The association between zolpidem and infection in patients with sleep disturbance.
OBJECTIVE
Recent case reports suggest that zolpidem usage may be associated with infection events. The aim of this study was to determine the risk of infection events in patients with sleep disturbance taking zolpidem in a full 3-year follow-up study.


METHODS
A total of 17474 subjects with a diagnosis of sleep disturbance in 2002 and 2003 were identified, of whom 5882 had used zolpidem after recruitment. A Cox proportional hazard model was used to estimate the 3-year infection event-free rates for the patients using zolpidem and those not using zolpidem after adjusting for confounding factors. To maximize case ascertainment, only patients hospitalized for infection events were included.


RESULTS
A total of 646 patients had had infection events, 331 (5.63%) of whom had been taking zolpidem and 315 (2.71%) had not. Zolpidem usage increased the risk of infection events. After adjustments for gender, age, co-morbidities, and other medications, patients using zolpidem with cDDD 1-28, 29-84, and >84 had hazard ratios of 1.67 (95% CI, 1.32-2.11), 1.91 (95% CI, 1.47-2.49) and 1.62 (95% CI, 1.32-1.98) respectively, compared with patients who did not use zolpidem.


CONCLUSIONS
Zolpidem increased the risk of infection events in sleep disturbance patients. This increased risk of infection should be explained to sleep disturbance patients, and prescriptions of zolpidem to chronic insomnia patients should be restricted.
Division of Nephrology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan.
Chih-Yuan
CY
Huang
Department of Community Psychiatry, Kai-Syuan Psychiatric Hospital, Kaohsiung City, Taiwan; Graduate Institute of Health Care and Department of Nursing, Meiho University, Ping-Tong County, Taiwan.
Frank Hunag-Chih
FH
Chou
Division of Neurology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Yung-Sung
YS
Huang
Department of Orthopedics, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Chang-Jen
CJ
Yang
Department of Pharmacy, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan; Division of Hematology-Oncology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Yu-Chieh
YC
Su
Department of Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Shiun-Yang
SY
Juang
Division of Metabolism and Endocrinology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan.
Pin-Fan
PF
Chen
Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
Pesus
P
Chou
Department of Pharmacy, Chiayi Branch, Taichung Veterans General Hospital, Chiayi, Taiwan.
Ching-An
CA
Lee
Cancer Center, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan. Electronic address: enttcd@hotmail.com.
Ching-Chih
CC
Lee
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D007239:Infections / Q000453:epidemiology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D016016:Proportional Hazards Models; D011725:Pyridines / Q000627:therapeutic use*; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D013624:Taiwan; D055815:Young Adult; D000077334:Zolpidem
D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
Immunity; Infection; Mean daily dose; Zolpidem