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Beydoun HA, Beydoun MA, Kwon E, Alemu BT, Zonderman AB, Brunner R. Relationship of psychotropic medication use with physical function among postmenopausal women. GeroScience 2024:10.1007/s11357-024-01141-z. [PMID: 38517642 DOI: 10.1007/s11357-024-01141-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024] Open
Abstract
To examine cross-sectional and longitudinal relationships of psychotropic medications with physical function after menopause. Analyses involved 4557 Women's Health Initiative Long Life Study (WHI-LLS) participants (mean age at WHI enrollment (1993-1998): 62.8 years). Antidepressant, anxiolytic, and sedative/hypnotic medications were evaluated at WHI enrollment and 3-year follow-up visits. Performance-based physical function [Short Physical Performance Battery (SPPB)] was assessed at the 2012-2013 WHI-LLS visit. Self-reported physical function [RAND-36] was examined at WHI enrollment and the last available follow-up visit-an average of 22 [±2.8] (range: 12-27) years post-enrollment. Multivariable regression models controlled for socio-demographic, lifestyle, and health characteristics. Anxiolytics were not related to physical function. At WHI enrollment, antidepressant use was cross-sectionally related to worse self-reported physical function defined as a continuous (β = -6.27, 95% confidence interval [CI]: -8.48, -4.07) or as a categorical (< 78 vs. ≥ 78) (odds ratio [OR] = 2.10, 95% CI: 1.48, 2.98) outcome. Antidepressant use at WHI enrollment was also associated with worse performance-based physical function (SPPB) [< 10 vs. ≥ 10] (OR = 1.53, 95% CI: 1.05, 2.21) at the 2012-2013 WHI-LLS visit. Compared to non-users, those using sedative/hypnotics at WHI enrollment but not at the 3-year follow-up visit reported a faster decline in physical function between WHI enrollment and follow-up visits. Among postmenopausal women, antidepressant use was cross-sectionally related to worse self-reported physical function, and with worse performance-based physical function after > 20 years of follow-up. Complex relationships found for hypnotic/sedatives were unexpected and necessitate further investigation.
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Affiliation(s)
- Hind A Beydoun
- Department of Research Programs, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA.
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA.
| | - May A Beydoun
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Edward Kwon
- Department of Family Medicine, A.T. Augusta Military Medical Center, 9300 DeWitt Loop, Fort Belvoir, VA, 22060, USA
| | - Brook T Alemu
- Health Sciences Program, School of Health Sciences, Western Carolina University, Cullowhee, NC, USA
| | - Alan B Zonderman
- Laboratory of Epidemiology and Population Sciences, National Institute on Aging, NIA/NIH/IRP, Baltimore, MD, USA
| | - Robert Brunner
- Department of Family and Community Medicine (Emeritus), School of Medicine, University of Nevada Reno, Reno, NV, USA
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2
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Bond L, McTiernan D, Connaughton M, Heron EA, Coogan AN, McGrath J. Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service. Ir J Psychol Med 2023:1-9. [PMID: 37650149 DOI: 10.1017/ipm.2023.41] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
OBJECTIVES Sleep problems are common amongst children and adolescents with attention deficit hyperactivity disorder (ADHD). The purpose of this study was to investigate sleep problems in children and adolescents attending a specialist ADHD service. METHODS This was a cross-sectional online survey combined with a retrospective chart review, conducted in the ADHD Assessment, Diagnosis, Management, initiation, Research and Education (ADMiRE) service, the first public specialist ADHD service for young people in Ireland. Participants were caregivers of children and adolescents with ADHD attending ADMiRE. Sleep was assessed using The Children's Sleep Habits Questionnaire (CSHQ) and ADHD symptoms were assessed using an abbreviated version of the Swanson, Nolan and Pelham Teacher and Parent Rating Scale (SNAP-IV). Details regarding patient demographics, co-morbidities and medication were collected from patient records. RESULTS Eighty-four percent of young people scored above the clinical cut-off for a sleep disorder. The most frequently reported sleep problems were related to sleep onset and sleep duration, and 64% of respondents met the criteria for two or more sleep problems. ADHD severity was associated with greater sleep problems. Co-morbid physical, neurodevelopmental, and mental health disorders as well as stimulant use were not associated with greater sleep problems. CONCLUSION Sleep problems are very common amongst children and adolescents with ADHD. This study has demonstrated an association between more sleep problems and ADHD severity. These findings highlight the need for both effective ADHD treatment to ensure optional sleep in young people as well as effective interventions for sleep problems to prevent worsening of ADHD symptoms.
