title: Relationship between zolpidem use and stroke risk: a Taiwanese population-based case-control study.
abstract: OBJECTIVE
  To evaluate the relationship between the use of zolpidem and risk of subsequent stroke in Taiwanese patients.
  
  
  METHODS
  This case-control study used data obtained from the National Health Insurance Research Database to determine whether the use of zolpidem is associated with an increased risk of stroke. The case group comprised 12,747 patients who were newly diagnosed with stroke between January 1, 2005, and December 31, 2009. We also randomly selected a 4-fold greater number of patients without stroke as a control group. Patients with ischemic and hemorrhagic stroke were frequency-matched with controls on sex, age, and year of index date. We measured the effect of zolpidem and determined the adjusted odds ratios (ORs) with 95% confidence intervals (CIs).
  
  
  RESULTS
  We found that exposure to zolpidem was associated with increased risk of ischemic stroke (OR = 1.37; 95% CI, 1.30-1.44). The risk of ischemic stroke increased significantly with increasing exposure to zolpidem; for average exposures of ≤ 70, 71-470, and > 470 mg per year, the ORs were 1.20, 1.41, and 1.50, respectively; the P value for the trend was < .0001. Regardless of whether people presented with a sleep disorder, the risk of stroke was still greatly increased with zolpidem exposure; the adjusted OR was 1.37 without sleep disorder and 1.41 with sleep disorder.
  
  
  CONCLUSIONS
  This population-based study positively associated the use of zolpidem with increased risk of ischemic stroke. Our findings warrant further large-scale and in-depth investigations in this area.
authors.affiliation: Department of Neurology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Wei-Shih
authors.initials: WS
authors.lastname: Huang
authors.forename: Chon-Haw
authors.initials: CH
authors.lastname: Tsai
authors.forename: Che-Chen
authors.initials: CC
authors.lastname: Lin
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
authors.forename: Yen-Jung
authors.initials: YJ
authors.lastname: Chang
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000139:chemically induced* / Q000453:epidemiology; D016022:Case-Control Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000009:adverse effects*; D012042:Registries; D012306:Risk; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000453:epidemiology; D020521:Stroke / Q000139:chemically induced* / Q000453:epidemiology; D013624:Taiwan; D055815:Young Adult; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem