Medical Technology Innovation Center, Juntendo University, Bunkyo-ku, Tokyo, Japan.
Cardiovascular Respiratory Sleep Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan.
Open Heart. 2024 Aug 30;11(2):e002889. doi: 10.1136/openhrt-2024-002889.
Studies comparing the safety of orexin receptor antagonists and other hypnotic types for older patients with heart failure (HF) remain lacking. This study aimed to compare orexin receptor antagonists (suvorexant) with benzodiazepines or Z-drugs for sleep treatment and investigate the risk of acute HF-related rehospitalisation in older patients with HF.
This study used a cohort design to analyse data from an administrative claims database from April 2008 to December 2020. The study population was determined based on inclusion and exclusion criteria from a cohort of 1 159 937 patients aged ≥65 years, selected through random sampling. The follow-up period was censored based on multiple criteria, including outcome occurrences and hypnotic classification changes. Kaplan-Meier survival analysis and Cox proportional hazards models were conducted for risk assessment.
The analysis included 1858 patients, aged ≥65 years and experiencing their first HF-related hospitalisation. These patients were categorised based on the initially prescribed hypnotic classification, including suvorexant, benzodiazepines and Z-drugs in 490, 606 and 762 patients, respectively. The average age and SD were similar across all hypnotic classes at 82.7±7.6 years. Kaplan-Meier curves indicated a higher trend of rehospitalisation risk for benzodiazepines and Z-drugs than for suvorexant. The adjusted HRs were 2.77 (95% CI 1.17 to 6.52) for benzodiazepines and 2.98 (95% CI 1.33 to 6.68) for Z-drugs.
Suvorexant administration for sleep treatment in older patients with HF shows a potentially reduced risk of acute HF-related rehospitalisation compared with benzodiazepines and Z-drugs. The results of this study provide valuable information for selecting hypnotics in older patients with HF having concurrent sleep disorders.
比较食欲素受体拮抗剂和其他催眠类型在心力衰竭（HF）老年患者中的安全性的研究仍然缺乏。本研究旨在比较食欲素受体拮抗剂（苏沃雷生）与苯二氮䓬类或 Z 类药物治疗睡眠，并调查 HF 老年患者中与急性 HF 相关的再入院风险。
本研究使用队列设计分析了 2008 年 4 月至 2020 年 12 月期间来自行政索赔数据库的数据。研究人群是根据包含和排除标准从 1159937 名年龄≥65 岁的患者队列中随机抽样确定的。根据结局发生和催眠分类变化等多个标准对随访期进行了删失。采用 Kaplan-Meier 生存分析和 Cox 比例风险模型进行风险评估。
分析包括 1858 名年龄≥65 岁并经历首次 HF 相关住院的患者。这些患者根据最初规定的催眠分类进行分类，包括苏沃雷生、苯二氮䓬类和 Z 类药物分别有 490、606 和 762 例。所有催眠类别的平均年龄和标准差相似，均为 82.7±7.6 岁。Kaplan-Meier 曲线表明，与苏沃雷生相比，苯二氮䓬类和 Z 类药物的再入院风险呈较高趋势。调整后的 HR 分别为苯二氮䓬类 2.77（95%CI 1.17 至 6.52）和 Z 类 2.98（95%CI 1.33 至 6.68）。
与苯二氮䓬类和 Z 类药物相比，HF 老年患者中苏沃雷生用于治疗睡眠的药物可能降低与急性 HF 相关的再入院风险。本研究结果为选择同时患有睡眠障碍的 HF 老年患者的催眠药提供了有价值的信息。
