Abstract
The aim of this study was to examine the risk of falls associated with the use of non-gamma amino butyric acid (GABA) sleep medications, suvorexant and ramelteon. This case-control and case-crossover study was performed at the Kudanzaka Hospital, Chiyoda Ward, Tokyo. A total of 325 patients who had falls and 1295 controls matched by sex and age were included. The inclusion criteria for the case group were hospitalized patients who had their first fall and that for the control were patients who were hospitalized and did not have a fall, between January 2016 and November 2018. The internal sleep medications administered were classified as suvorexant, ramelteon, non-benzodiazepines, benzodiazepines, or kampo. In the case-control study, age, sex, clinical department, the fall down risk score, and hospitalized duration were adjusted in the logistic regression model. In the case-control study, multivariable logistic regression showed that the use of suvorexant (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.29-5.28), nonbenzodiazepines (OR: 2.49, 95% CI: 1.73-3.59), and benzodiazepines (OR: 1.65, 95% CI: 1.16-2.34) was significantly associated with an increased OR of falls. However, the use of ramelteon (OR: 1.40, 95% CI: 0.60-3.16) and kampo (OR: 1.55, 95% CI: 0.75-3.19) was not significantly associated with an increased OR of falls. In the case-crossover study, the use of suvorexant (OR: 1.78, 95% CI: 1.05-3.00) and nonbenzodiazepines (OR: 1.63, 95% CI: 1.17-2.27) was significantly associated with an increased OR of falls. Similar patterns were observed in several sensitivity analyses. It was suggested that suvorexant increases the OR of falls. This result is robust in various analyses. This study showed that the risk of falls also exists for non-GABA sleep medication, suvorexant, and thus it is necessary to carefully prescribe hypnotic drugs under appropriate assessment.
Highlights
Falls are a major cause of fractures and accidents and are associated with reduced activities of daily living (ADL) in elderly people [1,2,3]
The aim of this study was to examine the risk of falls associated with the use of non-gamma amino butyric acid (GABA) sleep medications, suvorexant and ramelteon
This study showed that the risk of falls exists for non-GABA sleep medication, suvorexant, and it is necessary to carefully prescribe hypnotic drugs under appropriate assessment
Summary
Falls are a major cause of fractures and accidents and are associated with reduced activities of daily living (ADL) in elderly people [1,2,3]. Oral intake of sleep medications is a major risk factor for falls. A systematic review found that the use of four or more internal medicines was associated with about 1.7–2.7 times increased risk of falls in the elderly [5]. Non-benzodiazepines were not considered to be associated with an increased risk of falls and fractures [6]. Though the elderly are at a high risk of falling due to lack of focus of attention, muscle weakness, and sensory deficits [12], at the same time the prevalence of insomnia increases [9, 11]
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