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Affiliation(s)
- L Bond
- Linn Dara Child and Adolescent Mental Health Service, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | - D McTiernan
- Linn Dara Child and Adolescent Mental Health Service, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
| | | | - E A Heron
- Trinity College Dublin, Dublin, Ireland
| | - A N Coogan
- Department of Psychology, Maynooth University, Kildare, Ireland
| | - J McGrath
- Linn Dara Child and Adolescent Mental Health Service, Dublin, Ireland
- Trinity College Dublin, Dublin, Ireland
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3
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Dolsen EA, Byers AL, Flentje A, Goulet JL, Jasuja GK, Lynch KE, Maguen S, Neylan TC. Sleep disturbance and suicide risk among sexual and gender minority people. Neurobiol Stress 2022; 21:100488. [PMID: 36164391 PMCID: PMC9508603 DOI: 10.1016/j.ynstr.2022.100488] [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: 05/19/2022] [Revised: 09/13/2022] [Accepted: 09/14/2022] [Indexed: 11/01/2022] Open
Abstract
Sleep disturbance has emerged as an independent, mechanistic, and modifiable risk factor for suicide. Sexual and gender minority (SGM) people disproportionately experience sleep disturbance and are at higher risk of death by suicide relative to cisgender and/or heterosexual individuals. The present narrative review evaluates nascent research related to sleep disturbance and suicide-related thoughts and behaviors (STBs) among SGM populations, and discusses how experiences of minority stress may explain heightened risk among SGM people. Although there is a growing understanding of the link between sleep disturbance and STBs, most research has not been conducted in SGM populations or has not examined suicide as an outcome. Research is needed to examine whether and how aspects of sleep disturbances relate to STBs among SGM people in order to better tailor sleep treatments for SGM populations.
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Affiliation(s)
- Emily A Dolsen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Amy L Byers
- Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Research Service, San Francisco Veterans Affairs Health Care System, San Francisco, CA, USA.,Department of Medicine, Division of Geriatrics, University of California, San Francisco, CA, USA
| | - Annesa Flentje
- Department of Community Health Systems, School of Nursing, University of California, San Francisco, CA, USA.,Alliance Health Project, Department of Psychiatry and Behavioral Sciences, School of Medicine, University of California, San Francisco, USA
| | - Joseph L Goulet
- Yale School of Medicine, Department of Emergency Medicine, New Haven, CT, USA.,VA Connecticut Healthcare System, West Haven, CT, USA
| | - Guneet K Jasuja
- Center for Healthcare Organization and Implementation Research, VA Bedford Healthcare System, Bedford, MA, USA.,Section of General Internal Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Kristine E Lynch
- VA Informatics and Computing Infrastructure (VINCI), VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Department of Internal Medicine, Division of Epidemiology, Salt Lake City, UT, USA
| | - Shira Maguen
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
| | - Thomas C Neylan
- Mental Health Service, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA.,Department of Psychiatry and Behavioral Sciences, University of California, San Francisco, CA, USA.,Mental Illness Research Education and Clinical Centers, San Francisco Veterans Affairs Healthcare System, San Francisco, CA, USA
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4
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Moore PT. Infra-low frequency neurofeedback and insomnia as a model of CNS dysregulation. Front Hum Neurosci 2022; 16:959491. [PMID: 36211128 PMCID: PMC9534730 DOI: 10.3389/fnhum.2022.959491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/12/2022] [Indexed: 11/13/2022] Open
Abstract
This paper will review what is conventionally known of sleep homeostasis and focus on insomnia as a primary manifestation of brain dysregulation, whether as a solitary symptom or as part of a larger syndrome such as post-traumatic stress disorder, PTSD. It will discuss in brief behavioral/mindfulness treatments that have been used to treat neurologic diseases, as this is germane to the phenomenology of neurofeedback (NF). It will explore how neurofeedback may work at the subconscious level and cover the current clinical experience of the effectiveness of this technique in the treatment of insomnia. It will conclude with a case presentation.
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Linnet K, Sigurdsson JA, Tomasdottir MO, Sigurdsson EL, Gudmundsson LS. Association between prescription of hypnotics/anxiolytics and mortality in multimorbid and non-multimorbid patients: a longitudinal cohort study in primary care. BMJ Open 2019; 9:e033545. [PMID: 31811011 PMCID: PMC6924757 DOI: 10.1136/bmjopen-2019-033545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To assess the risk of mortality in primary care patients, multimorbid (≥2 chronic conditions) or not, prescribed hypnotics/anxiolytics. DESIGN A longitudinal cohort study SETTING: Primary healthcare in the Reykjavik area. PARTICIPANTS 114 084 individuals (aged 10-79 years, average 38.5, SD 18.4) contacting general practitioners during 2009-2012 (mortality follow-up to 31 December 2016). Of those, the reference group comprised 58 560 persons who were neither multimorbid nor had redeemed prescriptions for hypnotics/anxiolytics. Participants (16 108) redeeming prescriptions for hypnotics/anxiolytics on a regular basis for 3 consecutive years were considered as consistent, long-term users. They were subdivided into low-dose (1-300 defined daily doses (DDD)/3 years), medium-dose (301-1095 DDDs/3 years) and high-dose users (>1095 DDDs/3 years). All six groups taking these drugs were compared with the reference group. MAIN OUTCOME MEASURES All-cause mortality. RESULTS HRs were calculated with the no multimorbidity-no drug group as a reference, using Cox proportional hazards regression model adjusting for age, sex and the number of chronic conditions (n=111 767), patients with cancer excluded. During follow-up, 516 358 person-years in total, 1926 persons died. Mean follow-up was 1685 days (4.6 years), range 1-1826 days (5.0 years). For all multimorbid patients who took no drugs the HR was 1.14 (95% CI 1.00 to 1.30) compared with those without multimorbidity. HRs in the non-multimorbid participants varied from 1.49 to 3.35 (95% CI ranging from 1.03 to 4.11) with increasing doses of hypnotics/anxiolytics, and correspondingly from 1.55 to 3.52 (1.18 to 4.29) in multimorbid patients. CONCLUSIONS Mortality increased in a dose-dependent manner among both multimorbid and non-multimorbid patients taking hypnotics/anxiolytics. This increase was clearly associated with prescribing of these drugs. Their use should be limited to the recommended period of 2-4 up to 6 weeks; long-term use may incur increased risk and should be re-examined.
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Affiliation(s)
- Kristjan Linnet
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
| | - Johann Agust Sigurdsson
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Margret Olafia Tomasdottir
- Department of Family Medicine, Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
| | - Emil Larus Sigurdsson
- Development Centre for Primary Healthcare in Iceland, Primary Health Care of the Capital Area, Reykjavik, Iceland
- Department of Family Medicine, Faculty of Medicine, University of Iceland School of Health Sciences, Reykjavik, Iceland
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Benca RM, Teodorescu M. Sleep physiology and disorders in aging and dementia. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:477-493. [PMID: 31753150 DOI: 10.1016/b978-0-12-804766-8.00026-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Sleep problems occur commonly in normal and pathologic aging. Older adults typically have more difficulty falling asleep and remaining asleep, report more daytime napping, and have an increased prevalence of primary sleep disorders such as insomnia, parasomnias, sleep apnea, and sleep-related movement disorders. Medical and psychiatric disorders as well as medications used to treat them also contribute to sleep disturbances in aging. Patients with mild cognitive impairment and dementia have more severe sleep problems, and disturbed sleep and sleep disorders contribute to earlier onset and more rapid progression of neurodegenerative disorders. Approaches to diagnosing and treating sleep disorders in the elderly are discussed.
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Affiliation(s)
- Ruth M Benca
- Department of Psychiatry and Human Behavior, University of California, Irvine, CA, United States.
| | - Mihai Teodorescu
- Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, United States
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Kronholm E, Jousilahti P, Laatikainen T, Lallukka T, Peltonen M, Seppänen J, Virta L. Trajectories in hypnotic use and approaching death: a register linked case-control study. Sleep Med 2018; 57:153-161. [PMID: 29706555 DOI: 10.1016/j.sleep.2018.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Revised: 01/18/2018] [Accepted: 02/23/2018] [Indexed: 01/28/2023]
Abstract
PURPOSE Whether the association between hypnotic and increased mortality risk is created by causation or confounding, has been long debated. We further examined the possibility of confounding by indication with a comprehensive approach. METHODS The National FINRISK Study cohorts of 1997, 2002, and 2007 (25,436 participants aged 25-74) were followed up until July 2012. There were 1822 deaths, and at least one gender, baseline age and cohort matched 'control' was found for 1728 'cases' yielding a final analytical sample of 3955 individuals. An index age, equivalent to the age at death of their respective cases' was set for each control. Hypnotic drug purchases were followed from the Finnish nationwide register during a 36-month run-up period before the date of death/index date. The prevalence and incidence of hypnotic purchases were compared between cases and matched controls. Moreover, latent developmental trajectories of purchases were modelled and their relations with specific and all-cause death risks were analysed. RESULTS An increasing difference between cases and controls was observed as regards the use of hypnotic drugs. During the last 30 months before the date of death/index date, the rate ratio of incident purchases between cases and controls was 2.37 (95% CL, 1.79-3.12) among older and 3.61 (95% CL, 2.37-5.89) among younger individuals. The developmental trajectories of hypnotic drug purchases were differently and by interpretation plausibly associated with specific mortality risks. CONCLUSIONS In most cases the association between hypnotics and mortality risk is created by symptomatic treatment when death is approaching.
