8%; n = 44); Tramadol (7%; n = 39); Pregabalin (6%; n = 31). Drivers taking PDI drugs had more often chronic pain (OR [95% CI] = 2.30 [1.54–3.46]), history of depressive disorder (4.28 [3.00–6.14]) and polypharmacy (taking at least 5 different medications; 4.32 [2.97–6.41]), and less often T2DM (0.54 [0.37–0.79]), and AF (0.48 [0.32–0.71]). Conversely, they had a lower Activities of Daily Living score (0.34 [0.17–0.68]). Conclusions The rate of aged drivers in the S.AGES cohort taking PDI drugs is concerning and highlights the need to carefully assess and reassess PDI-drug prescriptions in this population, particularly hypnotics, anxiolytics and opioids. Trial registration ClinicalTrials.gov NCT01065909 (First posted: February 9th, 2010). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02726-5.
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Affiliation(s)
- Sarah Zitoun
- University of Paris-Saclay, Inserm, CESP, Team MOODS, 94270, Le Kremlin-Bicêtre, France.,Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Department of Psychiatry, 94270, Le Kremlin-Bicêtre, France
| | - Edouard Baudouin
- Assistance Publique - Hôpitaux de Paris, Paul Brousse Hospital, Department of Geriatric, 94800, Villejuif, France
| | - Emmanuelle Corruble
- University of Paris-Saclay, Inserm, CESP, Team MOODS, 94270, Le Kremlin-Bicêtre, France.,Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Department of Psychiatry, 94270, Le Kremlin-Bicêtre, France
| | - Jean-Sébastien Vidal
- Assistance Publique - Hôpitaux de Paris, Hôpital Broca, F-75013, Paris, France.,Université de Paris, EA 4468, F-75013, Paris, France
| | - Laurent Becquemont
- University of Paris-Saclay, Inserm, CESP, Team MOODS, 94270, Le Kremlin-Bicêtre, France.,Assistance Publique - Hôpitaux de Paris, Bicêtre Hospital, Department of Psychiatry, 94270, Le Kremlin-Bicêtre, France
| | - Emmanuelle Duron
- University of Paris-Saclay, Inserm, CESP, Team MOODS, 94270, Le Kremlin-Bicêtre, France. .,Assistance Publique - Hôpitaux de Paris, Paul Brousse Hospital, Department of Geriatric, 94800, Villejuif, France.
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Bourdeau M, Guibert N, Fort E, Boulogne S, Lagarde E, Charbotel B. Medicine consumptions and occupational road risk. ACCIDENT; ANALYSIS AND PREVENTION 2021; 158:106202. [PMID: 34051434 DOI: 10.1016/j.aap.2021.106202] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/12/2021] [Accepted: 05/18/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Whereas an increased risk of road traffic crashes has been highlighted as linked to some medicine consumptions, there is no available data on this risk according to the type of journey (private, commuting or mission). Drivers on occupational journey (commuting or mission) are likely to have different coping behaviors related to the use of medicines than drivers on private journey. The aim of our study was to investigate the association between exposure to ten classes of medicines and the risk of being responsible for a road traffic crash according to the type of journey (private, commuting or mission). METHODS The data used came from three French national databases: the national police database of injurious crashes, the police reports and the national health care insurance database. A total of 179,269 drivers aged between 18 and 65 years old involved in an injurious crash in France between July 2005 and December 2015 were included in the analyses. Logistic regression models stratified by journey were used to estimate the Odds Ratios (OR) and 95 % confidence intervals (95 % CI), adjusted for potential confounding factors. RESULTS Medicines exposure levels were generally lower for drivers during occupational journeys, the risk of being responsible for a road traffic crash seems to be higher on commuting or mission journeys than on private journeys for four medicines. Indeed, for antiepileptics the OR was 1.59 [1.01-2.51] for mission journeys, 1.63 [1.24-2.15] for commuting journeys, and 1.47 [1.25-1.73] for private journey. For psycholeptics the OR was 1.02 [0.80-1.28] for mission journey, 1.19 [1.03-1.39] for commuting and 1.17 [1.08-1.26] for private journey. For psychoanaleptics OR was 1.35 [1.02-1.78] for mission journeys, 1.37 [1.17-1.60] for commuting journeys and 1.26 [1.14-1.40] for private journeys. Finally, for other nervous system drugs OR reached 2.04 [1.35-3.07] for mission journeys compared to 1.43 [1.21-1.70] for private journeys. CONCLUSION Our results encourage the implementation of preventive measures about some treatments and diseases in the context of occupational journeys.
