High Dosage of Hypnotics Predicts Subsequent Sleep-Related Breathing Disorders and Is Associated with Worse Outcomes for Depression

Abstract

The rates of sleep related breathing disorders (SRBD) and treatment outcomes of depression were compared among insomnia patients who had stratified levels of hypnotic use during a 10-year follow-up (2001-2010). A nationwide population-based cohort study. A nationally representative cohort of 1,000,000 enrollees. Data were collected from patients with major depressive disorder (MDD) and comorbid insomnia during January 2001 to December 2003 (study cohort N = 3,235). The mean dosage of hypnotics at baseline in the study cohort was calculated, and this information was used to categorize the cohort into three equal-sized groups based on levels of hypnotic dosage. Patient response to antidepressants during a period that extended from 1 year before to 1 year after the study (short-term outcome) and patient psychiatric and non-psychiatric visits and hospitalizations during follow-up (long-term outcome) were analyzed. High-dosage patients presented the highest rates of subsequent SRBD diagnosis (3.9%), compared to medium-dosage patients (2.2%) and low-dosage patients (2.0%) (P = 0.011). Significantly more patients in the high-dosage group were difficult to treat with antidepressants compared to the other 2 groups (8.7% vs. 4.1% vs. 3.0%, P < 0.001), and their long-term depression outcome was worse for most parameters. Logistic regression showed that high-dosage hypnotics predicted the development of SRBD later (OR 1.678 [CI, 1.051 to 2.680], P = 0.030). There is a reliable association between a history of high dosages of hypnotics, subsequent diagnosis of sleep related breathing disorder, and worse depression outcomes.