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    Controlling for poor health did NOT explain the excess deaths associated with sleeping pills


    Posted by .(JavaScript must be enabled to view this email address)
    Monday, April 02, 2012 9:50 am Email this article
    Adjusting for poor health, things such as asthma, cardiovascular disease, kidney disease, etc, did NOT explain the increased risk of death associated with sleeping pills.
    "Control of selective prescription of hypnotics for patients in poor health did not explain the observed excess mortality," the paper notes.
    Later they say, "neither the level of individual health nor the presence of particular [health problems such as asthma or cardiovascular disease or kidney disease, etc] explains the bulk of the hazard associated with the use of hypnotic medications."

    How Sleeping Pills Might Increase the Risk of Death

    Sleeping pills might increase risk of death by increasing infections, depression, suicide, falls, car crashes, etc

    “Multiple causal pathways by which hypnotics might lead to mortality have been demonstrated,” the paper notes.

    “Though the acute lethality of benzodiazepine agonists seems less than that of barbiturates, it has been demonstrated in animals given high doses of benzodiazepine agonists, especially in combination with alcohol.

    “Moreover, benzodiazepines and agonists are often present in mixed-drug overdoses.

    “Compilation of randomised controlled trials has shown that hypnotics increase inci-dent depression.

    “Several non-randomised studies have reported an increase in suicide associated with hypnotics use, and depression may increase mortality through other mechanisms besides suicide.

    “Controlled trials show that hypnotics impair motor and cognitive skills, such as driving.

    “Hypnotics have been associated with increased automobile crashes and an increase in falls, due to hangover sedation.

    “In some patients, hypnotics increase sleep apnoea, prolong apnoeas or suppress respiratory drive, though among other patients, there may be mild improvement.

    “Sleep apnoeas, in turn, may lead to motor vehicle crashes, hypertension, heart failure, arrhythmias, cardiovascular diseases and death.

    “Hypnotics may cause somnambulistic night-eating syndromes resulting in poor diet and obesity as well as other automaton-like behaviours, which can be dangerous.

    “Indeed, in controlled trials, participants randomised to hypnotics experience more adverse medical events overall than those randomised to placebo.”

    “Sparse data from randomised controlled trials of hypnotics suggested increased rates of cancer, and those findings are supported by studies demonstrating carcinogenic effects of hypnotics in laboratory rodents and by evidence that hypnotics can cause chromosomal damage.

    “Our finding that for lymphomas, lung, colon and prostate cancers, the HR for hypnotic usage was even greater than the HR for current smoking (supplemental table 11) argues for specific biologic mechanisms.

    “It is possible that patients receiving hypnotics experienced more medical care than non-users, providing greater surveillance and potential cancer detection as contrasted to non-users, even though the Cox models matched users and non-users by numbers of comorbidities.

    “However, it would be hard to imagine how greater surveillance of hypnotic users could explain two- to threefold higher HR for some cancers with no excess mortality for other cancers (see supplemental table 11), whereas specific biological effects of hypnotics would more plausibly explain the differences in HR between cancers.

    Subjects

    Subjects: 10,000+ people taking sleeping pills vs 23,000+ not taking sleeping pills

    The study followed 10,529 people given prescriptions for sleeping pills and compared them with 23,636 matched controls who had not been given a prescription for sleeping pills.

    Follow-up Period

    Average follow-up of 2.5 years

    The subjects were followed for an average of 2.5 years.

    REFERENCE

    Kripke D, Langer R, Kline L. Hypnotics’ association with mortality or cancer: A matched cohort study. BMJ Open. 2012, 2(1):e000850.

    AUTHOR’S CONTACT INFORMATION

    Dr Daniel F Kripke
    Scripps Clinic Viterbi Family Sleep Center
    La Jolla, California, USA
    .(JavaScript must be enabled to view this email address)

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