Wang Sheng-Huei, Chen Wei-Shan, Tang Shih-En, Lin Hung-Che, Peng Chung-Kan, Chu Hsuan-Te, Kao Chia-Hung
Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
Front Pharmacol. 2019 Jan 7;9:1513. doi: 10.3389/fphar.2018.01513. eCollection 2018.
Obstructive sleep apnea (OSA) and insomnia commonly coexist; hypnotics are broadly prescribed for insomnia therapy. However, the safety of hypnotics use in OSA patients is unclear. We conducted a retrospective case-control study to investigate the risk of adverse respiratory events in hypnotics-using OSA patients. We obtained data from the Taiwan National Health Insurance Database from 1996 to 2013. The case group included 216 OSA patients with newly diagnosed adverse respiratory events, including pneumonia and acute respiratory failure. The control group included OSA patients without adverse respiratory events, which was randomly frequency-matched to the case group at a 1:1 ratio according to age, gender, and index year. Hypnotics exposure included benzodiazepines (BZD) and non-benzodiazepines (non-BZD). A recent user was defined as a patient who had taken hypnotics for 1-30 days, while a long-term user was one who had taken hypnotics for 31-365 days. Multivariable adjusted analysis showed recent BZD use is an independent risk for adverse respiratory events (OR = 2.70; 95% CI = 1.15-6.33; < 0.001). Subgroup analysis showed both recent and long-term BZD use increased the risk of acute respiratory failure compared to never BZD use (OR = 28.6; 95% CI = 5.24-156; < 0.001, OR = 10.1; 95% CI = 1.51-67.7; < 0.05, respectively). Neither BZD nor non-BZD use increased the risk of pneumonia in OSA patients. BZD use might increase the risk of acute respiratory failure in OSA patients.
阻塞性睡眠呼吸暂停（OSA）与失眠常并存；催眠药被广泛用于失眠治疗。然而，催眠药在OSA患者中使用的安全性尚不清楚。我们进行了一项回顾性病例对照研究，以调查使用催眠药的OSA患者发生不良呼吸事件的风险。我们从1996年至2013年的台湾国民健康保险数据库中获取数据。病例组包括216例新诊断为不良呼吸事件的OSA患者，包括肺炎和急性呼吸衰竭。对照组包括无不良呼吸事件的OSA患者，根据年龄、性别和索引年份以1:1的比例与病例组进行随机频率匹配。催眠药暴露包括苯二氮䓬类药物（BZD）和非苯二氮䓬类药物（非BZD）。近期使用者定义为服用催眠药1 - 30天的患者，长期使用者为服用催眠药31 - 365天的患者。多变量调整分析显示，近期使用BZD是发生不良呼吸事件的独立危险因素（OR = 2.70；95%CI = 1.15 - 6.33；P < 0.001）。亚组分析显示，与从未使用BZD相比，近期和长期使用BZD均增加了急性呼吸衰竭的风险（分别为OR = 28.6；95%CI = 5.24 - 156；P < 0.001，OR = 10.1；95%CI = 1.51 - 67.7；P < 0.05）。使用BZD和非BZD均未增加OSA患者发生肺炎的风险。使用BZD可能会增加OSA患者发生急性呼吸衰竭的风险。
