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Observational Study
. 2015 Dec 28;10(12):e0145271.
doi: 10.1371/journal.pone.0145271. eCollection 2015.

The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study

Tzuo-Yun Lan  1 , Ya-Fang Zeng  1 , Gau-Jun Tang  1 , Hui-Chuan Kao  2 , Hsien-Jane Chiu  3 , Tsuo-Hung Lan  4 , Hsiao-Feng Ho  5
Affiliations
Observational Study

The Use of Hypnotics and Mortality--A Population-Based Retrospective Cohort Study

Tzuo-Yun Lan et al. PLoS One. .

Abstract

Background: Sleep disorders, especially chronic insomnia, have become major health problem worldwide and, as a result, the use of hypnotics is steadily increasing. However, few studies with a large sample size and long-term observation have been conducted to investigate the relationship between specific hypnotics and mortality.

Methods: We conducted this retrospective cohort study using data from the National Health Insurance Research Database in Taiwan. Information from claims data including basic characteristics, the use of hypnotics, and survival from 2000 to 2009 for 1,320,322 individuals were included. The use of hypnotics was divided into groups using the defined daily dose and the cumulative length of use. Hazard ratios (HRs) were calculated from a Cox proportional hazards model, with two different matching techniques to examine the associations.

Results: Compared to the non-users, both users of benzodiazepines (HR = 1.81; 95% confidence interval [CI] = 1.78-1.85) and mixed users (HR = 1.44; 95% CI = 1.42-1.47) had a higher risk of death, whereas the users of other non-benzodiazepines users showed no differences. Zolpidem users (HR = 0.73; 95% CI = 0.71-0.75) exhibited a lower risk of mortality in the adjusted models. This pattern remained similar in both matching techniques. Secondary analysis indicated that zolpidem users had a reduced risk of major cause-specific mortality except cancer, and that this protective effect was dose-responsive, with those using for more than 1 year having the lowest risk.

Conclusions: The effects of different types of hypnotics on mortality were diverse in this large cohort with long-term follow-up based on representative claims data in Taiwan. The use of zolpidem was associated with a reduced risk of mortality.

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Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Estimated zolpidem usage from 2000 to 2009 in Taiwan.
(Estimates were calculated by dividing the annual cost by the average price for a zolpidem tablet. Source: Bureau of National Health Insurance in Taiwan).
Fig 2
Fig 2. Flowchart of sample selection and classification.
(“Mixed” refers to the use of a combination of zolpidem and other non-BZDs or non-BZDs and BZDs).
See this image and copyright information in PMC

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