title: High dosage of hypnotics predicts subsequent sleep-related breathing disorders and is associated with worse outcomes for depression.
abstract: OBJECTIVE
  The rates of sleep related breathing disorders (SRBD) and treatment outcomes of depression were compared among insomnia patients who had stratified levels of hypnotic use during a 10-year follow-up (2001-2010).
  
  
  METHODS
  A nationwide population-based cohort study.
  
  
  METHODS
  A nationally representative cohort of 1,000,000 enrollees.
  
  
  METHODS
  Data were collected from patients with major depressive disorder (MDD) and comorbid insomnia during January 2001 to December 2003 (study cohort N = 3,235). The mean dosage of hypnotics at baseline in the study cohort was calculated, and this information was used to categorize the cohort into three equal-sized groups based on levels of hypnotic dosage.
  
  
  METHODS
  Patient response to antidepressants during a period that extended from 1 year before to 1 year after the study (short-term outcome) and patient psychiatric and non-psychiatric visits and hospitalizations during follow-up (long-term outcome) were analyzed.
  
  
  RESULTS
  High-dosage patients presented the highest rates of subsequent SRBD diagnosis (3.9%), compared to medium-dosage patients (2.2%) and low-dosage patients (2.0%) (P = 0.011). Significantly more patients in the high-dosage group were difficult to treat with antidepressants compared to the other 2 groups (8.7% vs. 4.1% vs. 3.0%, P < 0.001), and their long-term depression outcome was worse for most parameters. Logistic regression showed that high-dosage hypnotics predicted the development of SRBD later (OR 1.678 [CI, 1.051 to 2.680], P = 0.030).
  
  
  CONCLUSIONS
  There is a reliable association between a history of high dosages of hypnotics, subsequent diagnosis of sleep related breathing disorder, and worse depression outcomes.
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Cheng-Ta
authors.initials: CT
authors.lastname: Li
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ya-Mei
authors.initials: YM
authors.lastname: Bai
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Ying-Chiao
authors.initials: YC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan.
authors.forename: Wei-Chung
authors.initials: WC
authors.lastname: Mao
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Mu-Hong
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Medical Research and Education, Taipei Veterans General Hospital, Taiwan.
authors.forename: Pei-Chi
authors.initials: PC
authors.lastname: Tu
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ying-Sheue
authors.initials: YS
authors.lastname: Chen
authors.affiliation: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Tzeng-Ji
authors.initials: TJ
authors.lastname: Chen
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Wen-Hang
authors.initials: WH
authors.lastname: Chang
authors.affiliation: Department of Psychiatry, Taipei Veterans General Hospital, Taipei, Taiwan ; Division of Psychiatry, School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors.forename: Tung-Ping
authors.initials: TP
authors.lastname: Su
mesh_terms: D000328:Adult; D017668:Age of Onset; D015331:Cohort Studies; D015897:Comorbidity; D003865:Major Depressive Disorder / Q000453:epidemiology*; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D017063:Outcome Assessment, Health Care; D012119:Respiration / Q000187:drug effects*; D012891:Sleep Apnea Syndromes / Q000139:chemically induced* / Q000453:epidemiology* / Q000503:physiopathology; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy*; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome
chemical_list: D006993:Hypnotics and Sedatives
keywords: Insomnia; antidepressants; depression; hypnotics; sleep apneas; sleep-related