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Affiliation(s)
- Manon Bourdeau
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France
| | - Nicolas Guibert
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France; Hospices Civils de Lyon, Service de médecine du travail, Hôpital Edouard Herriot, 69003, Lyon, France
| | - Emmanuel Fort
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France.
| | - Sébastien Boulogne
- Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, F-69495 Pierre Bénite, France; Hospices Civils de Lyon, Service neurologie fonctionnelle et épileptologie, Hôpital neurologique, Hospices civils de Lyon, 69577, Bron, France
| | - Emmanuel Lagarde
- Univ. Bordeaux, Inserm, Bordeaux Population Health Research Center, Team IETO, UMR 1219, F-33000 Bordeaux, France
| | - Barbara Charbotel
- University of Lyon, University of Lyon 1, University of Gustave Eiffel, UMRESTTE, UMR T_9405, F- 69373, Lyon, France; Hospices Civils de Lyon, Service des Maladies Professionnelles, Centre Hospitalier Lyon Sud, F-69495 Pierre Bénite, France
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Herrero Babiloni A, Beetz G, Bruneau A, Martel MO, Cistulli PA, Nixdorf DR, Conway JM, Lavigne GJ. Multitargeting the sleep-pain interaction with pharmacological approaches: A narrative review with suggestions on new avenues of investigation. Sleep Med Rev 2021; 59:101459. [PMID: 33601274 DOI: 10.1016/j.smrv.2021.101459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 12/21/2022]
Abstract
The multimorbidity formed by sleep disturbances and pain conditions is highly prevalent and has a significant impact in global health and in the socioeconomic system. Although different approaches have been directed toward its management, evidence regarding an optimal treatment is lacking, and pharmacological options are often preferred. Health professionals (e.g., pain and sleep clinicians) tend to focus on their respective expertise, targeting a single symptom with a single drug. This may increase polypharmacy and the risk of drug interactions, adverse events, and mortality. Hence, the use of medications that can directly or indirectly improve sleep, pain, and other possible accompanying conditions without exacerbating them becomes especially relevant. The objectives of this comprehensive review are to: a) describe the beneficial or deleterious effects that some commonly used medications to manage pain have on sleep and sleep disorders; and b) describe the beneficial or deleterious effects that frequently prescribed medications for sleep may have on pain. Moreover, medications targeting some specific sleep-pain interactions will be suggested and future directions for improving sleep and alleviating pain of these patients will be provided with clinical and research perspectives.
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Affiliation(s)
- Alberto Herrero Babiloni
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada.
| | - Gabrielle Beetz
- Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada
| | - Alice Bruneau
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada
| | - Marc O Martel
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Faculty of Dentistry & Department of Anesthesia, McGill University, Canada
| | - Peter A Cistulli
- Sleep Research Group, Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia; Centre for Sleep Health and Research, Department of Respiratory and Sleep Medicine, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Donald R Nixdorf
- Division of TMD and Orofacial Pain, Department of Diagnostic and Biological Sciences, School of Dentistry, University of Minnesota, Minneapolis, MN, USA; Department of Neurology, Medical School, University of Minnesota, Minneapolis, MN, USA; HealthPartners Institute for Education and Research, Bloomington, MN, USA
| | | | - Gilles J Lavigne
- Division of Experimental Medicine, McGill University, Montreal, Québec, Canada; Center for Advanced Research in Sleep Medicine, Research Centre, Hôpital du Sacré-Coeur de Montréal (CIUSSS du Nord de-l'Île-de-Montréal), Québec, Canada; Faculty of Dental Medicine, Université de Montréal, Québec, Canada
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Royant-Parola S, Kovess V, Brion A, Dagneaux S, Hartley S. Do hypnotics increase the risk of driving accidents or near miss accidents due to hypovigilance? The effects of sex, chronic sleepiness, sleep habits and sleep pathology. PLoS One 2020; 15:e0236404. [PMID: 32716956 PMCID: PMC7384619 DOI: 10.1371/journal.pone.0236404] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 07/06/2020] [Indexed: 01/02/2023] Open
Abstract
Driving accidents due to hypovigilance are common but the role of hypnotics is unclear in patients suffering from sleep disorders. Our study examined factors influencing accidents and near miss accidents attributed to sleepiness at the wheel (ANMAS). Using data from an online questionnaire aimed at patients with sleep disorders, we analysed the associations between ANMAS, sociodemographic data, symptoms of sleep disorders, severity of insomnia (Insomnia Severity Index (ISI)) symptoms of anxiety and depression (Hospital Anxiety and Depression scale with depression (HADD) and anxiety (HADA) subscales), chronic sleepiness (Epworth sleepiness scale ESS), hypnotic use and information about sleep habits. Hypnotics were hierarchically grouped into Z-drugs, sedative medication, melatonin and over the counter (OTC) alternative treatments. Of 10802 participants; 9.1% reported ANMAS (Men 11.1% women 8.3%) and 24.4% took hypnotics (Z-drugs 8.5%, sedative medication 8%, melatonin 