Medications for Insomnia or Anxiety Linked to 36% Increase in Mortality Risk

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Medications for Insomnia or Anxiety Linked to 36% Increase in Mortality Risk

October 5, 2010 — Sedative drug use is associated with a 36% increase in mortality risk, according to the results of a population-based study reported in the September issue of the Canadian Journal of Psychiatry.

"Although widely used in the general population, sleeping pills and minor tranquilizers, also known as antianxiety agents, have been associated with undesirable outcomes," writes Geneviève Belleville, PhD, from the Université Laval's School of Psychology in Quebec City, Canada. "Reports about the association of these drugs with an elevated mortality rate are inconsistent and controversial."

From 1994 to 2007, a sample of 14,117 people aged 18 to 102 years participated in a panel survey and provided data every second year. The main study endpoints were self-reported use of anxiolytic and hypnotic drugs, and death.

Odds of mortality were 3.22 times higher for participants reporting anxiolytic or hypnotic drug use in the past month vs those who did not report use of anxiolytic or hypnotic drugs in the past month (95% confidence interval [CI], 2.70 - 3.84). This odds ratio (OR) was still significant but was attenuated to 1.36 (95% CI, 1.09 - 1.70), after adjustment for confounding sociodemographic, lifestyle, depression, and other health factors.

"These medications aren't candy, and taking them is far from harmless," Dr. Belleville said in a news release. "Given that cognitive behavioral therapies have shown good results in treating insomnia and anxiety, doctors should systematically discuss such therapies with their patients as an option. Combining a pharmacological approach in the short term with psychological treatment is a promising strategy for reducing anxiety and promoting sleep."

Limitations of this study include evaluation of sedative drug use using a dichotomous, yes-or-no question; failure to control for the presence of anxiety disorders in the prediction model of mortality; and reliance on self-report, creating the potential for biases regarding context, primacy and recency effects, suggestibility, and social desirability.

Although the mechanisms by which sedatives contributed to increased mortality risk were undetermined, these drugs impair reaction time, alertness, and coordination, thereby increasing the risk for falls and other accidents. Respiratory inhibition may aggravate sleep-disordered breathing, and central nervous system inhibition may impair judgment and increase the risk for suicide.

"Sedative drug use is associated with a small but significant increase in mortality risk," the study authors write. "Further research is required to confirm the mechanisms by which sedative drug use increases mortality risk. Where possible, physicians should systematically consider possibilities for nonpharmacological treatment of sleep disturbances and anxiety."

This study was supported by a postdoctoral grant from the Fonds de Recherche en Santé du Québec awarded to Dr. Belleville. Dr. Belleville has disclosed no relevant financial relationships.

Can J Psychiatry. 2010;55:137-146.

http://www.medscape.com/viewarticle/729897