Zolpidem use and motor vehicle collisions in older drivers

Abstract

Background/Objectives Prescription sleep medication use is most prevalent among women and older adults. Morning drowsiness and impaired coordination are side-effects of sleep medications that may affect driving safety. The association between current use of zolpidem-containing medications and motor vehicle collisions (MVCs) was evaluated among very old drivers. Patients/Methods Participants were current drivers aged ≥70 years residing in north-central Alabama, spoke English, had a valid driver's license, and drove within the past 3 months (n=2,000). Current zolpidem use was determined by pill-bottle review. Participant's 5-year MVC history was determined from Alabama Department of Public Safety accident reports. The 5-year MVC and at-fault MVC rate ratios (RR) were estimated comparing zolpidem users with nonusers in the overall sample and a-priori defined age and sex subgroups. Results The unadjusted RR (95%CI) of MVCs comparing zolpidem users with nonusers was attenuated after adjustment (1.46 [1.02-2.08] and 1.38 [0.97-1.98], respectively). Among women, the unadjusted and adjusted RRs (95%CI) were 1.65 (1.03-2.66) and 1.61 (1.00-2.60), respectively. The unadjusted and adjusted RRs (95%CI) among those aged ≥80 years were 2.24 (1.19-4.57) and 2.35 (1.20-4.61), respectively. There were no statistically significant associations among men or participants <80 years old. Similar patterns were present for at-fault MVCs. Conclusion Current zolpidem users, specifically women and individuals aged ≥80 years, had higher MVC rates than nonusers. Practitioners should consider behavioral treatment before initiating low doses of zolpidem and escalating it as needed to achieve restorative sleep in females and individuals aged ≥80 years to reduce the risk of zolpidem-associated MVCs.

Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research

“…The epidemiologic association made between Z-drugs and motor vehicle accidents is less robust than with the benzodiazepines yet is still significant enough to warrant concern among clinicians, public health researchers, and policy makers. Studies of differing methodologies and sample populations have reported overall risk/odds ratios ranging from a 38% increased risk/odds to over double the risk/odds of traffic accidents in zolpidem users over non-users [ 24 – 27 ]. Despite the compelling experimental evidence for driving impairment, the epidemiological evidence for zopiclone in vehicle accidents is less clear, as some studies have found an association [ 28 , 29 ] and others have not [ 27 ].…”

Driving Problems in the Elderly and Cognitively Impaired

“…Another study evaluating the association between current zolpidem use and motor vehicle collision rates demonstrated that zolpidem users, especially women and drivers older than 80 years, showed higher crash rates than non-users [33]. A double-blind, balanced, cross-over driving simulator study by Bocca et al demonstrated significant residual effects on driving ability after a single nighttime intake of zopiclone and zolpidem in middle-aged drivers (55-65 years) [34].…”

Chronic oral administration of Passiflora incarnata extract has no abnormal effects on metabolic and behavioral parameters in mice, except to induce sleep

“…Neuropsychiatric abnormal behaviors and symptoms, such as depression, anxiety and suicide have been reported in numerous studies [1,13,17,38]. Insomnia itself is an adverse event, but very dangerous physical and mental changes caused by sleeping pills have also been reported [2,4,15,16,19,25,29,33]. Drinking tea made from passion flowers, particularly Passiflora incarnata, has long been known to provide stability and induce sleep [22].…”

“…This is why it is known that sleeping pills are reported to have the above mentioned side effects. Many side effects of prescription sleeping pills have been reported according to the recent studies, which demonstrated that patients who suffering from irregular sleeping have possibility about metabolic disorders in bodies according to the studies [2,19,21]. In particularly, overdose and long-term intakes of sleeping pills are shown abnormal behavior during the sleep, and have reported high mortality rate of insomniac patients [19,21,29].…”