Mortality, exacerbation risk in patients with COPD not higher with insomnia hypnotics
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Key takeaways:
- Similar risks for mortality and exacerbations were found among patients with COPD taking insomnia hypnotics vs. other hypnotics.
- However, insomnia hypnotics increased the risk for both outcomes vs. no hypnotics.
WASHINGTON — Compared with other hypnotics, a class of insomnia hypnotics did not raise the risk for death or inpatient COPD exacerbations, according to research presented at the American Thoracic Society International Conference.
“Prior work among patients with COPD demonstrated greater risks for adverse outcomes among patients prescribed non-benzodiazepine benzodiazepine receptor agonists (NBZRAs), or Z-drugs, relative to those without such prescriptions,” Jason M. Castaneda, MD, internal medicine resident at the University of Washington, and Lucas M. Donovan, MD, MS, assistant professor in the division of pulmonary, critical care and sleep medicine at the University of Washington and sleep doctor at VA Puget Sound Health Care System, told Healio in a statement. “We were concerned that these prior observations may be due to greater unmeasured baseline risks among individuals with insomnia relative to those without (ie, confounding by indication). Consistent with this suspicion, we did not detect a difference in the risk of mortality or inpatient COPD exacerbation between NBZRAs and other first-line sleep medications.”
In an observational study, Castaneda, Donovan and colleagues evaluated 298,301 patients with COPD from the Veterans Health Administration to see if NBZRA prescriptions changed the risk for mortality or inpatient COPD exacerbations compared with other hypnotic prescriptions (melatonin, ramelteon, trazodone and doxepin).
Researchers looked within a 90-day timeframe to figure out how many patients were newly prescribed NBZRA (n = 1,276), other hypnotics (n = 3,372) or neither.
To assess differences in outcomes between both prescription groups using Cox models, researchers propensity matched patients based on 40 variables that covered demographics, medical comorbidities, sleep comorbidities and COPD severity markers, according to the abstract.
In the matched cohort of 1,276 patients with a NBZRA prescription and 1,276 patients with a prescription for other hypnotics, the risk for mortality or inpatient COPD exacerbation over 1 year did not differ (HR = 1.05; 95% CI, 0.83-1.33), according to the abstract. This was a surprising finding, Castaneda and Donovan told Healio.
“We were surprised at just how similar the outcomes were between the two groups,” they said. “Our findings suggest that NBZRAs do not put patients with COPD at greater risk for COPD exacerbations and death than other hypnotic drugs.”
Further, researchers matched those with an NBZRA prescription to those with no hypnotic prescription and found that patients with this prescription faced a higher risk for both outcomes (HR = 1.86; 95% CI, 1.41-2.45).
“Among patients with insomnia, cognitive behavioral therapy for insomnia is the first line treatment,” Castaneda and Donovan told Healio. “Among patients requiring short-term use, our findings suggest that NBZRAs, or Z-drugs, might not pose greater risk to patients with COPD than other first-line sleep medications. However, it is important to remember that patients prescribed hypnotics tend to be at greater risk of death or exacerbation than patients who are not prescribed such medications. What is unclear is whether hypnotic medications place patients at higher risk, or if patients with insomnia just have greater baseline risk.”
Randomized controlled trials are required to account for all unmeasured confounding variables, Castaneda and Donovan told Healio.
“Our hope is that our study is an example of how observational research can be rigorous and clinically meaningful,” they told Healio. “Observational studies can add significant value when conducted with intention and an eye for controlling potential biases. However, if we are to fully account for unmeasured confounding, we need randomized trials to test different approaches to insomnia among at-risk populations like COPD.”
Reference:
- Insomnia drug class may not influence death and exacerbation risks among patients with COPD. https://www.thoracic.org/about/newsroom/press-releases/conference/resources/copd-death-and-exacerbation-risk.pdf. Published May 23, 2023. Accessed May 23, 2023.