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Abstract：
The aim of this study was to examine the risk of falls associated with the use of non-gamma amino butyric acid (GABA) sleep medications, suvorexant and ramelteon. This case-control and case-crossover study was performed at the Kudanzaka Hospital, Chiyoda Ward, Tokyo. A total of 325 patients who had falls and 1295 controls matched by sex and age were included. The inclusion criteria for the case group were hospitalized patients who had their first fall and that for the control were patients who were hospitalized and did not have a fall, between January 2016 and November 2018. The internal sleep medications administered were classified as suvorexant, ramelteon, non-benzodiazepines, benzodiazepines, or kampo. In the case-control study, age, sex, clinical department, the fall down risk score, and hospitalized duration were adjusted in the logistic regression model. In the case-control study, multivariable logistic regression showed that the use of suvorexant (odds ratio [OR]: 2.61, 95% confidence interval [CI]: 1.29-5.28), nonbenzodiazepines (OR: 2.49, 95% CI: 1.73-3.59), and benzodiazepines (OR: 1.65, 95% CI: 1.16-2.34) was significantly associated with an increased OR of falls. However, the use of ramelteon (OR: 1.40, 95% CI: 0.60-3.16) and kampo (OR: 1.55, 95% CI: 0.75-3.19) was not significantly associated with an increased OR of falls. In the case-crossover study, the use of suvorexant (OR: 1.78, 95% CI: 1.05-3.00) and nonbenzodiazepines (OR: 1.63, 95% CI: 1.17-2.27) was significantly associated with an increased OR of falls. Similar patterns were observed in several sensitivity analyses. It was suggested that suvorexant increases the OR of falls. This result is robust in various analyses. This study showed that the risk of falls also exists for non-GABA sleep medication, suvorexant, and thus it is necessary to carefully prescribe hypnotic drugs under appropriate assessment.
摘要：
这项研究的目的是检查与使用非γ-氨基丁酸（GABA）睡眠药物相关的跌倒风险，Suvorexant和Ramelteon.这项病例对照和病例交叉研究是在Kudanzaka医院进行的，ChiyodaWard,东京。共包括325名跌倒患者和1295名性别和年龄匹配的对照。病例组的纳入标准为首次跌倒的住院患者,对照组为住院且未跌倒的患者,2016年1月至2018年11月。服用的内部睡眠药物被归类为suvorexant，Ramelteon,非苯二氮卓类药物，苯二氮卓类药物,或者Kampo.在病例对照研究中，年龄,性别,临床科室,跌倒风险评分，和住院时间在logistic回归模型中进行调整。在病例对照研究中，多变量逻辑回归显示，使用suvorexant（比值比[OR]：2.61，95％置信区间[CI]：1.29-5.28），非苯并二氮卓类药物（OR：2.49，95%CI：1.73-3.59），苯二氮卓类药物（OR：1.65，95％CI：1.16-2.34）与跌倒的OR增加显着相关。然而,使用ramelteon(OR:1.40,95%CI:0.60~3.16)和kampo(OR:1.55,95%CI:0.75~3.19)与跌倒OR增加无显著相关性.在案例交叉研究中，使用suvorexant(OR:1.78,95%CI:1.05~3.00)和非苯并二氮卓类药物(OR:1.63,95%CI:1.17~2.27)与跌倒的OR增加显著相关.在几个敏感性分析中观察到类似的模式。有人建议suvorexant增加跌倒的OR。该结果在各种分析中是稳健的。这项研究表明，非GABA睡眠药物也存在跌倒的风险，suvorexant,因此，有必要在适当评估下仔细处方催眠药物。
