目的:描述新诊断为失眠症的儿童和青少年,并描述他们使用睡眠和其他相关处方药的情况。
方法:在商业索赔数据库中(1/1/2016-12/31/2021),我们确定了有新记录的失眠诊断(G47.0x;F51.0x)的儿童和青少年(2~24岁),并检查了之前6个月的精神病诊断.我们评估了新失眠诊断后一周内分配的睡眠和相关处方药(即,曲唑酮,其他抗抑郁药,羟嗪,α-激动剂,苯二氮卓类药物,非苯二氮卓催眠药\'Z-药物\',抗精神病药,其他人)。分析按年龄和精神病合并症进行分层。
结果:在68,698名儿童和108,118名年龄较大的青年(18-24岁)中有新的失眠诊断,四分之三的人被诊断患有共病的精神疾病;焦虑症,抑郁症,多动症是最常见的。在那些没有精神病诊断的人中,20.2%的儿童和37.4%的老年青年在接下来的一周内分配了睡眠或相关药物。在没有共病精神病诊断的儿童中,α-受体阻滞剂,羟嗪,曲唑酮是最常见的药物;在老年青年中,曲唑酮是最常见的药物,其次是羟嗪,z-毒品,和SSRIs。睡眠和相关的处方药更常见于患有精神病合并症的患者。从2017年到2021年,在新的失眠诊断后,羟嗪处方增加,z-药物和苯二氮卓类药物处方减少。
结论:我们在全国范围内的年轻失眠患者样本中的发现强调了精神病合并症的高患病率以及他们接受的各种睡眠和相关药物。表征处方倾向可为指南开发和未来研究提供信息。
OBJECTIVE: To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications.
METHODS: Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants,
hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics \"z-drugs,\" antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities.
RESULTS: Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists,
hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by
hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in
hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions.
CONCLUSIONS: Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research.