Anxiolytic and hypnotic drugs

Background: An estimated 6% – 10% of U.S. adults took a hypnotic drug for poor sleep in 2010. At least 18 studies have reported significant (p<0.05) associations of hypnotic usage with increased mortality. However, most lacked data on newer, supposedly safer, short-acting drugs, and had limited control for confounding by health status. Furthermore, little is known regarding potentially heightened risks in specific vulnerable populations. Objective: The present study was designed to test whether newer short-acting hypnotic drugs were associated with increased mortality after controlling for comorbid conditions, and to assess risks within subgroups of patients with specific medical conditions. Methods: Using electronic medical records from a large U.S. health system the authors conducted a one-to-two matched-cohort survival analysis of associations between hypnotic drug use and mortality. Records were extracted for 10,529 hypnotic users and 23,676 matched controls with no hypnotic prescriptions, mean age 54 years, followed for an average of 2.5 years between 2002 and 2006. Hazard ratios (HR) for death were computed from Cox models controlled for risk factors and stratified on comorbidites. Results: The short-acting drugs zolpidem (41%) and temazapam (20%) accounted for the majority of use. Patients prescribed any hypnotic had substantially elevated hazards of dying compared to non-users. Importantly, the death hazard was evident even in the lowest tertile, 1 to 18 pills per year, HR 3.60 (95% Confidence Interval, 2.92 – 4.44). HRs for the remaining tertiles were 4.43 (3.67 – 5.36) and 5.32 (4.50 – 6.30), demonstrating a dose-response association. HR were robust within subgroups restricted to users and non-users with identical comorbidity, implying that selective use of hypnotics by patients in poor health was an unlikely explanation for the excess mortality. Obesity emerged as a marker of increased vulnerability. Among 2206 patients with a diagnosis of obesity, (mean BMI 38.8), the mortality HRs by hypnotic tertile were 8.07 (3.64 – 17.89), 6.37 (2.73 – 14.88), and 9.34 (4.47 – 19.52). Additional models were fitted for patients with the combination of Obesity + Diabetes + Hypertension to evaluate the possibility that this risk was driven by metabolic syndrome. HRs for that combination were slightly lower than those for obesity alone, suggesting that obesity was the primary factor. Conclusions: Short-acting hypnotics were associated with a more than 3-fold increased hazard of death that, even at low levels of use. Obese patients appear particularly vulnerable, perhaps through interaction with sleep apnea. Emerging evidence for substantial harm, even with limited exposure to hypnotics, should be weighed against any benefits.

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Prevalence and concentrations of sedative-hypnotic drugs in blood of drivers involved in road traffic crashes in the Padova region of Italy – not so easy to interpret

Forensic Science International ◽

10.1016/j.forsciint.2021.111097 ◽

2021 ◽

pp. 111097

Author(s):

Donata Favretto ◽

Sindi Visentin ◽

Alan W. Jones

Keyword(s):

Road Traffic ◽

Traffic Crashes ◽

Road Traffic Crashes ◽

Drugs In Blood ◽

Hypnotic Drugs

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Clinical Pharmacology of Anxiolytic-Hypnotic Drugs

Nordisk Psykiatrisk Tidsskrift ◽

10.3109/08039488409101898 ◽

1984 ◽

Vol 38 (5) ◽

pp. 513-519

Author(s):

Arne Melander

Keyword(s):

Clinical Pharmacology ◽

Hypnotic Drugs

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On the Use of Hypnotic Drugs in the Treatment of Insomnia

Journal of Mental Science ◽

10.1192/bjp.51.214.561 ◽

1905 ◽

Vol 51 (214) ◽

pp. 561-575

Author(s):

W. Maule Smith

Keyword(s):

Difference Of Opinion ◽

The Difference ◽

Hypnotic Drugs

Any drug which interferes with the workings of the higher cerebral functions is rightly regarded with suspicion, and the question of giving or withholding it is always open to doubt. Hence the difference of opinion with regard to the administration of hypnotics. In prescribing them the advantages have to be weighed against the disadvantages, and when that is done, and the former are in excess, then whatever disadvantages there may be have to be accepted since they are in the minority.

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Use of hypnotic drugs in a learning disabilities hospital

Psychiatric Bulletin ◽

10.1192/pb.22.3.166 ◽

1998 ◽

Vol 22 (3) ◽

pp. 166-168

Author(s):

Y. Kon ◽

M. Jackson ◽

R. Banerjee ◽

B. Robertshaw ◽

F. Dunne

Keyword(s):

Learning Disabilities ◽

Drug Usage ◽

Hypnotic Drug ◽

Hypnotic Medication ◽

Hospital Population ◽

Hypnotic Drugs

A one-day audit in a learning disabilities hospital revealed 15 patients (9.4% of the hospital population) on hypnotic medication. Guidelines were then developed for the use of hypnotic drugs. An audit of hypnotic drug usage was repeated for the 12-month period of 1994 which revealed that five patients were started on hypnotics.

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