Non-GABA sleep medications, suvorexant as risk factors for falls: Case-control and case-crossover study
Non-GABA sleep medications, suvorexant as risk factors for falls: Case-control and case-crossover study
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DOI：
10.1371/journal.pone.0238723
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发表时间：
2020-09-11
期刊：
影响因子：
3.7
通讯作者：
Sasabe, Masataka
中科院分区：
文献类型：
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作者：
Ishibashi, Yoshiki;Nishitani, Rie;Sasabe, Masataka
这项研究的目的是检查与使用非γ氨基丁酸（GABA）睡眠药物、抗抑郁药和拉美替宁有关的跌倒风险。本病例对照和病例交叉研究在东京千代田区库丹坂医院进行。总共包括325名跌倒患者和1295名按性别和年龄匹配的对照组。病例组的纳入标准是2016年1月至2018年11月期间首次跌倒的住院患者，对照组的纳入标准是住院且未跌倒的患者。所使用的内部睡眠药物被分类为suvorexant、ramelteon、非苯二氮卓类药物、苯二氮卓类药物或kampo。在病例对照研究中，在logistic回归模型中调整年龄、性别、临床科室、跌倒风险评分和住院时间。在病例对照研究中，多变量logistic回归显示，使用抗抑郁药（比值比[OR]: 2.61, 95%可信区间[CI]: 1.29-5.28）、非苯二氮卓类药物（比值比[OR]: 2.49, 95% CI: 1.73-3.59）和苯二氮卓类药物（比值比：1.65,95% CI: 1.16-2.34）与跌倒风险增加显著相关。然而，使用ramelteon （OR: 1.40, 95% CI: 0.60-3.16）和kampo （OR: 1.55, 95% CI: 0.75-3.19）与跌倒的OR增加没有显著相关。在病例交叉研究中，使用抗抑郁药（OR: 1.78, 95% CI: 1.05-3.00）和非苯二氮卓类药物（OR: 1.63, 95% CI: 1.17-2.27）与跌倒的OR增加显著相关。在几个敏感性分析中观察到类似的模式。研究表明，过量会增加跌倒的几率。这一结果在各种分析中都是稳健的。本研究表明，非gaba类安眠药也存在跌倒的风险，因此有必要在适当评估的情况下谨慎地开具催眠药物。
The aim of this study was to examine the risk of falls associated with the use of non-gamma amino butyric acid (GABA) sleep medications, suvorexant and ramelteon. This case-control and case-crossover study was performed at the Kudanzaka Hospital, Chiyoda Ward, Tokyo. A total of 325 patients who had falls and 1295 controls matched by sex and age were included. The inclusion criteria for the case group were hospitalized patients who had their first fall and that for the control were patients who were hospitalized and did not have a fall, between January 2016 and November 2018. The internal sleep medications administered were classified as suvorexant, ramelteon, non-benzodiazepines, benzodiazepines, or kampo. In the case-control study, age, sex, clinical department, the fall down risk score, and hospitalized duration were adjusted in the logistic regression model. In the case-control study, multivariable logistic regression showed that the use of suvorexant (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.29-5.28), nonbenzodiazepines (OR: 2.49, 95% CI: 1.73-3.59), and benzodiazepines (OR: 1.65, 95% CI: 1.16-2.34) was significantly associated with an increased OR of falls. However, the use of ramelteon (OR: 1.40, 95% CI: 0.60-3.16) and kampo (OR: 1.55, 95% CI: 0.75-3.19) was not significantly associated with an increased OR of falls. In the case-crossover study, the use of suvorexant (OR: 1.78, 95% CI: 1.05-3.00) and nonbenzodiazepines (OR: 1.63, 95% CI: 1.17-2.27) was significantly associated with an increased OR of falls. Similar patterns were observed in several sensitivity analyses. It was suggested that suvorexant increases the OR of falls. This result is robust in various analyses. This study showed that the risk of falls also exists for non-GABA sleep medication, suvorexant, and thus it is necessary to carefully prescribe hypnotic drugs under appropriate assessment.