Mortality associated with anxiolytic and hypnotic drugs—A systematic review and meta-analysis

Parsaik, Ajay K.; Mascarenhas, Soniya S.; Khosh-Chashm, Darrow; Hashmi, Aqeel; John, Vineeth; Okusaga, Olaoluwa; Singh, Balwinder

doi:10.1177/0004867415616695

Cited by 65 publications

(50 citation statements)

References 43 publications

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“…However, this study showed no significant association between use of hypnotics and incidence of ESKD (Table 3). A large number of cohort studies have reported users of hypnotics to be at risk of early death (41,42), suggesting that hypnotics should be prescribed with great caution in patients with CKD with short sleep duration. The clinical effects of modification of sleep duration on kidney function need to be examined in future studies.…”

Section: Discussionmentioning

confidence: 99%

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Yamamoto

Shinzawa

Isaka

et al. 2018

CJASN

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Background and objectives Shorter or longer sleep duration and poor sleep quality are risk factors for numerous cardio-metabolic diseases, cardiovascular disease, and mortality in subjects with normal kidney function. The association of sleep duration and sleep quality with health outcomes in patients with CKD remains uncertain.Design, setting, participants, & measurements A 4-year prospective cohort study in 17 nephrology centers in Japan, the CKD Japan Cohort (CKD-JAC) Study, assessed an association of self-reported sleep duration and sleep quality, on the basis of the Pittsburgh Sleep Quality Index (PSQI) questionnaire, with incidence of ESKD in 1601 patients with eGFR 10-59 ml/min per 1.73 m 2 using multivariable-adjusted Cox proportional hazards models.Results Baseline sleep duration and PSQI global score for the 1601 patients were mean6SD 7.061.3 hours and median 4 (interquartile range, 3-7), respectively. Poor sleep quality (PSQI global score $6) was common (n=588 [37%]). During a median of 4.0 (2.6-4.3) years of the follow-up period, 282 (18%) patients progressed to ESKD. After adjusting for age, sex, eGFR, urinary albumin excretion, smoking status, body mass index, history of diabetes and cardiovascular disease, systolic BP, blockade of the renin-angiotensin system, use of hypnotics, and Beck depression inventory score, both shorter (#5 hour) and longer (.8 hour) sleep duration were associated with ESKD (adjusted hazard ratios [95% confidence intervals] for #5.0, 5.1-6.0, 6.1-7.0, 7.1-8.0, and $8.0 hours were 2.05 [1.31 to3.21], 0.98 [0.67 to 1.44], 1.00 [reference], 1.22 [0.89 to 1.66], and 1.48 [1.01 to 2.16]), suggesting a U-shaped relationship between sleep duration and ESKD. PSQI global score $6 was also associated with incidence of ESKD (adjusted hazard ratios [95% confidence intervals] for PSQI global score #5 and $6 were 1.00 [reference] and 1.33 [1.03 to 1.71]).Conclusions Shorter (#5 hour) and longer (.8 hour) sleep duration and poor sleep quality (PSQI global score $6) were associated with ESKD in patients with CKD.

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Section: Discussionmentioning

confidence: 99%

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Yamamoto

Shinzawa

Isaka

et al. 2018

CJASN

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“…Recent cohort studies suggest an increased risk of exacerbations in benzodiazepine users with asthma and a higher likelihood of episodes of pneumonia and related mortality . A recent systemic review also highlighted an overall increased risk of all‐cause mortality in benzodiazepine users . Inappropriate use of benzodiazepines in Australia has been recently reported to lead to high costs of managing adverse events in residential aged care facilities …”

Section: Introductionmentioning

confidence: 99%

Benzodiazepine usage and patient preference for alternative therapies: A descriptive study

