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Cited by 6Chronic Obstructive Pulmonary Disease (COPD) ResearchSleep and related disordersPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 39 of the 39 references it cites were found in a registry or an index.

Risks of Zolpidem among Patients with Chronic Obstructive Pulmonary Disease

Castaneda, Jason M., Hee Wai, Travis, Spece, Laura J., Duan, Kevin I., Leonhard, Aristotle, Griffith, Matthew F., Plumley, Robert, Palen, Brian N., Feemster, Laura C., Au, David H., Donovan, Lucas M.·2024·Annals of the American Thoracic Society
DOI 10.1513/annalsats.202307-654oc
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Abstract

Abstract Rationale Nonbenzodiazepine benzodiazepine receptor agonists (NBZRA, e.g., zolpidem) are frequently used to treat insomnia among patients with chronic obstructive pulmonary disease (COPD). However, multiple observational studies find that patients with COPD who are prescribed NBZRAs have greater risks for mortality and respiratory complications than patients without such prescriptions. Without an active comparator, these studies are susceptible to confounding by indication. Objectives Compare the risk of death or inpatient COPD exacerbation among patients receiving zolpidem relative to patients receiving other hypnotics. Methods Using nationwide Veterans Health Administration (VA) data, we identified patients with clinically diagnosed COPD and new receipt of zolpidem or another hypnotic available on VA formulary without prior authorization (melatonin, trazodone, doxepin). We excluded those receiving traditional benzodiazepines or multiple concurrent hypnotics. We propensity-matched patients receiving zolpidem to other hypnotics on 32 variables, including demographics, comorbidities, and markers of COPD severity. We compared risk of the primary composite outcome of death or inpatient COPD exacerbation over 1 year. In secondary analyses, we propensity-matched patients receiving zolpidem to those without hypnotic receipt. Results Among 283,740 patients meeting inclusion criteria, 1,126 (0.4%) received zolpidem and 3,057 (1.1%) received other hypnotics. We propensity-matched patients receiving zolpidem 1:1 to peers receiving other hypnotics. We did not find a difference in the primary composite outcome of death or inpatient exacerbation (hazard ratio, 0.97; 95% confidence interval [CI], 0.77–1.23). In secondary analyses comparing patients receiving zolpidem to matched peers without hypnotic receipt, we observed greater risk of death or inpatient exacerbation with zolpidem (hazard ratio, 1.40; 95% CI, 1.09–1.81). Conclusions Among patients with COPD, we did not observe greater risks after new receipt of zolpidem relative to other hypnotics. However, we did observe greater risks relative to those without hypnotic receipt. This latter finding may reflect: 1) residual, unmeasured confounding related to insomnia; or 2) true adverse effects of hypnotics across classes. Future work is needed to better understand the risks of hypnotics in COPD.

Overview

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Crossref · 10.1513/annalsats.202307-654oc

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39 of 39 references verified0 citation errors · 0 not checkable

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  • Conditions such as congestive heart failure, bronchial asthma, and COPD can hinder sleep onset and maintenance and are commonly associated with sleep-disordered breathing, further impairing sleep and increasing reliance on hypnotics.

    “Conditions such as congestive heart failure, bronchial asthma, and chronic obstructive pulmonary disease (COPD) can hinder sleep onset and maintenance. These disorders are also commonly associated with sleep-disordered breathing (such as obstructive or central sleep apnea), further impairing sleep and increasing reliance on hypnotics.”

    From Z-drug abuse and dependence: Clinical guideline of the Brazilian Academy of Neurology for diagnosis and management (2025) · cites this paper as [55]

Citations

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Research works printed but not linked: 3

  1. George, 2000, Perspectives on the management of insomnia in patients with chronic respiratory disorders, Sleep, 23, S31
  2. Zammit, 1999, Quality of life in people with insomnia, Sleep, 22, S379
  3. Montgomery, 2002, Cognitive behavioural interventions for sleep problems in adults aged 60+, Cochrane Database Syst Rev, CD003161

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Metadata

Authors
Castaneda, J. M., Hee Wai, T., Spece, L. J., Duan, K. I., Leonhard, A., Griffith, M. F., Plumley, R., Palen, B. N., Feemster, L. C., Au, D. H., & Donovan, L. M.
Affiliations
  • University of Washington (US)
  • University of British Columbia, Vancouver, British Columbia, Canada; and
  • University of British Columbia (CA)
  • VA Puget Sound Health Care System (US)
ORCID
Venue
Annals of the American Thoracic Society
Publisher
Oxford University Press (OUP)
Published
2024-01-01
Volume
21
Issue
1
Pages
68-75
ISSN
  • 2325-6621 (ISSN-L)
  • 2329-6933
DOI
10.1513/annalsats.202307-654oc
OpenAlex
W4388233527
Cited by
6
References
39
Citations by year
2026: 5 · 2025: 1
FWCI
1.11
Type
journal article
Language
en
Open access
closed
Licence
academic.oup.com/pages/standard-publication-reuse-rights (vor)
Locations
  • Annals of the American Thoracic Society (publishedVersion)
  • PubMed (publishedVersion)
Funders
Health Services Research and Development (CDA 18-187)
Topics
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
zolpidem, chronic obstructive pulmonary disease, hypnotics, insomnia, COPD exacerbations, mortality, confounding by indication, veterans, melatonin, trazodone, doxepin, adverse drug reactions, propensity score matching, confounding by treatment
MeSH terms
Zolpidem, Benzodiazepines, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Pulmonary Disease, Chronic Obstructive

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