Rumble R, Morgan K
School of Pharmacy, University of Tasmania, Sandy Bay, Australia.
J Am Geriatr Soc. 1992 Aug;40(8):787-91. doi: 10.1111/j.1532-5415.1992.tb01850.x.
To re-assess relationships between mortality, hypnotic use, subjective insomnia, and sleep duration.
A prospective study examining 5-year mortality among hypnotic drug users and respondents with subjective insomnia identified in a longitudinal study of health, activity, and lifestyle (Nottingham Longitudinal Study of Activity and Ageing).
General community.
1042 survey respondents, aged over 65 years, randomly selected from the community and stratified at age 75 years.
Recorded mortality.
During the 5-year period, 352 respondents died. The mortality rate was significantly greater among those taking some form of medication for sleep (n = 208) than for those not taking sleep medication (n = 812; chi-square = 4.91, df = 1, P = 0.027). When sleep medication users were categorized as either "hypnotic users" (ie, users of medication with recognized hypnotic or sedative actions) or "other users" (including analgesics and other over-the-counter medicines), only "other users" showed significant excess mortality (chi-square = 7.27, df = 1, P = 0.007). Logistic regression showed that "other users" were 2.5 times more likely to die than "non-users" even when gender, health risk, and usual sleep duration were controlled. There were no significant relationships between mortality and subjective insomnia or reported duration of sleep.
Earlier reported relationships between excess mortality and use of medication for sleep are replicated in this study. Among elderly people, however, this relationship does not derive from the pharmacological characteristics of prescription hypnotics. Rather, it appears that reported self-medication to promote sleep, using a variety of non-sedative products, provides an epidemiological "marker" for a group within which levels of morbidity and mortality are particularly high. Excess mortality associated with very short or long sleep duration was not replicated in this study. Overall, these findings provide little epidemiological support for a wide-spread interaction between benzodiazepine hypnotic use and sleep disordered breathing in old age.
重新评估死亡率、催眠药物使用、主观失眠与睡眠时间之间的关系。
一项前瞻性研究，在一项关于健康、活动和生活方式的纵向研究（诺丁汉活动与衰老纵向研究）中，对催眠药物使用者和有主观失眠症状的受访者的5年死亡率进行调查。
普通社区。
1042名年龄超过65岁的受访者，从社区中随机选取，并按75岁分层。
记录的死亡率。
在5年期间，352名受访者死亡。服用某种形式睡眠药物的人群（n = 208）的死亡率显著高于未服用睡眠药物的人群（n = 812；卡方检验 = 4.91，自由度 = 1，P = 0.027）。当将睡眠药物使用者分为“催眠药物使用者”（即使用具有公认催眠或镇静作用药物的人群）或“其他使用者”（包括镇痛药和其他非处方药）时，只有“其他使用者”显示出显著更高的死亡率（卡方检验 = 7.27，自由度 = 1，P = 0.007）。逻辑回归分析表明，即使在控制了性别、健康风险和通常睡眠时间后，“其他使用者”死亡的可能性仍是“非使用者”的2.5倍。死亡率与主观失眠或报告的睡眠时间之间没有显著关系。
本研究重复了先前报道的过高死亡率与使用睡眠药物之间的关系。然而，在老年人中，这种关系并非源于处方催眠药物的药理学特性。相反，似乎使用各种非镇静产品进行自我促眠报告为一个发病率和死亡率特别高的群体提供了一个流行病学“标志”。本研究未重复与极短或极长睡眠时间相关的过高死亡率。总体而言，这些发现几乎没有为老年期苯二氮䓬类催眠药物使用与睡眠呼吸障碍之间广泛存在的相互作用提供流行病学支持。
