Sleep medication use and risk of fractures in breast cancer survivors

Reina Haque,Liehong Chen,Rowan T Chlebowski

doi:10.1007/s10549-021-06392-4

Abstract

PurposeSleep problems are more common in breast cancer survivors than those without a cancer history. Our goal was to examine the risk of fractures among breast cancers survivors who used prescription sleep aids.MethodsWe conducted a retrospective cohort study of 21,346 adult women diagnosed with stage 0–III breast cancer between 2009 and 2016 and followed them through 2017. We examined person-year rates of fractures by sleep medication use and calculated adjusted hazard ratios (HR) and 95% confidence intervals (CI) with Cox proportional hazards models using time-dependent variables for sleep medications and covariate medications (antidepressants, anti-anxiety medications, and bisphosphonates) adjusted for demographics, comorbidities, and tumor characteristics and cancer treatments.ResultsThe sleep medication use was common (40%) in breast cancer survivors and was associated with a 33% increased risk of fractures (adjusted HR = 1.33, 95% CI: 1.20–1.49). Further, in a sensitivity analysis based on new use of sleep medication, the fracture risk was even stronger (adjusted HR = 1.44, 95% CI: 1.26–1.64).ConclusionGiven the high use of sleep medications and the high risk of fractures in breast cancer survivors, this study suggests that non-pharmacologic management of sleep problems might be considered as alternative therapy.

Highlights

For many of the 3.8 million female breast cancer survivors living in the US in 2019, improved survival is complicated by long-term psychosocial effects including sleep problems [1]
We identified first incident fractures that occurred after breast cancer diagnosis, from the health plan’s electronic health records (EHR)
In the third sensitivity analysis based on the subset of women with spine bone mineral density (n = 8,498), as expected, we found that the fracture risk associated with sleep medication use decreased with better

Summary

Introduction

For many of the 3.8 million female breast cancer survivors living in the US in 2019, improved survival is complicated by long-term psychosocial effects including sleep problems [1]. The prevalence of insomnia symptoms is nearly 40% in cancer survivors versus 10%–15% in the general U.S population [2]. Breast cancer survivors are more likely to have physical symptoms and psychological distress than patients with other types of cancers possibly due the treatment side-effects [5, 6]. Hot flashes caused by tamoxifen can lead to or exacerbate sleep problems in breast cancer survivors [7]. Limited information exists about use of sleep aids in breast cancer survivors and consequent health outcomes

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