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Affiliation(s)
- Erkki Kronholm
- National Institute for Health and Welfare, Helsinki, Finland; Finnish Institute of Occupational Health, Turku, Finland.
| | | | | | - Tea Lallukka
- Finnish Institute of Occupational Health, Helsinki, Finland; Department of Public Health, University of Helsinki, Finland
| | - Markku Peltonen
- National Institute for Health and Welfare, Helsinki, Finland
| | | | - Lauri Virta
- The Social Insurance Institution, Turku, Finland
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8
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White AJ, Weinberg CR, Park YM, D'Aloisio AA, Vogtmann E, Nichols HB, Sandler DP. Sleep characteristics, light at night and breast cancer risk in a prospective cohort. Int J Cancer 2017; 141:2204-2214. [PMID: 28791684 DOI: 10.1002/ijc.30920] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/26/2017] [Accepted: 07/27/2017] [Indexed: 12/12/2022]
Abstract
Increasing numbers of women in the US are getting too little sleep. Inadequate sleep has been associated with impaired metabolic function and endocrine disruption. Sister Study cohort participants (n = 50,884), completed baseline and follow-up questionnaires on sleep patterns. Incident breast cancers estrogen receptor (ER) status of the tumor were ascertained from questionnaires and medical records. Cox regression was used to estimate adjusted hazard ratios (HRs) and 95% confidence intervals (95% CIs). Analyses of sleep characteristics reported at the first follow-up interview included only participants who were breast cancer-free at time of follow-up interview. Over ∼7 years of follow-up, 2,736 breast cancer cases (invasive and ductal carcinoma in situ) were diagnosed. There was little evidence that usual sleep duration or other sleep characteristics were associated with breast cancer. However, relative to those with no difficulty sleeping, women who reported having difficulty sleeping ≥ 4 nights a week were at an increased risk of overall (HR = 1.32, 95% CI: 1.09-1.61) and postmenopausal breast cancer (HR = 1.51, 95% CI 1.24-1.85). Risk of ER+ invasive cancer was elevated for women who reported having a light or television on in the room while sleeping (HR = 1.20, 95% CI: 0.97-1.47) or who typically got less sleep than they needed to feel their best (HR = 1.21, 95% CI: 0.98-1.50). In our study, most sleep characteristics, including sleep duration, were not associated with an increased risk although higher risk was observed for some markers of inadequate or poor quality sleep.
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Affiliation(s)
- Alexandra J White
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
| | - Clarice R Weinberg
- Biostatistics Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
| | - Yong-Moon Park
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
| | - Aimee A D'Aloisio
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC.,Social & Scientific Systems, Durham, NC
| | - Emily Vogtmann
- Division of Cancer Epidemiology and Genetics, Metabolic Epidemiology Branch, National Cancer Institute, NIH, Bethesda, MD
| | - Hazel B Nichols
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC
| | - Dale P Sandler
- Epidemiology Branch, National Institute of Environmental Health Sciences, NIH, Research Triangle Park, NC
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9
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Nakajima K, Suwa K, Toyama K. Age-dependent changes in the association between sleep duration and impaired glucose metabolism. World J Diabetes 2017; 8:397-406. [PMID: 28861177 PMCID: PMC5561039 DOI: 10.4239/wjd.v8.i8.397] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2016] [Revised: 03/03/2017] [Accepted: 03/16/2017] [Indexed: 02/05/2023] Open
Abstract
AIM To investigate whether the association between sleep duration and impaired glucose metabolism varies among younger and older populations. METHODS We reviewed data of self-reported habitual sleep duration per night, HbA1c levels, and clinically relevant factors in a cross-sectional checkup database of 75472 Japanese from the general population aged 20-79 years (51695 men and 23777 women). Associations of prediabetes (HbA1c ≥ 5.7% and/or diabetic pharmacotherapy) or diabetes (HbA1c ≥ 6.5% and/or diabetic pharmacotherapy) with short and long sleep durations compared with a reference sleep duration (7 h) were investigated by multivariate logistic regression analysis. We controlled for potential relevant confounders, including age, sex, and work duration per day according to younger and older subjects. RESULTS As age advanced, sleep duration became longer and this increase in the 40s and 50s was two times greater in men than in women. This finding was accompanied by a deterioration in HbA1c levels. In subjects aged younger than 40 years (n = 32929), HbA1c levels were inversely and linearly correlated with sleep duration in both sexes. However, in subjects aged 40 years or older (n = 42543), HbA1c levels showed a non-linear relationship against sleep duration with a nadir at 7 h. Multivariate logistic regression analysis showed that in younger subjects, short durations of sleep (≤ 5 h and 6 h) were positively associated with prediabetes (both P < 0.001), but a long duration of sleep (≥ 8 h) was inversely associated with prediabetes (P < 0.001). These associations remained significant after adjustment for relevant confounders, including age, sex, and work duration per day (ORs = 1.20, 95%CI: 1.05-1.37, P < 0.001; ORs = 1.12, 95%CI: 1.02-1.24, P < 0.05; and ORs = 0.84, 95%CI: 0.72-0.99, P < 0.05, respectively). In contrast, in older subjects, besides an association of prediabetes with a short duration of sleep (≤ 5 h) (ORs = 1.12, 95%CI: 1.03-1.21, P < 0.01), diabetes was significantly associated with a long duration of sleep (≥ 8 h) (ORs = 1.11, 95%CI: 1.02-1.25, P < 0.05). CONCLUSION A short sleep duration may be associated with prediabetes throughout life. However, the association between a long sleep duration and glucose metabolism can change with aging.
