Insomnia Diagnosis, Prescribed Hypnotic Medication Use, and Risk for Serious Fall Injuries in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
Insomnia Diagnosis, Prescribed Hypnotic Medication Use, and Risk for Serious Fall Injuries in the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study.
复制标题
中风地理和种族差异原因 (REGARDS) 研究中的失眠诊断、处方催眠药物的使用以及严重跌倒受伤的风险。
DOI：
10.1093/sleep/zsac063
复制
发表时间：
2022
期刊：
影响因子：
5.6
通讯作者：
Bowling,CBarrett
中科院分区：
文献类型：
--
作者：
Thomas,SJustin;Sakhuja,Swati;Colantonio,LisandroD;Li,Mei;Muntner,Paul;Reynolds,Kristi;Bowling,CBarrett
研究目的失眠在老年人中很常见，并与跌倒的风险增加有关。确定跌倒与失眠的相关性是否更强，或者是否可以使用处方催眠药物来指导干预措施，以降低跌倒风险。方法我们研究了9087名中风地理和种族差异(RECOS)研究参与者中，失眠诊断和/或处方催眠药物使用与严重跌伤风险的前瞻性关联。研究参与者年龄在65岁或以上，以医疗保险为基础(2003-2007年)。失眠的诊断是基于Medicare索赔中的ICD-9代码，处方催眠药物的使用是通过药瓶审查确定的。结果在平均6.8年的时间里，1660名(18.3%)的参与者有过严重的跌伤。在不失眠或服用处方催眠药物(-失眠/-催眠药物)、仅失眠(+失眠/-催眠药物)、仅服用处方催眠药物(-失眠/-催眠药物)、仅服用处方催眠药物(-失眠/-催眠药物)、仅服用处方催眠药物(-失眠/+催眠药物)的参与者中，每1000人年严重跌倒伤害的发生率分别为24.8(95%CI：23.5，26.1)、28.8(95%CI：18.6、38.9)、32.6(95%CI：28.2、37.0)和46.6(95%CI：26.7、66.5)。以及分别患有失眠和服用处方催眠药物(+失眠/+催眠药物)。与-失眠/-催眠药组相比，+失眠/-催眠药、-失眠/+催眠药和+失眠/+催眠药对严重坠落伤的多因素调整危险比分别为1.13(95%CI：0.79，1.61)、1.29(95%CI：1.11，1.50)和1.60(95%CI：1.01，2.56)。
Study ObjectivesInsomnia is common among older adults and associated with an increased risk for falls. Determining if falls are more strongly associated with insomnia or prescribed hypnotic medications could be used to guide interventions to reduce falls risk.MethodsWe examined the prospective association of a diagnosis of insomnia and/or prescribed hypnotic medication use with the risk for serious fall injuries among 9087 Reasons for Geographic and Racial Differences in Stroke (REGARDS) study participants aged 65 years or older with Medicare fee-for-service health insurance at baseline (2003–2007). A diagnosis of insomnia was based on ICD-9 codes in Medicare claims and prescribed hypnotic medication use was determined through a pill bottle review. Serious fall injuries were identified by Medicare claims between baseline and December 31, 2018.ResultsOver a median of 6.8 years, 1660 (18.3%) participants had a serious fall injury. The incidence rates for a serious fall injury per 1000 person-years were 24.8 (95%CI: 23.5, 26.1), 28.8 (95%CI: 18.6, 38.9), 32.6 (95%CI: 28.2, 37.0), and 46.6 (95%CI: 26.7, 66.5) for participants without insomnia or taking prescribed hypnotic medication (–insomnia/–hypnotics), with insomnia only (+insomnia/–hypnotics), taking prescribed hypnotic medication only (–insomnia/+hypnotics), and with insomnia and taking prescribed hypnotic medication (+insomnia/+hypnotics), respectively. Compared with the –insomnia/–hypnotic group, the multivariable-adjusted hazard ratios for a serious fall injury were 1.13 (95%CI: 0.79, 1.61), 1.29 (95%CI: 1.11, 1.50), and 1.60 (95%CI: 1.01, 2.56) for +insomnia/–hypnotics, –insomnia/+hypnotics, and +insomnia/+hypnotics, respectively.ConclusionsThe risk for serious fall injuries was higher for those taking prescribed hypnotic medications but not with an insomnia diagnosis.