Use of Sedative-Hypnotics and Mortality: A Population-Based Retrospective Cohort Study

STUDY OBJECTIVES: Researchers have previously reported a possible association between sedative-hypnotics and increased mortality. However, the relationship remains controversial. We investigated the association between sedative-hypnotics and mortality using a large population-based database from the Republic of Korea. METHODS: We used a National Health Insurance Service database. The study population was a 5% random sample of the database from the years 2002– 2015. Individuals who were age 40 years and older were included in the analysis. The sedative-hypnotic users were defined as individuals prescribed 30 or more defined daily doses of sedative-hypnotics per year since January 2004. Sedative-hypnotics were classified based on type and total amount. We estimated the risk of mortality (death from January 2004 to December 2015) using time-dependent Cox regression model adjusted for age, sex, Charlson Comorbidity Index, and psychiatric comorbidity. RESULTS: We identified 180,823 study participants who used sedative-hypnotics and 320,136 nonusers. In a multivariate model, study participants who used sedative-hypnotics had significantly higher mortality risk than nonusers (hazard ratio [HR] 1.14, 95% confidence interval [CI] 1.12–1.16). Specifically, study participants who used zolpidem had a higher mortality risk (HR 1.59, 95% CI 1.52–1.67) than nonusers. CONCLUSIONS: Based on the current study results, sedative-hypnotics were associated with an increased risk of mortality, especially in study participants who used zolpidem. CITATION: Choi JW, Lee J, Jung SJ, Shin A, Lee YJ. Use of sedative-hypnotics and mortality: a population-based retrospective cohort study. J Clin Sleep Med. 2018;14(10):1669–1677.