Su-Jung Chen1,2,3, Chiu-Mei Yeh4, Tze-Fan Chao5,6, Chia-Jen Liu3,7,8, Kang-Ling Wang5,6, Tzeng-Ji Chen4, Pesus Chou9, Fu-Der Wang1,3. 1. Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 2. Department of Medicine, Taipei Veterans General Hospital Su-Ao and Yuan-Shan Branch, I-Lan, Taiwan. 3. Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan. 4. Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 5. Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 6. Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan. 7. Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan. 8. Department of Internal Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan. 9. Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Abstract
STUDY OBJECTIVES: Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD), and benzodiazepine receptor agonists (BZRAs) are the most commonly used drugs despite their adverse effects on respiratory function. The aim of this study was to investigate whether the use of BZRAs was associated with an increased risk of respiratory failure (RF) in COPD patients. DESIGN: Matched case-control study. SETTING: National Health Insurance Research Database (NHIRD) in Taiwan. PARTICIPANTS: The case group consisted of 2,434 COPD patients with RF, and the control group consisted of 2,434 COPD patients without RF, matched for age, sex, and date of enrollment. MEASUREMENTS AND RESULTS: Exposure to BZRAs during the 180-day period preceding the index date was analyzed and compared in the case and control groups. Conditional logistic regression was performed, and the use of BZRAs was associated with an increased risk of RF (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.14-2.13). In subgroup analysis, we found that the benzodiazepine (BZD) users had a higher risk of RF (aOR 1.58, 95% CI 1.14-2.20), whereas the risk in non-benzodiazepine (non-BZD) users was insignificant (aOR 0.85, 95% CI 0.51-1.44). A greater than 2-fold increase in risk was found in those who received two or more kinds of BZRAs and those using a combination of BZD and non-BZD medications. CONCLUSIONS: The use of benzodiazepine receptor agonists was a significant risk factor for respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Compared to benzodiazepine, the prescription of non-benzodiazepine may be safer for the management of insomnia in COPD patients.
STUDY OBJECTIVES:Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD), and benzodiazepine receptor agonists (BZRAs) are the most commonly used drugs despite their adverse effects on respiratory function. The aim of this study was to investigate whether the use of BZRAs was associated with an increased risk of respiratory failure (RF) in COPDpatients. DESIGN: Matched case-control study. SETTING: National Health Insurance Research Database (NHIRD) in Taiwan. PARTICIPANTS: The case group consisted of 2,434 COPDpatients with RF, and the control group consisted of 2,434 COPDpatients without RF, matched for age, sex, and date of enrollment. MEASUREMENTS AND RESULTS: Exposure to BZRAs during the 180-day period preceding the index date was analyzed and compared in the case and control groups. Conditional logistic regression was performed, and the use of BZRAs was associated with an increased risk of RF (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.14-2.13). In subgroup analysis, we found that the benzodiazepine (BZD) users had a higher risk of RF (aOR 1.58, 95% CI 1.14-2.20), whereas the risk in non-benzodiazepine (non-BZD) users was insignificant (aOR 0.85, 95% CI 0.51-1.44). A greater than 2-fold increase in risk was found in those who received two or more kinds of BZRAs and those using a combination of BZD and non-BZD medications. CONCLUSIONS: The use of benzodiazepine receptor agonists was a significant risk factor for respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Compared to benzodiazepine, the prescription of non-benzodiazepine may be safer for the management of insomnia in COPDpatients.
Authors: Lucas M Donovan; Carol A Malte; Laura J Spece; Matthew F Griffith; Laura C Feemster; Steven B Zeliadt; David H Au; Eric J Hawkins Journal: Ann Am Thorac Soc Date: 2019-09
Authors: Lucas M Donovan; Carol A Malte; Laura J Spece; Matthew F Griffith; Laura C Feemster; Ruth A Engelberg; David H Au; Eric J Hawkins Journal: Ann Am Thorac Soc Date: 2019-01