Danish Center for Sleep Medicine, Neurophysiology Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
Center for Neuropsychiatric Schizophrenia Research & Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, Mental Health Center Glostrup, Copenhagen University Hospital, Glostrup, Denmark.
Sleep Med. 2018 Mar;43:19-24. doi: 10.1016/j.sleep.2017.11.1142. Epub 2017 Dec 20.
This study aimed to evaluate all-cause mortality in relation to the use of benzodiazepines, antidepressants and antipsychotics in obstructive sleep apnoea (OSA) patients and matched controls.
Patients with a diagnosis of OSA and no pre-index use of psychotropic medication (n = 38,735) were compared with control subjects (n = 75,941) matched by age, gender, marital status and community location. National register data were used to obtain information on diagnoses (the Danish National Patient Registry), mortality (the Central Person Register) and psychotropic medication use (the Danish Register on Medicinal Product Statistics).
All-cause mortality was higher in patients with OSA than in control subjects. Mortality hazard ratios were higher for OSA patients and controls who were prescribed serotonergic antidepressant drugs (HR = 1.808, SD = 0.015, p = 0.001 in OSA patients; HR = 2.607, SD = 0.158, p < 0.001 in controls), tricyclic antidepressants (HR = 1.846, SD = 0.166, p < 0.001; HR = 2.087, SD = 0.172, p < 0.001), benzodiazepines (HR = 2.590, SD = 0.040, p < 0.001); (HR = 3.705, SD = 0.085, p < 0.001), benzodiazepine-like drugs (HR = 1.980, SD = 0.087, p < 0.001; HR = 2.227, SD = 0.083, p < 0.001), first-generation antipsychotics (HR = 2.894, SD = 0.268, p < 0.001; HR = 1.210, SD = 0.509, NS), and second-generation antipsychotics (HR = 2.069, SD = 0.182, p < 0.001; HR = 1.355, SD = 0.171, NS), compared with those who did not receive the drugs. Interaction analysis suggested that similar or slightly lower mortality was associated with selective serotonin re-uptake inhibitors, benzodiazepines and second-generation antipsychotics in OSA compared with controls when comorbidities were taken into consideration.
All-cause mortality was higher in OSA patients and especially controls treated with benzodiazepines, antidepressants or antipsychotics than in untreated controls. The findings were not controlled for psychiatric comorbidity and the results may have partly been attributable to confounding by indication. The results raised the possibility that the use of psychotropic medication may have deleterious health consequences, but the risk did not seem to be higher in OSA than in controls.
本研究旨在评估在阻塞性睡眠呼吸暂停（OSA）患者和匹配对照者中使用苯二氮䓬类药物、抗抑郁药和抗精神病药与全因死亡率的关系。
将诊断为 OSA 且无指数前使用精神药物（n=38735）的患者与年龄、性别、婚姻状况和社区位置匹配的对照组（n=75941）进行比较。国家登记数据用于获取诊断信息（丹麦国家患者登记处）、死亡率（中央人员登记处）和精神药物使用情况（丹麦药品统计登记处）。
OSA 患者的全因死亡率高于对照组。与未接受药物治疗的患者相比，接受 5-羟色胺再摄取抑制剂抗抑郁药（HR=1.808，SD=0.015，p=0.001；OSA 患者；HR=2.607，SD=0.158，p<0.001；对照组）、三环类抗抑郁药（HR=1.846，SD=0.166，p<0.001；HR=2.087，SD=0.172，p<0.001）、苯二氮䓬类药物（HR=1.846，SD=0.166，p<0.001；HR=2.087，SD=0.172，p<0.001）、苯二氮䓬类药物（HR=2.590，SD=0.040，p<0.001）；（HR=3.705，SD=0.085，p<0.001）、苯二氮䓬类类似物（HR=1.980，SD=0.087，p<0.001；HR=2.227，SD=0.083，p<0.001）、第一代抗精神病药（HR=2.894，SD=0.268，p<0.001；HR=1.210，SD=0.509，NS）和第二代抗精神病药（HR=2.069，SD=0.182，p<0.001；HR=1.355，SD=0.171，NS）的全因死亡率更高，与未接受药物治疗的患者相比。交互分析表明，与对照组相比，在考虑合并症时，选择性 5-羟色胺再摄取抑制剂、苯二氮䓬类药物和第二代抗精神病药在 OSA 患者中与死亡率较低或相似，而在对照组中与死亡率较高相关。
与未接受治疗的对照组相比，OSA 患者和接受苯二氮䓬类药物、抗抑郁药或抗精神病药治疗的患者的全因死亡率更高。研究结果未考虑精神共病情况，且结果可能部分归因于指示性偏倚。研究结果提示，使用精神药物可能对健康产生有害影响，但在 OSA 患者中，这种风险似乎并不高于对照组。
