Stone Katie L, Ensrud Kristine E, Ancoli-Israel Sonia
California Pacific Medical Center, Research Institute, San Francisco, CA 94107, USA.
Sleep Med. 2008 Sep;9 Suppl 1:S18-22. doi: 10.1016/S1389-9457(08)70012-1.
Insomnia is common in older people and can be associated with significant daytime dysfunction. Sleep problems, and the medications used to treat them, may contribute to the risk of falls and fractures in this population; however, the independent effects of disturbed sleep or the risk of hypnotic use are not well understood. Data arising from the Study of Osteoporotic Fractures (SOF) cohort of elderly women have confirmed the link between sleep problems (measured subjectively or objectively) and an increased risk of falls after taking into account the use of insomnia medications (benzodiazepines) in a community-dwelling population of older women. The data also suggest that benzodiazepine use is associated with increased risk of falls, although this association is less clear-cut when insomnia/sleep problems are taken into consideration. The risk of falls should be considered when prescribing benzodiazepines in this population. So far no data exist concerning whether the effective treatment of insomnia in the elderly may help prevent falls. Furthermore, studies are warranted to evaluate the efficacy and safety of the non-benzodiazepine BZRAs (benzodiazepine receptor agonists) in relation to risk of falls. In addition, there is a need to include fall risk factors such as postural sway and reaction time as outcomes for trials of new insomnia treatments.
失眠在老年人中很常见，并且可能与明显的日间功能障碍有关。睡眠问题以及用于治疗这些问题的药物可能会增加该人群跌倒和骨折的风险；然而，睡眠紊乱的独立影响或使用催眠药物的风险尚未得到充分了解。来自老年女性骨质疏松性骨折研究（SOF）队列的数据证实，在考虑社区居住老年女性使用失眠药物（苯二氮䓬类）的情况下，睡眠问题（主观或客观测量）与跌倒风险增加之间存在关联。数据还表明，使用苯二氮䓬类药物与跌倒风险增加有关，尽管在考虑失眠/睡眠问题时这种关联不太明确。在该人群中开具苯二氮䓬类药物处方时应考虑跌倒风险。到目前为止，尚无关于有效治疗老年人失眠是否有助于预防跌倒的数据。此外，有必要开展研究以评估非苯二氮䓬类苯二氮䓬受体激动剂（BZRAs）与跌倒风险相关的疗效和安全性。此外，有必要将姿势摇摆和反应时间等跌倒风险因素纳入新失眠治疗试验的结果中。
