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Cited by 5Sleep and related disordersChronic Obstructive Pulmonary Disease (COPD) ResearchPharmaceutical Practices and Patient Outcomes

The DOI matches its Crossref record; 43 of the 43 references it cites were found in a registry or an index.

Association Between Hypnotic Use and All-Cause Mortality in Patients with Chronic Obstructive Pulmonary Disease and Insomnia

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El-Solh, Ali A, Lawson, Yolanda, Wilding, Gregory E·2023·International Journal of Chronic Obstructive Pulmonary Disease
DOI 10.2147/copd.s430609PMC PMC10629458
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Abstract

Purpose: Hypnotics are commonly prescribed in patients with COPD to manage insomnia. Given the considerable risks associated with these drugs, the aim of the study was to evaluate the risk of all-cause mortality associated with hypnotics in a cohort of veterans with COPD presenting with insomnia. Methods: We conducted a retrospective cohort study that used Veterans Health Administration Corporate Data Warehouse with data supplemented by linkage to Medicare, Medicaid, and National Death Index data from 2010 through 2019. The primary outcome was all-cause mortality. Analyses were conducted using propensity score 1:1 matching to balance baseline characteristics. Results: Of the 5759 veterans with COPD (mean [SD] age, 71.7 [11.2]; 92% men), 3585 newly initiated hypnotic agents during the study period. During a mean follow-up of 7.4 (SD, 2.7) years, a total of 2301 deaths occurred, with 65.2 and 48.7 total deaths per 1000 person-years among hypnotic users and nonusers, respectively. After propensity matching, hypnotic use was associated with a 22% increased risk of mortality compared with hypnotic nonusers (hazard ratio [HR] 1.22; 95% confidence interval [CI],1.11-1.35). The benzodiazepine receptor agonists (BZRAs) group experienced a higher incidence rate of all-cause mortality compared to hypnotic nonusers (Incidence rate ratio [IRR] 1.27; 95% CI, 1.14-1.43). Conversely, the mortality rate of non-BZRA hypnotics decreased after the first 2 years and was not significantly different for hypnotic nonusers (IRR 1.04; 95% CI, 0.82-1.11). Conclusion: Among patients with COPD and insomnia, treatment with hypnotics was associated with a higher risk of all-cause mortality. The association was observed in patients prescribed BZRAs. The risk of mortality for non-BZRAs moderated after the first 2 years, indicating a class effect.

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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 [54]

    The Introduction (page unavailable) says COPD patients frequently have sleep disturbances, including delayed sleep onset and frequent arousals, and that hypnotics are frequently prescribed for their insomnia. It does not establish the same claims for congestive heart failure or bronchial asthma, or say that these conditions are commonly associated with obstructive or central sleep apnea that increases reliance on hypnotics. The Discussion mentions worsening apneas as a possible adverse effect of hypnotics, not as the proposed reason for their use. (LLM, conf=0.88)

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Metadata

Authors
El-Solh, A. A., Lawson, Y., & Wilding, G. E.
Affiliations
  • Buffalo VA Medical Center (US)
  • University at Buffalo, State University of New York (US)
Corresponding author
El-Solh, Ali A
ORCID
Venue
International Journal of Chronic Obstructive Pulmonary Disease
Publisher
Informa UK Limited
Published
2023-11
Volume
Volume 18
Pages
2393-2404
ISSN
  • 1176-9106 (ISSN-L)
  • 1178-2005
DOI
10.2147/copd.s430609
PMC
PMC10629458
OpenAlex
W4388298551
Cited by
5
References
43
Citations by year
2025: 2 · 2024: 3
FWCI
1.29
Type
journal article
Language
en
Open access
Licence
Locations
  • International Journal of COPD (publishedVersion, cc-by-nc)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • Dove Medical Press (Taylor and Francis Group) (submittedVersion, cc-by-nc)
Funders
  • U.S. Department of Veterans Affairs (I01 CX001656)
  • Office of Research and Development
Topics
  • Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
  • Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
  • Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
Keywords
hypnotics, chronic obstructive pulmonary disease, insomnia, all-cause mortality, benzodiazepine receptor agonists, veterans, drug safety, mortality risk
MeSH terms
Aged, Female, Medicare, Humans, Hypnotics and Sedatives, Sleep Initiation and Maintenance Disorders, Male, Retrospective Studies, United States, Pulmonary Disease, Chronic Obstructive

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