目的:催眠药可能会增加老年神经认知障碍患者跌倒和骨折的风险。食欲素受体拮抗剂最近被批准,但是新药和骨折之间的关系仍不清楚。这项研究旨在使用全国住院患者数据库评估患有神经认知障碍的老年患者的催眠类型与院内骨折之间的关系。
方法:使用日本诊断程序组合数据库,我们收集了2014年4月至2021年3月期间年龄≥65岁的神经认知障碍住院患者的信息.我们研究了苯二氮卓类药物处方模式的趋势,Z-药物,食欲素受体拮抗剂和褪黑素受体激动剂。我们还对院内骨折进行了1:4匹配的病例对照分析。每种催眠药物的比值比使用带有步行能力调整的广义估计方程来估计,合并症,骨质疏松,透析,选择性5-羟色胺再摄取抑制剂的使用和抗痴呆药物的使用。
结果:苯二氮卓催眠药的处方减少,食欲素受体拮抗剂的处方增加。这项病例对照分析包括6832例骨折患者和23463例对照。超短作用苯二氮卓类药物,短效苯二氮卓类药物和Z类药物与骨折风险增加相关(比值比[95%置信区间]1.38[1.08-1.77],1.38[1.27-1.50],1.49[1.37-1.61],分别)。Orexin受体拮抗剂与骨折风险增加无关(1.07[0.95-1.19])。
结论:与其他类型的催眠药相比,在患有神经认知障碍的老年患者中,食欲素受体拮抗剂与院内骨折无关.GeriatrGerontolInt2023;••:••-•。
OBJECTIVE: Hypnotics might increase the risk of falls and fractures in older patients with neurocognitive disorders. Orexin receptor antagonists have recently been approved, but the relationship between the new drugs and fractures remains unclarified. This study aimed to evaluate the association between the type of hypnotic and in-hospital fractures in older patients with neurocognitive disorders using a nationwide inpatient database.
METHODS: Using the Japanese Diagnosis Procedure Combination database, we collected information on inpatients aged ≥65 years with neurocognitive disorders between April 2014 and March 2021. We examined trends in the prescription patterns of benzodiazepine drugs, Z-drugs, orexin receptor antagonists and melatonin receptor agonists. We also carried out a 1:4 matched
case-control analysis of in-hospital fractures. The odds ratio of each hypnotic drug was estimated using a generalized estimating equation with adjustment for walking ability, comorbidities, osteoporosis, dialysis, selective serotonin reuptake inhibitor use and anti-dementia drug use.
RESULTS: The prescription of benzodiazepine hypnotics decreased and that of orexin receptor antagonists increased. This
case-control analysis included 6832 patients with fractures and 23 463 controls. Ultrashort-acting benzodiazepines, short-acting benzodiazepines and Z-drugs were associated with an increased risk of bone fracture (odds ratio [95% confidence interval] 1.38 [1.08-1.77], 1.38 [1.27-1.50], 1.49 [1.37-1.61], respectively). Orexin receptor antagonists were not associated with an increased risk of bone fracture (1.07 [0.95-1.19]).
CONCLUSIONS: In contrast to other types of hypnotics, orexin receptor antagonists were not associated with in-hospital fractures in older patients with neurocognitive disorders. Geriatr Gerontol Int 2023; 23: 500-505.