The association between zolpidem and infection in patients with sleep disturbance

Huang, Chih‐Yuan; Chou, Frank Hunag-Chih; Huang, Yung-Sung; Yang, Chang-Jen; Su, Yu‐Chieh; Juang, Shiun-Yang; Chen, Pin-Fan; Chou, Pesus; Lee, Ching-An; Lee, Ching‐Chih

doi:10.1016/j.jpsychires.2014.03.017

Cited by 37 publications

(37 citation statements)

References 17 publications

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“…This finding was not confirmed by one Taiwanese study 34 , but another Taiwanese study focusing on patients with sleep disturbances found that use of zolpidem was associated with 62%–91% increased hospitalizations for serious infections 35 . A Taiwan study of patients with chronic obstructive pulmonary disease found highly significant odds ratios associated with benzodiazepine use of 9.3 for pneumonia, 10.4 for acute chronic obstructive pulmonary disease (COPD) exacerbation, 45.0 for acute respiratory failure, and 18.6 for cardiopulmonary arrest; whereas the odds ratios for "Z" drugs such as zolpidem were of almost similar magnitude 3 .…”

Section: Hypnotics Can Cause Serious and Potentially Lethal Infectionsmentioning

confidence: 80%

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

Kripke

2016

F1000Res

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This is a review of hypnotic drug risks and benefits, reassessing and updating advice presented to the Commissioner of the Food and Drug Administration (United States FDA). Almost every month, new information appears about the risks of hypnotics (sleeping pills). This review includes new information on the growing USA overdose epidemic, eight new epidemiologic studies of hypnotics’ mortality not available for previous compilations, and new emphasis on risks of short-term hypnotic prescription. The most important risks of hypnotics include excess mortality, especially overdose deaths, quiet deaths at night, infections, cancer, depression and suicide, automobile crashes, falls, and other accidents, and hypnotic-withdrawal insomnia. The short-term use of one-two prescriptions is associated with greater risk per dose than long-term use. Hypnotics are usually prescribed without approved indication, most often with specific contraindications, but even when indicated, there is little or no benefit. The recommended doses objectively increase sleep little if at all, daytime performance is often made worse, not better, and the lack of general health benefits is commonly misrepresented in advertising. Treatments such as the cognitive behavioral treatment of insomnia and bright light treatment of circadian rhythm disorders might offer safer and more effective alternative approaches to insomnia.

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Section: Hypnotics Can Cause Serious and Potentially Lethal Infectionsmentioning

confidence: 80%

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

Kripke

2016

F1000Res

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“…Also, controlled trials prove that many hypnotics impair next-day driving performance. Moreover, hypnotics are epidemiologically associated with an increased rate of driver-at-fault vehicle crashes as well as falls and serious infections [13,[27][28][29][30][31][32][33][34][35][36]. Other studies show that hypnotic use is associated with new cancer incidence [37][38][39].…”

Section: Over-adjustment Of Confoundersmentioning

confidence: 99%

Mortality Risk of Hypnotics: Strengths and Limits of Evidence

Kripke

2015

Drug Saf

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Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p \ 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival. Key PointsMost sleeping pills e.g., benzodiazepines and ''Z'' benzodiazepine agonists (like eszopiclone) are associated with early death, and they most probably cause serious increases in mortality.Benzodiazepine agonist sleeping pills and diphenhydramine should not be prescribed for insomnia, except in long-term controlled trials and hospice care.

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“…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.…”

Section: Overview Of Studiesmentioning

confidence: 99%

“…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.…”

Section: Overview Of Studiesmentioning

confidence: 99%