Department of Pharmacy, Saga University Hospital, Saga, Japan.
Department of Pharmacy, Saga University Hospital, Saga, Japan; Department of Preventive Medicine, Faculty of Medicine, Saga University, Saga, Japan.
Sleep Med. 2022 Dec;100:410-418. doi: 10.1016/j.sleep.2022.09.020. Epub 2022 Sep 28.
Findings on the increased mortality risk in individuals with insomnia are inconsistent across studies. Rather than improving insomnia by sleep control, hypnotic use may be one factor in the increased risk of death; however, the effects of hypnotics on mortality remains unclear. This study aimed to examine the association between all-cause mortality and hypnotic use in a large sample, while adjusting for the effects of comorbidities.
Overall, 92,527 individuals aged 35-69 years were followed up for mortality in the Japan Multi-Institutional Collaborative Cohort Study. Regular use of hypnotics was assessed using a self-administered questionnaire. Since cancer history carries a substantial risk of death and is associated with the treatment of insomnia with hypnotics, participants with a cancer history were excluded. The hazard ratio (HR) and 95% confidence interval (CI) for all-cause mortality related to hypnotic use were estimated using a Cox proportional hazard model with adjustments for covariates including sleeping hours and comorbidities (body mass index, ischemic heart disease, stroke, and diabetes).
During the follow-up (mean, 8.4 ± 2.5 years), 1,492 mortalities were recorded, and the prevalence of taking hypnotics was 4.2%. Hypnotic use was associated with significantly greater risk of all-cause mortality, even after adjustment for the covariates (HR, 1.32; 95% CI, 1.07-1.63). The association between hypnotic use and all-cause mortality was robust in males (HR, 1.51; 95% CI, 1.15-1.96), and participants aged <60 years (HR, 1.75; 95% CI, 1.21-2.54).
Our study revealed sex-age specific associations between hypnotic use and all-cause mortality.
关于失眠患者死亡率升高的研究结果并不一致。催眠药物的使用可能是导致死亡率升高的一个因素，而不是通过睡眠控制来改善失眠；然而，催眠药物对死亡率的影响仍不清楚。本研究旨在通过调整合并症的影响，在大样本中检查催眠药物使用与全因死亡率之间的关系。
在日本多机构合作队列研究中，共有 92527 名年龄在 35-69 岁的参与者接受了死亡率随访。催眠药物的常规使用通过自我管理问卷进行评估。由于癌症病史会导致死亡风险显著增加，并与使用催眠药物治疗失眠有关，因此排除了有癌症病史的参与者。使用 Cox 比例风险模型，通过调整包括睡眠时间和合并症（体重指数、缺血性心脏病、中风和糖尿病）在内的协变量，估计与催眠药物使用相关的全因死亡率的风险比（HR）和 95%置信区间（CI）。
在随访期间（平均 8.4±2.5 年），记录到 1492 例死亡，催眠药物的使用率为 4.2%。即使在调整了协变量后，催眠药物的使用与全因死亡率显著相关（HR，1.32；95% CI，1.07-1.63）。催眠药物使用与全因死亡率之间的关联在男性（HR，1.51；95% CI，1.15-1.96）和年龄<60 岁的参与者（HR，1.75；95% CI，1.21-2.54）中是稳健的。
我们的研究揭示了催眠药物使用与全因死亡率之间存在性别和年龄特异性关联。