Sake

Wong

Bartlett

et al. 2019

Health Science Reports

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Background and aims The prevalence of chronic benzodiazepine use in primary care settings remains high despite clear evidence of adverse health outcomes resulting from long‐term use and the availability of effective alternative behavioural therapies. Eliciting factors influencing past or current usage experience of benzodiazepine users and their future behavioural intention regarding discontinuation or alternative behavioural therapy adoption could be useful in developing informed strategies facilitating successful benzodiazepine withdrawal in long‐term users. The aim of this study was to identify patient factors influencing their current long‐term benzodiazepine use, past withdrawal attempt, and future intention to trial safer alternative behavioural therapies. Additionally, the study also aimed to explore patients' preference for information sources on behavioural therapies. Methods Point of purchase surveys were conducted with patients obtaining benzodiazepines from selected pharmacies across New South Wales (NSW), Australia. Survey items included the Beliefs about Medicines Questionnaire (BMQ‐specific), questions about patient's sociodemographic characteristics, as well as their views about long‐term benzodiazepine use and behavioural therapies. Results Seventy‐five patients were recruited from 12 pharmacies across New South Wales (NSW). The surveys were conducted from November 2016 to July 2017. The mean (±SD) age of the participants was 54.3 (±16.7) with a range of 23 to 86 years, and 67% of the participants had been using the benzodiazepine for at least 1 year. Lower‐education levels, stronger beliefs about the necessity of use, and lower concerns about ongoing benzodiazepine use were significantly associated with prolonged use. Sixty‐four percent of the participants were not interested in behavioural therapies, and there was a significant relationship between the participants' future preference for behavioural therapies and their concerns about the potential adverse effects of benzodiazepines. A majority of the participants rated general practitioners (GPs) as their first choice and pharmacists as the second choice for discussing behavioural therapies. Conclusions Specific individual sociodemographic characteristics of benzodiazepine users and their medication‐related beliefs influence their current benzodiazepine usage and future intention to trial behavioural therapies as an alternative to their benzodiazepines. Based on the reported preferences of benzodiazepine users in this study, developing and evaluating GP‐pharmacist collaborative services to improve the uptake of behavioural therapies as an alternative to benzodiazepines can be recommended.

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“…Since that time evidence of broad-ranging harms resulting from long-term BDZ use has continued to grow, including cognitive deficits [8][9][10], reductions in quality of life [11][12][13], depression [14][15][16], risk of suicide [17], risk for road accidents [18,19], and specific to older adults-the risk of falls [20][21][22], developing dementia [23][24][25], and of mortality [26][27][28]. Short-term, paradoxical effects such as increased anxiety, agitation, disinhibition, and aggression have also been observed [29,30].…”

Section: Costs Of Benzodiazepine Usementioning

confidence: 99%

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

Oldenhof

Anderson-Wurf²,

Hall

et al. 2019

JCM

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Internationally there is an escalation of prescription-related overdose deaths, particularly related to benzodiazepine use. As a result, many countries have implemented prescription monitoring programs (PMPs) to increase the regulation of benzodiazepine medications. PMPs centralize prescription data for prescribers and pharmacists and generate alerts to high-doses, risky combinations, or multiple prescribers with the aim to reduce inappropriate prescribing and subsequently the potential of patient harm. However, it has become clear that prescribers have been provided with minimal guidance and insufficient training to effectively integrate PMP information into their decision making around prescribing these medications. Accordingly, this paper discusses how PMPs have given rise to a range of unintended consequences in those who have been prescribed benzodiazepines (BDZs). Given that a gradual taper is generally required to mitigate withdrawal from BDZs, there are concerns that alerts from PMPs have resulted in BDZs being ceased abruptly, resulting in a range of unintended harms to patients. It is argued that best practice guidelines based upon a patient-centered framework of decision-making, need to be developed and implemented, in order to curtail the unintended consequences of PMPs. This paper outlines some key considerations when starting the conversation with patients about their BDZ use.

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Mortality associated with anxiolytic and hypnotic drugs—A systematic review and meta-analysis

Abstract: This meta-analysis suggests that hypnotics or anxiolytics drugs use is associated with increased mortality and hence should be used with caution. Future studies focused on underlying mechanism of increased mortality with hypnotics or anxiolytics use are required.

Cited by 65 publications

References 43 publications

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Sleep Quality and Sleep Duration with CKD are Associated with Progression to ESKD

Benzodiazepine usage and patient preference for alternative therapies: A descriptive study

Beyond Prescriptions Monitoring Programs: The Importance of Having the Conversation about Benzodiazepine Use

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