By Rick Nauert PhD
A new report warns that obesity may increase the risk of death tied to sleeping pills. The finding is sobering as obese individuals often have sleep problems associated with sleep apnea and other conditions.
Researchers determined mortality rates doubled, even among individuals prescribed 18 or fewer pills in a year.
“Obesity emerged as a marker of increased vulnerability,” said Robert Langer, M.D., M.P.H., during the American Heart Association’s Epidemiology and Prevention Scientific Session in San Diego.
“The associations between sleeping pills and increased mortality were present, and relatively stronger, even in people aged 18 to 54,” said Langer, a family physician and epidemiologist with the Jackson Hole Center for Preventive Medicine in Jackson, Wyo.
“Obese patients appear particularly vulnerable, perhaps through interaction with sleep apnea,” said study co-author Daniel Kripke, M.D., a psychiatrist with Scripps Clinic’s Viterbi Family Sleep Center in San Diego. He noted that sleeping pills were previously associated with more and longer pauses in breathing in people with sleep apnea.
Among obese patients, use of sleeping pills was associated with about one extra death per year for every 100 people who were prescribed the medications, Langer said.
Additionally, men who took sleeping pills were about twice as likely to die as women who received the medications, after accounting for other factors, he said.
The findings were the latest to emerge from a study of almost 40,000 patients, and have been published in the open-access online journal BMJ Open.
Researchers say the findings show that eight of the most commonly used hypnotic drugs were associated with increased hazards of mortality and cancer. Medications include zolpidem (known by the brand name Ambien) and temazepam (also known as Restoril).
Scientists had hoped that these newer drugs were safer than older hypnotics because of their shorter duration of action. However, they were found to have associations with excess deaths no different from the older drugs they have largely replaced.
Researchers used strict study methods to eliminate the possibility that other factors led to the results. For example, study participants who were prescribed sleeping pills were matched with control patients of similar ages, gender and health who did not receive hypnotics.
Langer and his team discovered that obese patients in the study (average body mass index of 38.8) had an eightfold increased chance of death among those who were prescribed the smallest number of pills (18 or fewer annually) when compared with similar study participants who did not take the medications.
The mortality rate was 9.3 times higher on average among obese patients receiving the largest number of pills (132 or more annually).
Death was 4.6 times more likely on average among all patients who received any amount of sleeping pills.
Sleep problems abound in the United States with use of prescription pharmaceuticals growing by 23 percent from 2006 to 2010. The new data casts a pall over a rapidly expanding pharmaceutical segment as companies report about $2 billion in annual sales.
In the study, researchers obtained electronic medical record information on almost 40,000 patients cared for by a large integrated health system in the northeastern United States.
The research included 10,531 sleeping pill users who were prescribed the medications for an average of 2.5 years and 23,674 control participants who were not prescribed the drugs. Information came from outpatient clinic visits conducted between Jan. 1, 2002, and Sept. 30, 2006.
Researchers admit that a study limitation is that the study was an observational, rather than an randomized clinical trial, limiting a direct cause and effect relationship.
“It is important to note that our results are based on observational data, so even though we did everything we could to ensure their validity, it’s still possible that other factors explain the associations,” said co-author Lawrence E. Kline, D.O.”We hope our work will spur additional research in this area using information from other populations.”
The research should prompt physicians to consider alternatives to hypnotic medications, Kline said.
Another option is cognitive therapy that teaches patients to better understand the nature of sleep. For example, some people suffering from insomnia might require less than the eight hours of sleep commonly recommended for each night.
Patients also can benefit from practicing good sleeping habits and relaxation, as well as taking advantage of the body’s natural clock, which is driven by the rising and setting of the sun, Kline said. “Understanding how to use the circadian rhythm is a very powerful tool that doesn’t require a prescription,” he said.
Another important insight is that insomnia may stem from emotional problems such as depression. In these cases, physicians should treat the psychological disorder rather than prescribe sleeping pills that could prove to be harmful, Kripke said.
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