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10
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Abstract
Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.
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Affiliation(s)
- Daniel F Kripke
- UCSD, 8437 Sugarman Drive, La Jolla, CA, 92037-2226, USA. .,Scripps Clinic Viterbi Family Sleep Center, La Jolla, USA.
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11
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Linnet K, Gudmundsson LS, Birgisdottir FG, Sigurdsson EL, Johannsson M, Tomasdottir MO, Sigurdsson JA. Multimorbidity and use of hypnotic and anxiolytic drugs: cross-sectional and follow-up study in primary healthcare in Iceland. BMC FAMILY PRACTICE 2016. [PMID: 27267943 DOI: 10.1186/s12875‐016‐0469‐0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND The prevalence of multimorbidity is increasing worldwide, presumably leading to an increased use of medicines. During the last decades the use of hypnotic and anxiolytic benzodiazepine derivatives and related drugs has increased dramatically. These drugs are frequently prescribed for people with a sleep disorder often merely designated as "insomnia" in the medical records and lacking a clear connection with the roots of the patients' problems. Our aim was to analyse the prevalence of multimorbidity in primary healthcare in Iceland, while concurrently investigating a possible association with the prevalence and incidence of hypnotic/anxiolytic prescriptions, short-term versus chronic use. METHODS Data were retrieved from a comprehensive database of medical records from primary healthcare in Iceland to find multimorbid patients and prescriptions for hypnotics and anxiolytics, linking diagnoses (ICD-10) and prescriptions (2009-2012) to examine a possible association. Nearly 222,000 patients, 83 % being local residents in the capital area, who contacted 16 healthcare centres served in total by 140 general practitioners, were set as a reference to find the prevalence of multimorbidity as well as the prevalence and incidence of hypnotic/anxiolytic prescriptions. RESULTS The prevalence of multimorbidity in the primary care population was 35 %, lowest in the young, increasing with age up to the 80+ group where it dropped somewhat. The prevalence of hypnotic/anxiolytic prescriptions was 13.9 %. The incidence rate was 19.4 per 1000 persons per year in 2011, and 85 % of the patients prescribed hypnotics/anxiolytics were multimorbid. Compared to patients without multimorbidity, multimorbid patients were far more likely to be prescribed a hypnotic and/or an anxiolytic, OR = 14.9 (95 % CI = 14.4-15.4). CONCLUSIONS Patients with multiple chronic conditions are common in the primary care setting, and prevalence and incidence of hypnotic/anxiolytic prescriptions are high. Solely explaining use of these drugs by linear thinking, i.e. that "insomnia" leads to their prescription is probably simplistic, since the majority of patients prescribed these drugs are multimorbid having several chronic conditions which could lead to sleeping problems. However, multimorbidity as such is not an indication for hypnotics, and doctors should be urged to greater caution in their prescribing, bearing in mind non-pharmacological therapy options.
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Affiliation(s)
- Kristjan Linnet
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.