5.6% and alternative treatments 2.5%). Logistic regression analysis identified the following risk factors for ANMAS: moderate (OR 2.4; CI: 2.10-2.79) and severe sleepiness (ESS OR 5.66; CI: 4.74-6.77), depression (HADD OR 1.2; CI: 1.03-1.47), anxiety (HADA OR 1.2;CI: 1.01-1.47), and insufficient sleep (OR1.4; CI: 1.2-1.7). Hypnotics were not associated with an increased risk of ANMAS in patients suffering from insomnia. Risk factors varied according to sex: in females, sex (OR 0.; CI: 0.55-0.74), mild insomnia (OR 0.5; CI: 0.3-0.8) and use of alternative treatments (OR 0.455, CI:0.23-0.89) were protective factors and risk was increased by sleepiness, sleep debt, social jetlag, caffeine use, anxiety and depression. In men no protective factors were identified: sleepiness, sleep debt, and severe insomnia were associated with an increased risk of ANMAS. In clinical practice, all patients with daytime sleepiness and men with severe insomnia should be counselled concerning driving risk and encouraged to avoid sleep debt.
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Affiliation(s)
| | | | | | | | - Sarah Hartley
- Réseau Morphée, Garches, France
- EA 4047, APHP Hôpital Raymond Poincaré, Sleep Center, Université de Versailles Saint-Quentin en Yvelines, Garches, France
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Martínez P, Contreras D, Moreno M. Safe mobility, socioeconomic inequalities, and aging: A 12-year multilevel interrupted time-series analysis of road traffic death rates in a Latin American country. PLoS One 2020; 15:e0224545. [PMID: 31910212 PMCID: PMC6946134 DOI: 10.1371/journal.pone.0224545] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 10/16/2019] [Indexed: 11/18/2022] Open
Abstract
As the resources for road safety in developing countries are scarce and unevenly distributed, vulnerable road users -such as the elderly- may be particularly at risk of road traffic deaths. To date, the impact of road safety measures over the rate of road traffic deaths in older adults (60 years or older), considering the within-country socioeconomic inequalities, has not been explored in developing nations. This study takes the Chilean case as an example -with its 2005 traffic law reform as one of the road safety measures investigated-, in which open data available from official national sources for all its 13 regions over the 2002-2013 period were used for a multilevel interrupted time-series analysis. A statistically significant secular reduction of the rates of road traffic deaths in the elderly population was found (incidence rate ratio [IRR] 0.95, 95% confidence interval [CI] 0.91 to 0.99), but no evidence for a significant intercept or slope change after the traffic law reform was observed. Regions with the highest number of traffic offenses prosecuted in local police courts had lower rates of road traffic deaths in older adults (IRR 0.95, 95% CI 0.90 to 1.00), and those regions in the third (IRR 1.61, 95% CI 1.16 to 2.25) and the fifth (IRR 1.66, 95% CI 1.08 to 2.54) quintiles of socioeconomic deprivation had higher rates of road traffic deaths in the elderly. Such findings strongly support the conceptualization of the road safety of seniors in developing countries as a social equity issue, with implications for the design of traffic regulations and road environments.
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Affiliation(s)
- Pablo Martínez
- CITIAPS, Universidad de Santiago de Chile, Santiago, Chile
- Escuela de Psicología, Facultad de Humanidades, Universidad de Santiago de Chile, Santiago, Chile
- Departamento de Psiquiatría y Salud Mental, Hospital Clínico Universidad de Chile, Santiago, Chile
- Instituto Milenio para la Investigación en Depresión y Personalidad (MIDAP), Santiago, Chile
- Núcleo Milenio para Mejorar la Salud Mental de Adolescentes y Jóvenes (Imhay), Santiago, Chile
- * E-mail:
| | | | - Mónica Moreno
- CITIAPS, Universidad de Santiago de Chile, Santiago, Chile
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Abstract
BACKGROUND In 2013 the Food and Drug Administration (FDA) claimed the existence of new data showing women to be at risk for excessive daytime sedation and impaired driving proficiency following bedtime doses of zolpidem. The putative explanation was the reduced metabolic clearance of zolpidem and higher morning blood concentrations in women compared to men. The FDA acted to reduce the recommended dosage for women down to 50% of the dose for men. No other regulatory agency worldwide has taken similar action. METHODS Gender effects on zolpidem pharmacokinetics, pharmacodynamics, adverse effects, clinical efficacy, and driving performance were evaluated through a further analysis of data from a previous study, together with a literature review. RESULTS Women had on average 35% lower apparent clearance of zolpidem than men (236 vs 364 mL/min, P < 0.001). This difference was not explained by body weight. In some laboratory studies, women had greater functional impairment than men taking the same dose, but in all studies active drug was not distinguishable from placebo at 8 hours after oral dosage. On-the-road driving studies likewise showed no evidence of driving impairment in men or women at 8 hours after 10 mg of oral immediate-release zolpidem. No clinical trial demonstrated a gender-related difference in clinical efficacy or adverse reactions, and there was no evidence of a particular risk to women. CONCLUSIONS Dosage reduction in women is not supported by available scientific evidence, and may in fact lead to underdosing and the consequent hazard of inadequately treated insomnia.
