Risk of Dementia in Patients with Insomnia and Long-term Use of Hypnotics: A Population-based Retrospective Cohort Study

Abstract

BackgroundHypnotics have been reported to be associated with dementia. However, the relationship between insomnia, hypnotics and dementia is still controversial. We sought to examine the risk of dementia in patients with long-term insomnia and the contribution of hypnotics.MethodsData was collected from Taiwan’s Longitudinal Health Insurance Database. The study cohort comprised all patients aged 50 years or older with a first diagnosis of insomnia from 2002 to 2007. The comparison cohort consisted of randomly selected patients matched by age and gender. Each patient was individually tracked for 3 years from their insomnia index date to identify whether the patient had a first diagnosis of dementia. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsWe identified 5693 subjects with long-term insomnia and 28,465 individuals without. After adjusting for hypertension, diabetes mellitus, hyperlipidemia, and stroke, those with long-term insomnia had significantly higher risks of dementia (HR, 2.34; 95% CI, 1.92–2.85). Patients with long-term insomnia and aged 50 to 65 years had a higher increased risk of dementia (HR, 5.22; 95% CI, 2.62–10.41) than those older than 65 years (HR, 2.33; 95% CI, 1.90–2.88). The use of hypnotics with a longer half-life and at a higher prescribed dose predicted a greater increased risk of dementia.ConclusionsPatients with long-term use of hypnotics have more than a 2-fold increased risk of dementia, especially those aged 50 to 65 years. In addition, the dosage and half-lives of the hypnotics used should be considered, because greater exposure to these medications leads to a higher risk of developing dementia.

Cognitive Behavioral Therapy in the Treatment of Insomnia

“…Krystal et al reported a higher rate of serious adverse effects with eszopiclone than with placebo (3% vs. 1%) at 6 months. 108 Neither 6-month trial reported evidence of tolerance or withdrawal symptoms following discontinuation. 108,109 Specific adverse effects associated with eszopiclone use were somnolence (9% vs. 3% for placebo), unpleasant taste (23% vs. 3%), and myalgia (9% vs. 4%).…”

“…Three moderate risk of bias RCTs (n=1929) analyzed the efficacy of eszopiclone 2-3 mg daily [108][109][110] (Table 13). The mean age was 49 years; 63 percent were female.…”

“…Participants were randomized to 2 mg 110 or 3 mg eszopiclone. [108][109][110] One trial lasted 6 weeks 110 and two lasted 6 months. 108,109 All trials reported industry sponsorship and had moderate risk of bias.…”

“…Low-strength evidence showed that eszopiclone decreased wake time after sleep onset more than placebo, but there was substantial heterogeneity between trials (I 2 = 70%). Within the two 6-month trials, Walsh et al 109 reported greater improvement in wake time after sleep onset with eszopiclone compared with placebo (mean difference of 18 minutes) and Krystal et al 108 reported eszopiclone was not more effective than placebo. …”

Are Sleep Disturbances a Risk for Chronic Traumatic Encephalopathy? Only the Shadow Knows

“…17,18 Recently, epidemiologic studies have identifi ed a link between both OSA and insomnia, and subsequent development of dementia. 19,20 With respect to OSA, a variety of neuroimaging studies suggest evidence of brain neuronal loss or dysfunction. 21 Gray matter abnormalities also have been observed some, [22][23][24] but not all studies of patients with chronic insomnia.…”