| | - Larus S Gudmundsson
- Clinical Quality and Services, Directorate of Health, Reykjavik, Iceland.,Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Frida G Birgisdottir
- Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Emil L Sigurdsson
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnus Johannsson
- Clinical Quality and Services, Directorate of Health, Reykjavik, Iceland.,Department of Pharmacology and Toxicology, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Margret O Tomasdottir
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Medicine, Department of Public Health and General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johann A Sigurdsson
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Medicine, Department of Public Health and General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
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12
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Linnet K, Gudmundsson LS, Birgisdottir FG, Sigurdsson EL, Johannsson M, Tomasdottir MO, Sigurdsson JA. Multimorbidity and use of hypnotic and anxiolytic drugs: cross-sectional and follow-up study in primary healthcare in Iceland. BMC FAMILY PRACTICE 2016; 17:69. [PMID: 27267943 PMCID: PMC4896036 DOI: 10.1186/s12875-016-0469-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 06/02/2016] [Indexed: 11/10/2022]
Abstract
Background The prevalence of multimorbidity is increasing worldwide, presumably leading to an increased use of medicines. During the last decades the use of hypnotic and anxiolytic benzodiazepine derivatives and related drugs has increased dramatically. These drugs are frequently prescribed for people with a sleep disorder often merely designated as “insomnia” in the medical records and lacking a clear connection with the roots of the patients’ problems. Our aim was to analyse the prevalence of multimorbidity in primary healthcare in Iceland, while concurrently investigating a possible association with the prevalence and incidence of hypnotic/anxiolytic prescriptions, short-term versus chronic use. Methods Data were retrieved from a comprehensive database of medical records from primary healthcare in Iceland to find multimorbid patients and prescriptions for hypnotics and anxiolytics, linking diagnoses (ICD-10) and prescriptions (2009–2012) to examine a possible association. Nearly 222,000 patients, 83 % being local residents in the capital area, who contacted 16 healthcare centres served in total by 140 general practitioners, were set as a reference to find the prevalence of multimorbidity as well as the prevalence and incidence of hypnotic/anxiolytic prescriptions. Results The prevalence of multimorbidity in the primary care population was 35 %, lowest in the young, increasing with age up to the 80+ group where it dropped somewhat. The prevalence of hypnotic/anxiolytic prescriptions was 13.9 %. The incidence rate was 19.4 per 1000 persons per year in 2011, and 85 % of the patients prescribed hypnotics/anxiolytics were multimorbid. Compared to patients without multimorbidity, multimorbid patients were far more likely to be prescribed a hypnotic and/or an anxiolytic, OR = 14.9 (95 % CI = 14.4–15.4). Conclusions Patients with multiple chronic conditions are common in the primary care setting, and prevalence and incidence of hypnotic/anxiolytic prescriptions are high. Solely explaining use of these drugs by linear thinking, i.e. that “insomnia” leads to their prescription is probably simplistic, since the majority of patients prescribed these drugs are multimorbid having several chronic conditions which could lead to sleeping problems. However, multimorbidity as such is not an indication for hypnotics, and doctors should be urged to greater caution in their prescribing, bearing in mind non-pharmacological therapy options.
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Affiliation(s)
- Kristjan Linnet
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.
| | - Larus S Gudmundsson
- Clinical Quality and Services, Directorate of Health, Reykjavik, Iceland.,Faculty of Pharmaceutical Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Centre of Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Frida G Birgisdottir
- Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Emil L Sigurdsson
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Magnus Johannsson
- Clinical Quality and Services, Directorate of Health, Reykjavik, Iceland.,Department of Pharmacology and Toxicology, Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
| | - Margret O Tomasdottir
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Medicine, Department of Public Health and General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
| | - Johann A Sigurdsson
- Centre of Development, Primary Health Care of the Capital Area, Reykjavik, Iceland.,Department of Family Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland.,Faculty of Medicine, Department of Public Health and General Practice Research Unit, Norwegian University of Science and Technology, Trondheim, Norway
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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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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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Affiliation(s)
- Daniel F Kripke
- Viterbi Family Sleep Center, Scripps Clinic, W-207, 10666 North Torrey Pines Road, La Jolla, CA, USA.
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Kripke DF, Langer RD. Evidence for harm, comment on ‘Use of benzodiazepines or benzodiazepine related drugs and the risk of cancer: a population-based case-control study’. Br J Clin Pharmacol 2015; 78:186-7. [PMID: 25083532 DOI: 10.1111/bcp.12265] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Lallukka T, Kaikkonen R, Härkänen T, Kronholm E, Partonen T, Rahkonen O, Koskinen S. Sleep and sickness absence: a nationally representative register-based follow-up study. Sleep 2014; 37:1413-25. [PMID: 25142569 DOI: 10.5665/sleep.3986] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES We aimed to examine various sleep measures as determinants of sickness absence while considering confounders. DESIGN Nationally representative Health 2000 Survey linked with sickness absence data from the Finnish Social Insurance Institution. SETTING Finland. PARTICIPANTS Working-aged women (n = 1,875) and men (n = 1,885). INTERVENTIONS N/A. MEASUREMENTS AND RESULTS Insomnia-related symptoms, early morning awakenings, being more tired during daytime than other people of same age, use of sleeping pills, excessive daytime sleepiness, probable sleep apnea (4 items about snoring/apnea), and reporting that sleep duration varies between different seasons were examined as determinants of sickness absence over a 7.2 year follow-up. Poisson and gamma regression models were fitted. After adjusting age, all examined sleep disturbances except excessive daytime sleepiness were associated with sickness absence among men (RRs 1.3-2.5). Among women, after adjusting for age, insomnia-related symptoms, early morning awakenings, being more tired than others, and use of sleeping pills were associated with sickness absence (RRs 1.4-1.8). After further adjustments for education, working conditions, health behaviors, and objectively measured mental and somatic health, the associations somewhat attenuated but mainly remained. The optimal sleep duration with the lowest risk of sickness absence was 7.6 hours for women and 7.8 hours for men. Although persistence of other health problems could affect the estimates, direct costs due to sickness absence could decrease by up to 28% if sleep disturbances could be fully addressed. CONCLUSIONS This study highlights the need for prevention of sleep disturbances and promotion of optimal sleep length to prevent sickness absence.