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Yang BR, Kim YJ, Kim MS, Jung SY, Choi NK, Hwang B, Park BJ, Lee J. Prescription of Zolpidem and the Risk of Fatal Motor Vehicle Collisions: A Population-Based, Case-Crossover Study from South Korea. CNS Drugs 2018; 32:593-600. [PMID: 29796977 DOI: 10.1007/s40263-018-0520-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Zolpidem is one of the most frequently used hypnotics worldwide, but associations with serious adverse effects such as motor vehicle collisions have been reported. OBJECTIVE The objective of this study was to evaluate the association of fatal motor vehicle collisions with a prescription for zolpidem, considering the context of the motor vehicle collisions. METHODS We conducted a case-crossover study, where each case served as its own control, by linking data about fatal motor vehicle collisions from the Korean Road Traffic Authority between 2010 and 2014 with national health insurance data. The case period was defined as 1 day before the fatal motor vehicle collisions, and was matched to four control periods at 90-day intervals. Conditional logistic regression was performed to calculate the odds ratio for fatal motor vehicle collisions associated with zolpidem exposure, and odds ratios were adjusted for time-varying exposure to confounding medications. A stratified analysis was performed by age group (younger than 65 years or not), the Charlson Comorbidity Index, and whether patients were new zolpidem users. RESULTS Among the 714 subjects, the adjusted odds ratio for a fatal motor vehicle collision associated with a prescription for zolpidem the previous day was 1.48 (95% confidence interval 1.06-2.07). After stratification, a significantly increased risk was observed in subjects with a high Charlson Comorbidity Index (odds ratio 1.81; 95% confidence interval 1.16-2.84), the younger age group (odds ratio: 1.62; 95% confidence interval 1.03-2.56), and new zolpidem users (odds ratio 2.37; 95% confidence interval 1.40-4.00). CONCLUSION A prescription for zolpidem on the previous day was significantly related to an increased risk of fatal motor vehicle collisions in this population-based case-crossover study.
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Affiliation(s)
- Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Ye-Jee Kim
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea
| | - Mi-Sook Kim
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Sun-Young Jung
- College of Pharmacy, Chung-Ang University, Seoul, Republic of Korea
| | - Nam-Kyong Choi
- Department of Health Convergence, College of Science and Industry Convergence, Ewha Womans University, Seoul, Republic of Korea
| | - Byungkwan Hwang
- Department of Neurology, Texas Tech University Health Science Center, Lubbock, TX, USA
| | - Byung-Joo Park
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Joongyub Lee
- School of Medicine, Inha University, Incheon, Republic of Korea.
- Department of Prevention and Management, Inha University Hospital, 27, Inhang-ro, Jung-gu, Incheon, Republic of Korea.
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2017] [Indexed: 09/02/2023] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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Kripke DF. Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit. F1000Res 2016; 5:918. [PMID: 27303633 PMCID: PMC4890308 DOI: 10.12688/f1000research.8729.1] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/11/2016] [Indexed: 12/14/2022] Open
Abstract
This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics' mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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12
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Abstract
This is a review of hypnotic drug risks and benefits. Almost every month, new information appears about the risks of hypnotics (sleeping pills). The most important risks of hypnotics include excess mortality (especially overdose deaths, quiet deaths at night, and suicides), infections, cancer, depression, automobile crashes, falls, other accidents, and hypnotic-withdrawal insomnia. Short-term use of one-two prescriptions is associated with even greater risk per dose than long-term use. Hypnotics have usually been prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse (not better) and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders offer safer and more effective alternative approaches to insomnia.
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Affiliation(s)
- Daniel F. Kripke
- University of California, San Diego, La Jolla, CA, 92037-2226, USA
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