The Korean journal of internal medicine

The Korean Association of Internal Medicine (대한내과학회)
권호 표지
DOI QR코드

DOI QR Code

Use of hypnotics and the risk of or mortality from heart disease: a meta-analysis of observational studies

  • Received : 2016.08.31
  • Accepted : 2017.02.12
  • Published : 2018.07.01
⟨ Previous Next ⟩

Abstract

Background/Aims: Some observational epidemiologic studies have reported conflicting results on the relationship between hypnotics use and the risk of developing and/or dying from heart disease. We investigated these associations using a meta-analysis of available literatures. Methods: We searched the databases PubMed and EMBASE, along with the bibliographies of relevant articles to find additional publications in February 2016. Results: Of 495 articles satisfying our initial criteria, two case-control studies and six cohort studies met our inclusion criteria and were included in the final analyses. Compared with never having used any kind of hypnotics, the odds ratio for overall use was 0.84 for risk of or mortality from heart disease (95% confidence interval, 0.79 to 0.89) in a random-effects meta-analysis of all eight studies. With respect to the geographical region, use of hypnotics was associated with a decreased risk or mortality of heart disease in Asia but not in Western countries. Among various types of sleep medications, zolpidem showed a decreased risk (-29%) of developing or dying from heart disease, but benzodiazepines were related with an increased risk (80%) of or mortality from heart disease. Conclusions: The current meta-analysis of observational epidemiological studies suggested an evidence of association between hypnotics use and a decreased risk of heart disease.

Keywords

References

  1. Colten HR, Altevogt BM. Sleep Disorders and Sleep Deprivation: An Unmet Public Health Problem. Washington (DC): National Academies Press, 2006.
  2. Nomura K, Yamaoka K, Nakao M, Yano E. Impact of insomnia on individual health dissatisfaction in Japan, South Korea, and Taiwan. Sleep 2005;28:1328-1332. https://doi.org/10.1093/sleep/28.10.1328
  3. Ancoli-Israel S, Roth T. Characteristics of insomnia in the United States: results of the 1991 National Sleep Foundation Survey. I. Sleep 1999;22 Suppl 2:S347-S353.
  4. Morin CM, LeBlanc M, Daley M, Gregoire JP, Merette C. Epidemiology of insomnia: prevalence, self-help treatments, consultations, and determinants of help-seeking behaviors. Sleep Med 2006;7:123-130. https://doi.org/10.1016/j.sleep.2005.08.008
  5. Mellinger GD, Balter MB, Uhlenhuth EH. Insomnia and its treatment: prevalence and correlates. Arch Gen Psychiatry 1985;42:225-232. https://doi.org/10.1001/archpsyc.1985.01790260019002
  6. Ohayon MM, Caulet M, Priest RG, Guilleminault C. Psychotropic medication consumption patterns in the UK general population. J Clin Epidemiol 1998;51:273-283. https://doi.org/10.1016/S0895-4356(97)00238-2
  7. Vermeeren A. Residual effects of hypnotics: epidemiology and clinical implications. CNS Drugs 2004;18:297-328. https://doi.org/10.2165/00023210-200418050-00003
  8. Alvarenga JM, Loyola Filho AI, Firmo JO, Lima-Costa MF, Uchoa E. Prevalence and sociodemographic characteristics associated with benzodiazepines use among community dwelling older adults: the Bambui Health and Aging Study (BHAS). Rev Bras Psiquiatr 2008;30:7-11.
  9. Sanna E, Busonero F, Talani G, et al. Comparison of the effects of zaleplon, zolpidem, and triazolam at various GABA(A) receptor subtypes. Eur J Pharmacol 2002;451:103-110. https://doi.org/10.1016/S0014-2999(02)02191-X
  10. Inagaki T, Miyaoka T, Tsuji S, Inami Y, Nishida A, Horiguchi J. Adverse reactions to zolpidem: case reports and a review of the literature. Prim Care Companion J Clin Psychiatry 2010;12:e1-e8.
  11. Mailliet F, Galloux P, Poisson D. Comparative effects of melatonin, zolpidem and diazepam on sleep, body temperature, blood pressure and heart rate measured by radiotelemetry in Wistar rats. Psychopharmacology (Berl) 2001;156:417-426. https://doi.org/10.1007/s002130100769
  12. Jehle J, Ficker E, Wan X, et al. Mechanisms of zolpideminduced long QT syndrome: acute inhibition of recombinant hERG K(+) channels and action potential prolongation in human cardiomyocytes derived from induced pluripotent stem cells. Br J Pharmacol 2013;168:1215-1229. https://doi.org/10.1111/bph.12002
  13. Kim DH, Lee JT, Lee IK, Ha JH. Comparative anticancer effects of flavonoids and diazepam in cultured cancer cells. Biol Pharm Bull 2008;31:255-259. https://doi.org/10.1248/bpb.31.255
  14. Weissinger J. NDA 19-908 ambien pharmacology memos & exclusivity summary [Internet]. Silver Spring (US): U.S. Food and Drug Administration, c1992 [cited 2017 Jul 21]. Available from: http://www.accessdata.fda.gov/drugsatfda_docs/nda/pre96/019908_S000_PHARM_MEMOS&EXCLUSIVITY_SUMMARY.pdf.
  15. Mallon L, Broman JE, Hetta J. Is usage of hypnotics associated with mortality? Sleep Med 2009;10:279-286. https://doi.org/10.1016/j.sleep.2008.12.004
  16. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002;21:1539-1558. https://doi.org/10.1002/sim.1186
  17. DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986;7:177-188. https://doi.org/10.1016/0197-2456(86)90046-2
  18. Merlo J, Hedblad B, Ogren M, et al. Increased risk of ischaemic heart disease mortality in elderly men using anxiolytics-hypnotics and analgesics: results of the 10-year follow-up of the prospective population study "Men born in 1914", Malmo, Sweden. Eur J Clin Pharmacol 1996;49:261-265. https://doi.org/10.1007/BF00226325
  19. Zhou X, Zhang Y, Chen J, Xu W. Use of non-benzodiazepine hypnotics is associated with decreased risk of coronary artery disease. Intern Med 2012;51:829-832. https://doi.org/10.2169/internalmedicine.51.6942
  20. Mallon L, Broman JE, Hetta J. Sleep complaints predict coronary artery disease mortality in males: a 12-year follow-up study of a middle-aged Swedish population. J Intern Med 2002;251:207-216. https://doi.org/10.1046/j.1365-2796.2002.00941.x