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Lee CC, Tsai KY, Hung YT, Chou FHC, Huang YS. Association of hypnotics with stroke risk: a population-based case-control study. Prim Care Companion CNS Disord 2014; 16:13m01583. [PMID: 25133061 DOI: 10.4088/pcc.13m01583] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The aim of this study was to determine what association, if any, hypnotics have on the risk of stroke events. METHOD In a nationwide population-based case-control study, cases were patients with incident stroke diagnosed between January 1, 2006, and December 31, 2006. Patients with hemorrhagic or ischemic stroke diagnosis codes (ICD-9-CM codes 430-438) and who had been hospitalized for further treatment were included in the study. Patients with any type of stroke diagnosed before 2006 were excluded. The authors selected 2,779 stroke patients and 27,790 controls matched for age, gender, physician visit date, and comorbidities. The impact of hypnotics on stroke was examined by multiple logistic regression models and sensitivity analyses. RESULTS Individuals prescribed any hypnotic had elevated risk of stroke compared to those prescribed no hypnotics. For groups prescribed 1-27, 28-148, and ≥ 149 pills, odds ratios for stroke were 1.71 (95% CI, 1.49-1.96), 1.84 (95% CI, 1.62-2.11), and 1.45 (95% CI, 1.26-1.68), respectively. Adjusted odds ratios were elevated in separate analyses for zolpidem and estazolam. The observed results were robust with stratification by comorbidities, such as hypertension and diabetes, and using ischemic stroke as the case group. CONCLUSIONS This study shows that, in a case-control study matched for age, gender, and comorbidities using multiple logistic regression and sensitivity tests, zolpidem and estazolam were slightly associated with an increased risk of stroke. Further large-scale and in-depth studies should be performed. Use of hypnotics should always be determined by specialists, and adverse effects should be continuously monitored.
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Affiliation(s)
- Ching-Chih Lee
- Department of Otolaryngology (Dr Lee), Department of Pediatrics (Dr Hung), and Division of Neurology, Department of Internal Medicine (Dr Huang), Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Lee); Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan (Drs Lee, Tsai, and Chou); School of Medicine, Tzu Chi University, Hualian, Taiwan (Drs Lee and Hung); and Graduate Institute of Health Care (Dr Chou) and Department of Nursing (Drs Chou and Tsai), Meiho University, Ping-Tong County, Taiwan
| | - Kuan-Yi Tsai
- Department of Otolaryngology (Dr Lee), Department of Pediatrics (Dr Hung), and Division of Neurology, Department of Internal Medicine (Dr Huang), Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Lee); Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan (Drs Lee, Tsai, and Chou); School of Medicine, Tzu Chi University, Hualian, Taiwan (Drs Lee and Hung); and Graduate Institute of Health Care (Dr Chou) and Department of Nursing (Drs Chou and Tsai), Meiho University, Ping-Tong County, Taiwan
| | - Yeh-Ting Hung
- Department of Otolaryngology (Dr Lee), Department of Pediatrics (Dr Hung), and Division of Neurology, Department of Internal Medicine (Dr Huang), Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Lee); Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan (Drs Lee, Tsai, and Chou); School of Medicine, Tzu Chi University, Hualian, Taiwan (Drs Lee and Hung); and Graduate Institute of Health Care (Dr Chou) and Department of Nursing (Drs Chou and Tsai), Meiho University, Ping-Tong County, Taiwan
| | - Frank Huang-Chih Chou
- Department of Otolaryngology (Dr Lee), Department of Pediatrics (Dr Hung), and Division of Neurology, Department of Internal Medicine (Dr Huang), Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Lee); Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan (Drs Lee, Tsai, and Chou); School of Medicine, Tzu Chi University, Hualian, Taiwan (Drs Lee and Hung); and Graduate Institute of Health Care (Dr Chou) and Department of Nursing (Drs Chou and Tsai), Meiho University, Ping-Tong County, Taiwan
| | - Yung-Sung Huang
- Department of Otolaryngology (Dr Lee), Department of Pediatrics (Dr Hung), and Division of Neurology, Department of Internal Medicine (Dr Huang), Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan (Dr Lee); Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan (Drs Lee, Tsai, and Chou); School of Medicine, Tzu Chi University, Hualian, Taiwan (Drs Lee and Hung); and Graduate Institute of Health Care (Dr Chou) and Department of Nursing (Drs Chou and Tsai), Meiho University, Ping-Tong County, Taiwan
