Conference Coverage

Are Nonbenzodiazepines Appropriate for Treating Sleep Disturbance in Dementia?

A review of research and hospital data indicates that this drug class increases the risk of fractures.


CHICAGO—Nonbenzodiazepine hypnotic “Z-drugs” (eg, zolpidem, zopiclone, and zaleplon) increase the risk of fractures in a dose-dependent manner in people with dementia, according to research presented at AAIC 2018. Patients with dementia who are receiving these drugs should be monitored, according to the researchers.

Approximately 60% of people with dementia have sleep disturbance. Z-drugs are often prescribed to help treat insomnia in older adults, but observers have raised concerns that these treatments may cause problems such as falls and fractures and increase confusion. Researchers have not fully investigated the safety and efficacy of Z-drugs in this patient population, however.

Chris Fox, MD, Professor of Psychiatry at Norwich Medical School at the University of East Anglia in the United Kingdom, and colleagues analyzed cohort studies using primary care data from the UK Clinical Practice Research Datalink that was linked to hospital admissions data. They also examined data from three clinical studies of people with dementia. To evaluate the benefits and harms of these medicines, the researchers compared data for 2,952 people with dementia who were newly prescribed Z-drugs with data for 1,651 people who were not prescribed sedatives or hypnotics.

Chris Fox, MD

Dr. Fox and colleagues defined the index date as the first date of a diagnosis of sleep disturbance or of a Z-drug prescription after dementia diagnosis. They excluded patients who had been prescribed a sedative during the previous year. Patients were followed for as long as two years or until 90 days after their last prescription. Dr. Fox’s group compared the two arms’ outcomes using Cox regression. They adjusted the data for sociodemographic variables, BMI, systolic blood pressure, diagnosed health conditions, and comedications.

The use of Z-drugs was associated with a 47% increased risk of any type of fracture. The risk increased among patients on higher doses. Z-drug use was also associated with greater risks of hip fracture and mortality. The study did not identify a higher risk of other events, such as falls, infections, stroke, or venous thromboembolism.

“Fractures in people with dementia can have a devastating impact, including loss of mobility, increased dependency, and worsening dementia,” said Dr. Fox. “We desperately need better alternatives to the drugs currently being prescribed for sleep problems and other noncognitive symptoms of dementia. Wherever possible, suitable nonpharmacologic alternatives should be considered, and where Z-drugs are prescribed, patients should receive care that reduces or prevents the occurrence of falls.”

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