The researchers from the Jacobs School of Medicine, the University of Buffalo, New York, and the Veterans’ Affairs Western New York Healthcare System found a significant association between the use of hypnotics for insomnia and an increased risk of all-cause mortality in patients with COPD. “The risk of death diverges with prolonged use depending on the hypnotic mechanism of action,” according to the authors who called for further research to establish a causal relationship.
The report in the International Journal of Chronic Obstructive Pulmonary Disease pointed out that hypnotics are commonly prescribed in patients with COPD to manage insomnia. “Given the considerable risks associated with these drugs, the aim of the study was to evaluate the risk of all-cause mortality associated with hypnotics in a cohort of veterans with COPD presenting with insomnia,” the researchers wrote.
The retrospective cohort study used information from the Veterans’ Health Administration Corporate Data Warehouse; the data were linked with Medicare, Medicaid, and National Death Index information from 2010 through 2019. All-cause mortality was defined as the primary outcome.
Of 5,759 patients with COPD included in the study, 3,585 newly initiated hypnotic agents during the investigation period. The veterans had a mean age of 71.7 years, and 92% were men.
During a mean follow up of 7.4 (SD, 2.7) years, 2,301 deaths were recorded; of those, 65.2 and 48.7 total deaths per 1,000 person-years occurred among hypnotic users and nonusers, respectively.
After propensity matching, the results indicated that hypnotic use was associated with a 22% increased risk of mortality compared with hypnotic nonusers (hazard ratio 1.22; 95% CI, 1.11-1.35).
“The benzodiazepine receptor agonists (BZRAs) group experienced a higher incidence rate of all-cause mortality compared to hypnotic nonusers (incidence rate ratio [IRR] 1.27; 95% CI, 1.14-1.43),” the researchers advised. “Conversely, the mortality rate of non-BZRA hypnotics decreased after the first 2 years and was not significantly different for hypnotic nonusers (IRR 1.04; 95% CI, 0.82-1.11).”
The study noted that the higher risk of all-cause mortality was observed in patients prescribed BZRAs, with the risk of mortality for non-BZRAs moderating after the first 2 years, indicating a class effect.
Background information in the report described how, in addition to its pulmonary complications, COPD also often leads to sleep disturbances in patients. The causes include persistent dyspnea, recurrent cough, anxiety, and pain.
“These sleep disturbances have been associated with increased symptom severity, recurrent exacerbations, and poor quality of life,” the authors pointed out. “Sleep quality is further aggravated by the side effects of COPD treatment (i.e. β-agonists and corticosteroids). Sleep characteristics include prolonged sleep onset latency, frequent arousals, and lower sleep efficiency.”
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