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Weich S, Pearce HL, Croft P, Singh S, Crome I, Bashford J, Frisher M. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ 2014; 348:g1996. [PMID: 24647164 PMCID: PMC3959619 DOI: 10.1136/bmj.g1996] [Citation(s) in RCA: 143] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To test the hypothesis that people taking anxiolytic and hypnotic drugs are at increased risk of premature mortality, using primary care prescription records and after adjusting for a wide range of potential confounders. DESIGN Retrospective cohort study. SETTING 273 UK primary care practices contributing data to the General Practice Research Database. PARTICIPANTS 34,727 patients aged 16 years and older first prescribed anxiolytic or hypnotic drugs, or both, between 1998 and 2001, and 69,418 patients with no prescriptions for such drugs (controls) matched by age, sex, and practice. Patients were followed-up for a mean of 7.6 years (range 0.1-13.4 years). MAIN OUTCOME All cause mortality ascertained from practice records. RESULTS Physical and psychiatric comorbidities and prescribing of non-study drugs were significantly more prevalent among those prescribed study drugs than among controls. The age adjusted hazard ratio for mortality during the whole follow-up period for use of any study drug in the first year after recruitment was 3.46 (95% confidence interval 3.34 to 3.59) and 3.32 (3.19 to 3.45) after adjusting for other potential confounders. Dose-response associations were found for all three classes of study drugs (benzodiazepines, Z drugs (zaleplon, zolpidem, and zopiclone), and other drugs). After excluding deaths in the first year, there were approximately four excess deaths linked to drug use per 100 people followed for an average of 7.6 years after their first prescription. CONCLUSIONS In this large cohort of patients attending UK primary care, anxiolytic and hypnotic drugs were associated with significantly increased risk of mortality over a seven year period, after adjusting for a range of potential confounders. As with all observational findings, however, these results are prone to bias arising from unmeasured and residual confounding.
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Affiliation(s)
- Scott Weich
- Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, West Midlands CV4 7AL, UK
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Sands-Lincoln M, Loucks EB, Lu B, Carskadon MA, Sharkey K, Stefanick ML, Ockene J, Shah N, Hairston KG, Robinson JG, Limacher M, Hale L, Eaton CB. Sleep duration, insomnia, and coronary heart disease among postmenopausal women in the Women's Health Initiative. J Womens Health (Larchmt) 2013; 22:477-86. [PMID: 23651054 DOI: 10.1089/jwh.2012.3918] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Long and short sleep duration are associated with increased risk for coronary heart disease (CHD) and cardiovascular disease (CVD); however, evidence is inconsistent. We sought to identify whether self-reported sleep duration and insomnia, based on a validated questionnaire, are associated with increased incident CHD and CVD among postmenopausal women. METHODS Women's Health Initiative Observational Study Participants (N=86,329; 50-79 years) who reported on sleep at baseline were followed for incident CVD events. Associations of sleep duration and insomnia with incident CHD and CVD were evaluated using Cox proportional hazards models over 10.3 years. RESULTS Women with high insomnia scores had elevated risk of CHD (38%) and CVD (27%) after adjustment for age and race, and in fully adjusted models (hazard ratio [HR]=1.19, 95% confidence interval [CI] 1.09-1.30; 1.11 95% CI 1.03-2.00). Shorter (≤5 hours) and longer (≥10 hours) sleep duration demonstrated significantly higher incident CHD (25%) and CVD (19%) in age- and race-adjusted models, but this was not significant in fully adjusted models. Formal tests for interaction indicated significant interactions between sleep duration and insomnia for risk of CHD (p<0.01) and CVD (p=0.02). Women with high insomnia scores and long sleep demonstrated the greatest risk of incident CHD compared to midrange sleep duration (HR=1.93, 95% CI 1.06-3.51) in fully adjusted models. CONCLUSIONS Sleep duration and insomnia are associated with CHD and CVD risk, and may interact to cause almost double the risk of CHD and CVD. Additional research is needed to understand how sleep quality modifies the association between prolonged sleep and cardiovascular outcomes.
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Affiliation(s)
- Megan Sands-Lincoln
- Department of Medicine, Center for Sleep and Circadian Neurobiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania 19104, USA.
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