Abstract
BackgroundHypnotics have been reported to be associated with dementia. However, the relationship between insomnia, hypnotics and dementia is still controversial. We sought to examine the risk of dementia in patients with long-term insomnia and the contribution of hypnotics.MethodsData was collected from Taiwan’s Longitudinal Health Insurance Database. The study cohort comprised all patients aged 50 years or older with a first diagnosis of insomnia from 2002 to 2007. The comparison cohort consisted of randomly selected patients matched by age and gender. Each patient was individually tracked for 3 years from their insomnia index date to identify whether the patient had a first diagnosis of dementia. Cox regression was used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs).ResultsWe identified 5693 subjects with long-term insomnia and 28,465 individuals without. After adjusting for hypertension, diabetes mellitus, hyperlipidemia, and stroke, those with long-term insomnia had significantly higher risks of dementia (HR, 2.34; 95% CI, 1.92–2.85). Patients with long-term insomnia and aged 50 to 65 years had a higher increased risk of dementia (HR, 5.22; 95% CI, 2.62–10.41) than those older than 65 years (HR, 2.33; 95% CI, 1.90–2.88). The use of hypnotics with a longer half-life and at a higher prescribed dose predicted a greater increased risk of dementia.ConclusionsPatients with long-term use of hypnotics have more than a 2-fold increased risk of dementia, especially those aged 50 to 65 years. In addition, the dosage and half-lives of the hypnotics used should be considered, because greater exposure to these medications leads to a higher risk of developing dementia.
Highlights
Hypnotics are among the most frequently used drugs for patients with insomnia
We examined the risk of dementia, including pre-senile dementia and senile dementia (ICD-9-CM code 290.0–290.3) and Alzheimer’s disease (AD) (ICD-9-CM code 331.0)
We identified 7957 subjects with long-term insomnia, of which 2264 were excluded because of a diagnosis of severe mental illness (SMI) or Parkinson’s disease (PD), leaving 5693 subjects for final analysis
Summary
Hypnotics are among the most frequently used drugs for patients with insomnia. They can be classified as benzodiazepines (BZDs) and non-benzodiazepines (non-BZDs). Fastbom et al reported a significantly lower incidence of dementia in elderly persons using BZDs [1]. Other studies reported that the use of BZDs is associated with a significantly increased risk of dementia [2,3]. Wu et al suggested that the risk of dementia, which was high for current BZD users, decreased as the duration of BZD discontinuation lengthened [3]; Lagnaoui et al reported the opposite findings [2]. Hypnotics have been reported to be associated with dementia. We sought to examine the risk of dementia in patients with long-term insomnia and the contribution of hypnotics
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