Nonbenzodiazepine Sedative Hypnotics and Risk of Fall-Related Injury

Tom, Sarah E.; Wickwire, Emerson M.; Park, Yujin; Albrecht, Jennifer S.

doi:10.5665/sleep.5742

Cited by 50 publications

(32 citation statements)

References 38 publications

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“…Since it usually occurs during the transformation of body posture, this is also compatible with the circumstance of injurious falls occurred at the bedside in our study. The previous studies had pointed out that the risk of hip fracture was significantly increased in elderly patients with taking sedative-hypnotics, in line with our suggestions that sedative-hypnotics was associated with severe injuries such as fractures after falls [25] . The reason for that may be due to the side effects on the central nervous system, especially in the first few hours after taking the drugs easily leading to some adverse reactions such as drowsiness, fatigue, impaired balance and functions of cognitive and motor, especially in elderly patients [26,27] .…”

Section: Development Of the Predicting Nomogramsupporting

confidence: 89%

Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-control Study in Multi-center Acute Hospitals

Zhao

et al. 2019

Preprint

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Background Injurious falls seriously threaten the safety of elderly patients. The identification of risk factors to predict the probability of injurious falls is an important issue still needed to be solved urgently. We aimed to identify predictors and develop a nomogram as an appropriate assessment tool for distinguishing high-risk populations of injurious falls from older adults in acute settings.Methods A retrospective case-control study was conducted in three acute care hospitals in Shanghai, China. We included elderly patients with injurious falls from 2014 to 2018, and the control patients without falls randomly identified from the electronic medical records. A new nomogram was established based on risk factors and its discrimination and calibration were verified to confirm the accuracy of the prediction. And the cut-off value of risk stratification was determined to help medical staff identify the high-risk groups.Results 115 elderly patients with injurious falls and 230 controls were identified in our study. The history of fractures, orthostatic hypotension, function status, sedative-hypnotics and the level of serum albumin were independent risk factors for injurious falls in elderly patients. And the scoring nomogram showed an acceptable predicting performance of injurious falls (C-index: 0.865, 95%CI: 0.789-0.941; corrected C-index: 0.868, 95%CI: 0.852-0.884). The threshold was 153 points to distinguish the high-risk groups from the aging patients, with acceptable sensitivity (72.2%) and specificity (86.1%).Conclusions The established nomogram will allow for identifying the high-risk populations among elderly patients, providing a new assessment tool to forecast the individual risk of injurious falls.

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Section: Development Of the Predicting Nomogramsupporting

confidence: 89%

Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-control Study in Multi-center Acute Hospitals

Zhao

et al. 2019

Preprint

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“…Other notable results with respect to the negative impact of BZRAs include: Tom et al . (), who reported that use of zolpidem was associated with greater risk of hip fracture and traumatic brain injury than eszopiclone; Sun et al . () who demonstrated a significant relationship between zolpidem use and suicide attempts, as well as completed suicides; and Joya et al .…”

Section: Insomniamentioning

confidence: 99%

European guideline for the diagnosis and treatment of insomnia

Riemann

Baglioni

Bassetti

et al. 2017

Journal of Sleep Research

1,534

1,234

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SUMMARYThis European guideline for the diagnosis and treatment of insomnia was developed by a task force of the European Sleep Research Society, with the aim of providing clinical recommendations for the management of adult patients with insomnia. The guideline is based on a systematic review of relevant meta-analyses published till June 2016. The target audience for this guideline includes all clinicians involved in the management of insomnia, and the target patient population includes adults with chronic insomnia disorder. The GRADE (Grading of Recommendations Assessment, Development and Evaluation) system was used to grade the evidence and guide recommendations. The diagnostic procedure for insomnia, and its co-morbidities, should include a clinical interview consisting of a sleep history (sleep habits, sleep environment, work schedules, circadian factors), the use of sleep questionnaires and sleep diaries, questions about somatic and mental health, a physical examination and additional measures if indicated (i.e. blood tests, electrocardiogram, electroencephalogram; strong recommendation, moderate-to high-quality evidence). Polysomnography can be used to evaluate other sleep disorders if suspected (i.e. periodic limb movement disorder, sleep-related breathing disorders), in treatment-resistant insomnia, for professional at-risk populations and when substantial sleep state ª 2017 European Sleep Research Society 675

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“…Generally, poorer sleep of the elderly may reflect degeneration of wake‐ and sleep‐promoting neurons in the brain (Mander, Winer, & Walker, ), as well as a phase‐advance of the sleep–wake system, which could potentially impact the efficacy of sleep treatments. The risk that the elderly may be more prone to nighttime and next‐day residual effects, particularly falls, with some existing sleep treatments is also a concern (Glass, Lanctot, Herrmann, Sproule, & Busto, ; Tom, Wickwire, Park, & Albrecht, ). Despite these concerns, few longer‐term (> 1 month) randomized controlled trials of sleep medications have been conducted in the elderly.…”

Section: Clinical Profile In the Elderlymentioning

confidence: 99%

Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications

Herring

Roth

Krystal

et al. 2018

Journal of Sleep Research

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Summary In this review, we outline the role of orexin receptor antagonists in disorders of sleep/wake and other potential neuropsychiatric conditions, with a focus on suvorexant, which is currently the only approved agent in this class. The efficacy of suvorexant was established in Phase 2–3 trials with treatment durations ranging from 1 to 12 months in patients with insomnia. Suvorexant is effective at improving sleep assessed by patient self‐report and by polysomnography, with generally little effect on underlying sleep architecture. The main side‐effect is next day somnolence. With the growing realization of the important connections between sleep and other disorders, studies are ongoing to explore this novel mechanism in other disorders such as Alzheimer's disease and depression.

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Nonbenzodiazepine Sedative Hypnotics and Risk of Fall-Related Injury

Abstract: For the treatment of insomnia in older adults, eszopiclone may present a safer alternative to zolpidem, in terms of fall-related injuries.

Cited by 50 publications

References 38 publications

Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-control Study in Multi-center Acute Hospitals

Developing a Scoring Model to Predict the Risk of Injurious Falls in Elderly Patients: A Retrospective Case-control Study in Multi-center Acute Hospitals

European guideline for the diagnosis and treatment of insomnia

Orexin receptor antagonists for the treatment of insomnia and potential treatment of other neuropsychiatric indications

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