Cohort study of the association of hypnotic use with mortality in postmenopausal women

Abstract

ObjectivePrevious studies found an association between hypnotic use and mortality risk. The prospective outcome data and the many baseline risk factors included in the Women's Health Initiative (WHI) provide an opportunity to better understand the reasons for this association.SettingThe WHI is a long-term national health study that focused on strategies for preventing disease in postmenopausal women. Participants were enrolled from 1993 to 1998.DesignBaseline hypnotic use was evaluated for an association with subsequent mortality or disease after adjusting for baseline risk.Subjects148 938 postmenopausal women between the ages of 50 and 79 throughout the USA. The median follow-up was 8 years.Main outcome measuresMortality. Secondary outcomes included myocardial infarction, stroke, diabetes and seven types of cancer.ResultsFor persons who use hypnotic medications almost daily the age-adjusted hazard ratio (HR) for mortality was 1.62 (95% CI 1.50 to 1.74). Greater hypnotic use was associated with less healthy levels of physical function, general health and smoking at baseline. After adjustment for these factors the HR for almost daily hypnotic use was 1.14 (1.06 to 1.23) for mortality and 1.53 (1.18 to 1.99) for melanoma; it was not significantly associated with increased incidence of other diseases tested. Less frequent hypnotic use and several types of sleeping difficulties were not associated with mortality, but sleeping more than 10 h a night had a risk-adjusted HR for mortality of 1.28 (1.01 to 1.61).ConclusionsThe association of hypnotic use with mortality and incident disease was greatly reduced after adjusting for baseline risk factors. These findings do not support a strong independent association of hypnotic use with most health outcomes.

Hypnotic drug risks of mortality, infection, depression, and cancer: but lack of benefit

“…Short-term hypnotic use is unsafe Data provided by Palmaro et al 16 and Chung et al 17 expanded the hints in the other large epidemiologic studies 18-20 that short-term hypnotic usage has surprisingly high risks: apparently short-term hypnotic use has higher risks than long-term usage on a per dose or per-unit-time basis. It is logical that for a patient with an "overdose" of common contributory factors such as aging, obesity, sleep apnea, alcohol overuse, and opiate use, even a single hypnotic dose could be lethal on the first night of consumption.…”

“…It should be noted that Weich et al 19 and Palmaro et al 16 found significant hazard ratios associated with diazepam and other benzodiazepines that are not considered hypnotics (though tranquilizer benzodiazepines may often be used for sleep). These more modern data with better drug identification and measurements of prescriptions during follow-up must be considered more reliable, but neither "Valium" nor "Librium" had been associated with excess mortality in the previous large U.S. CPSII study 21 .…”

“…Mixing weakens the risk-ratio contrasts observed. In long follow-ups, one is also studying the selected survivors of the more marked short-term risks that have been recently described 16,17 .…”

“…In this large study, both French and British case-control samples were drawn from reasonably-representative national samples 16 .…”

Do hypnotic drugs cause cancer, like cigarettes?

“…Another study failed to find a significant association, but had not been able to control for hypnotic dosage [2]. An analysis observing significant associations of hypnotic usage 5+/week with lung cancer and melanoma found that only melanoma remained significant after adjustment for confounders [3].…”