SEATTLE—The incidence and risk of falls and fractures is higher among patients who use hypnotics than in nonusers, regardless of whether such patients have a balance disorder, according to findings presented by Gary K. Zammit, PhD, and colleagues at the 23rd Annual Meeting of the Associated Professional Sleep Societies.
In a retrospective study, the researchers reviewed data regarding 40,549 patients who filled a prescription for a sedative hypnotic and 81,098 matched controls, which were derived from a managed care claims database. The investigators assessed whether use of sedative hypnotics was associated with risk of falls and fractures. This risk was estimated by calculating relative risk and attributable risk percentages with corresponding confidence intervals.
Risk of Falls and Fractures
Hypnotic users had a higher proportion of balance disorders compared with controls (3.33% vs 2.18%) and higher comorbidity as measured by the Charlson Comorbidity Index (1.07 vs 0.60), reported Dr. Zammit, Clinical Associate Professor in the Department of Psychiatry at Columbia University College of Physicians and Surgeons in New York City, and his team. Dr. Zammit is also President and CEO of Clinilabs, Inc, in New York City.
The researchers found that, in general, hypnotic users were more likely to have falls (1.39% vs 1.02%) and fractures (4.44% vs 2.58%) than were controls, and even hypnotic users without balance disorders were more likely than controls to have falls (1.38% vs 1%) and fractures (4.39% vs 2.54%).
The proportion of falls increased linearly with age, as did the proportion of fractures. The researchers noted that 1.27% of young adult hypnotic users, 1.31% of middle-aged users, and 5.36% of elderly hypnotic users had falls. Similarly, 3.94% of young adult users, 4.49% of middle-aged users, and 10.52% of elderly users had fractures.
For fractures, the risk ratio (RR) was 1.54 among young adult users, 1.59 among middle-aged users, and 1.69 among elderly users, and the attributable risk for hypnotic users was 42%. For falls, the RR was 1.41 among young adult users, 1.28 among middle-aged users, and 1.60 among elderly users, and the attributable risk for hypnotic users was 27%.
Causal Findings?
The study had various limitations, according to the researchers. For example, “we cannot infer any causality from these observational descriptive data,” Dr. Zammit and colleagues commented. Also,due to the retrospective design of the study, the authors had to rely on appropriate coding for clinical diagnoses and treatment. Furthermore, the disease for which the patients received the hypnotic treatment might have been the cause of the differences in frequency of falls and fractures, the researchers pointed out.
—Karen L. Spittler