  21. Belleville G. Mortality hazard associated with anxiolytic and hypnotic drug use in the National Population Health Survey. Can J Psychiatry 2010;55:558-567. https://doi.org/10.1177/070674371005500904
  22. Rod NH, Andersen I, Prescott E. Psychosocial risk factors and heart failure hospitalization: a prospective cohort study. Am J Epidemiol 2011;174:672-680. https://doi.org/10.1093/aje/kwr144
  23. Jaussent I, Ancelin ML, Berr C, et al. Hypnotics and mortality in an elderly general population: a 12-year prospective study. BMC Med 2013;11:212. https://doi.org/10.1186/1741-7015-11-212
  24. Lan TY, Zeng YF, Tang GJ, et al. The use of hypnotics and mortality: a population-based retrospective cohort study. PLoS One 2015;10:e0145271. https://doi.org/10.1371/journal.pone.0145271
  25. Sofi F, Cesari F, Casini A, Macchi C, Abbate R, Gensini GF. Insomnia and risk of cardiovascular disease: a meta-analysis. Eur J Prev Cardiol 2014;21:57-64. https://doi.org/10.1177/2047487312460020
  26. Vogelzangs N, Seldenrijk A, Beekman AT, van Hout HP, de Jonge P, Penninx BW. Cardiovascular disease in persons with depressive and anxiety disorders. J Affect Disord 2010;125:241-248. https://doi.org/10.1016/j.jad.2010.02.112
  27. Roest AM, Martens EJ, de Jonge P, Denollet J. Anxiety and risk of incident coronary heart disease: a meta-analysis. J Am Coll Cardiol 2010;56:38-46. https://doi.org/10.1016/j.jacc.2010.03.034
  28. Huang MP, Radadia K, Macone BW, Auerbach SH, Datta S. Effects of eszopiclone and zolpidem on sleep-wake behavior, anxiety-like behavior and contextual memory in rats. Behav Brain Res 2010;210:54-66. https://doi.org/10.1016/j.bbr.2010.02.018
  29. Price JF, Fowkes FG. Risk factors and the sex differential in coronary artery disease. Epidemiology 1997;8:584-591. https://doi.org/10.1097/00001648-199709000-00018
  30. Gensini GF, Comeglio M, Colella A. Classical risk factors and emerging elements in the risk profile for coronary artery disease. Eur Heart J 1998;19 Suppl A:A53-A61.
  31. Virmani R, Farb A, Burke AP. Risk factors in the pathogenesis of coronary artery disease. Compr Ther 1998;24:519-529.
  32. Lapane KL, Zierler S, Lasater TM, Barbour MM, Carleton R, Hume AL. Is the use of psychotropic drugs associated with increased risk of ischemic heart disease? Epidemiology 1995;6:376-381. https://doi.org/10.1097/00001648-199507000-00008
  33. Muzet A, Johnson LC, Spinweber CL. Benzodiazepine hypnotics increase heart rate during sleep. Sleep 1982;5:256-261. https://doi.org/10.1093/sleep/5.3.256
  34. Hojer J. Management of benzodiazepine overdose. CNS Drugs 1994;2:7-17. https://doi.org/10.2165/00023210-199402010-00002
  35. Ickowicz S, Hayashi K, Dong H, et al. Benzodiazepine use as an independent risk factor for HIV infection in a Canadian setting. Drug Alcohol Depend 2015;155:190-194. https://doi.org/10.1016/j.drugalcdep.2015.07.017
  36. Kingery JR, Alfred Y, Smart LR, et al. Short-term and long-term cardiovascular risk, metabolic syndrome and HIV in Tanzania. Heart 2016;102:1200-1205. https://doi.org/10.1136/heartjnl-2015-309026
  37. Bach P, Walton G, Hayashi K, et al. Benzodiazepine use and hepatitis C seroconversion in a cohort of persons who inject drugs. Am J Public Health 2016;106:1067-1072. https://doi.org/10.2105/AJPH.2016.303090
  38. Domont F, Cacoub P. Chronic hepatitis C virus infection, a new cardiovascular risk factor? Liver Int 2016;36:621-627. https://doi.org/10.1111/liv.13064
  39. Bild DE, Detrano R, Peterson D, et al. Ethnic differences in coronary calcification: the Multi-Ethnic Study of Atherosclerosis (MESA). Circulation 2005;111:1313-1320. https://doi.org/10.1161/01.CIR.0000157730.94423.4B
  40. deLemos AS, Wolfe ML, Long CJ, Sivapackianathan R, Rader DJ. Identification of genetic variants in endothelial lipase in persons with elevated high-density lipoprotein cholesterol. Circulation 2002;106:1321-1326. https://doi.org/10.1161/01.CIR.0000028423.07623.6A

Cited by

  1. Updates in insomnia diagnosis and treatment vol.54, pp.4, 2019, https://doi.org/10.1177/0091217419860716
  2. Cardiovascular Complications of Sleep Disorders: A Better Night’s Sleep for a Healthier Heart / From Bench to Bedside vol.18, pp.None, 2018, https://doi.org/10.2174/1570161118666200325102411