Change in Use of Sleep Medications After Gastric Bypass Surgery or Intensive Lifestyle Treatment in Adults with Obesity

Abstract

Objective: To examine the change in use of hypnotics and/or sedatives after gastric bypass surgery or intensive lifestyle modification in adults with obesity.

Methods: Adults with obesity who underwent gastric bypass surgery or initiated intensive lifestyle modification between 2007 and 2012 were identified through the Scandinavian Obesity Surgery Registry and a Swedish commercial weight loss database. The two cohorts were matched on BMI, age, sex, education, history of hypnotics and/or sedatives use, and treatment year (surgery n = 20,626; lifestyle n = 11,973; 77% women, mean age 41 years, mean BMI 41 kg/m² ). The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years.

Results: In the matched treatment cohorts, 4% had filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year follow-up, following an average weight loss of 37 kg and 18 kg in the surgery and intensive lifestyle cohorts, respectively, this proportion had increased to 7% in the surgery cohort but remained at 4% in the intensive lifestyle cohort (risk ratio 1.7; 95% CI: 1.4-2.1); at 2 years, the proportion had increased to 11% versus 5% (risk ratio 2.0; 95% CI: 1.7-2.4); and at 3 years, it had increased to 14% versus 6% (risk ratio 2.2; 95% CI: 1.9-2.6).

Conclusions: Gastric bypass surgery was associated with increased use of hypnotics and/or sedatives compared with intensive lifestyle modification.

Figure 1

Proportion of patients with filled hypnotics and/or sedatives prescriptions in the matched study population with 3 years of follow‐up (upper panel) and in the subgroup with 5 years of follow‐up (lower panel). Risk ratios (95% CI) apply to the between‐cohort differences at each follow‐up time point. Baseline characteristics of subgroups with 5 years of follow‐up are shown in Supporting Information Table S3. The proportion of patients with filled hypnotics and/or sedatives prescriptions in the unmatched study population is shown in Supporting Information Figure S4. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 2

Mean treatment dose among those with filled hypnotics and/or sedatives prescriptions at 1 and/or 2 years prior to treatment, in the matched study population with 3 years of follow‐up (upper panel) and in the subgroup with 5 years of follow‐up (lower panel). Error bars are 95% CI. Mean differences (95% CI) apply to the between‐cohort differences at each follow‐up time point. Baseline characteristics of subgroups with 5 years of follow‐up are shown in Supporting Information Table S3. Mean treatment dose among those with filled hypnotics and/or sedatives prescriptions in the unmatched study population are shown in Supporting Information Figure S5. Abbreviations: DDDs, defined daily doses. [Color figure can be viewed at wileyonlinelibrary.com]

Figure 3

Use of hypnotics and/or sedatives in the two treatment cohorts at 3‐year follow‐up, stratified by baseline characteristics, categorically in the overall matched study population (left) and continuously among those with filled hypnotics and/or sedatives prescriptions at 1 and/or 2 years prior to treatment (right). Abbreviation: DDDs, defined daily doses.

Figure 4

Within‐treatment cohort analysis of the relationship of BMI change and of presurgical use of CPAP on the categorical outcome (with filled hypnotics and/or sedative prescriptions, Yes/No) in the overall matched study population (left) and for the continuous outcome (mean treatment dose, DDDs) among those with filled hypnotics and/or sedatives prescriptions at 1 and/or 2 years prior to treatment (right). *Adjusted for baseline age, sex, education, and cumulative DDDs prior to treatment. ^†Poisson distribution assumed. Abbreviations: CPAP, continuous positive airway pressure; DDDs, defined daily doses.