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Sleep disturbances may be bothering enough to lead to substantial impairment of quality of life. Perimenopausal and postmenopausal women typically complain of sleep problems and therefore are often prescribed with hypnotics. Many previous studies have pointed at the serious adverse effects of prolonged use of hypnotics [1], but the impact of those data on clinical practice has not been significant. A new study from the USA may again raise attention to the risks of hypnotics [2]. Study participants included 10,529 adults (63% women, mean age 54 years) who received hypnotic prescriptions and 23,676 matched controls with no hypnotic prescriptions, followed for an average of 2.5 years. Data were adjusted for age, gender, smoking, body mass index, ethnicity, marital status, alcohol use and prior cancer. Patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics. For groups prescribed < 18, 18–132 and > 132 doses/year, hazard ratios (95% confidence intervals) were 3.6 (2.9–4.4), 4.4 (3.7–5.4) and 5.3 (4.5–6.3), respectively, demonstrating a dose–response association. Hazard ratios were elevated in separate analyses for several common hypnotics, including zolpidem, temazepam, eszopiclone, zaleplon, other benzodiazepines, barbiturates and sedative antihistamines. Hypnotic use in the upper third was associated with a significant elevation of incident cancer (hazard ratio 1.35; 95% confidence interval 1.2–1.5). Results were robust within groups suffering each co-morbidity, indicating that the death and cancer hazards associated with hypnotic drugs were not attributable to pre-existing disease.

Author(s)

  • Amos Pines
    Department of Medicine T, Ichilov Hospital, Tel-Aviv, Israel

Citations

  1. Glass J, Lanctot KL, Herrmann N, et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005;331:1169.
    http://www.ncbi.nlm.nih.gov/pubmed/16284208
  2. Kripke DF, Langer RD, Kline LE. Hypnotics association with mortality or cancer: a matched cohort study. BMJ Open 2012 Feb 27;2(1):e000850.
    http://www.ncbi.nlm.nih.gov/pubmed/22371848
  3. Belleville G. Mortality hazard associated with anxiolytic and hypnotic drug use in the National Population Health Survey. Can J Psychiatry 2010;55:558-67.
    http://www.ncbi.nlm.nih.gov/pubmed/20840803
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