title: Zolpidem and the risk of Parkinson's disease: a nationwide population-based study.
abstract: BACKGROUND
  This nationwide population-based study investigated the risk of Parkinson's disease (PD) after zolpidem use in patients with sleep disturbance using the National Health Insurance Research Database (NHIRD) in Taiwan.
  
  
  METHODS
  In total, 59,548 adult patients newly diagnosed with sleep disturbance and who used zolpidem were recruited as the study cohort, along with 42,171 subjects who did not use zolpidem as a comparison cohort from 2002 to 2009. Each patient was monitored for 5 years, and those who subsequently had PD were identified. A Cox proportional hazards model was used to compare the risk of PD between the study and comparison cohorts after adjusting for possible confounding risk factors.
  
  
  RESULTS
  The patients who received zolpidem had a higher cumulative rate of PD than those who did not receive zolpidem during the 5-year follow-up period (1.2% vs. 0.5%, P < 0.001). The adjusted hazard ratios were 1.10 (95% CI, 0.88-1.37), 1.41 (95% CI, 1.17-1.72), and 1.27 (95% CI, 1.05-1.55) for zolpidem use with 28-90, 91-365, and more than 365 cumulative defined daily doses (cDDDs), respectively, compared to those who did not use zolpidem.
  
  
  CONCLUSIONS
  Among the patients with sleep disturbance, zolpidem use increased the risk of PD after 5 years of follow-up. Further mechanistic research of zolpidem effect in PD is needed.
authors.affiliation: Department of Neurology, China Medical University Hospital and School of Medicine, China Medical University, Taichung, Taiwan.
authors.forename: Yu-Wan
authors.initials: YW
authors.lastname: Yang
authors.affiliation: Department of Urology, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taichung, Taiwan; School of Medicine, Tzu Chi University, Hualian, Taiwan.
authors.forename: Teng-Fu
authors.initials: TF
authors.lastname: Hsieh
authors.affiliation: Department of Medical Research, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC.
authors.forename: Chia-Hui
authors.initials: CH
authors.lastname: Yu
authors.affiliation: Division of Neurology, Department of Internal Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC. Electronic address: solomons1117@yahoo.com.tw.
authors.forename: Yung-Sung
authors.initials: YS
authors.lastname: Huang
authors.affiliation: School of Medicine, Tzu Chi University, Hualian, Taiwan; Department of Otolaryngology, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC; Department of Education, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC. Electronic address: hematcd@hotmail.com.
authors.forename: Ching-Chih
authors.initials: CC
authors.lastname: Lee
authors.affiliation: Department of Psychiatry, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, No. 2, Ming-Sheng Road, Dalin Town, Chiayi 622, Taiwan, ROC. Electronic address: tsaitsunghuang@hotmail.com.
authors.forename: Tsung-Huang
authors.initials: TH
authors.lastname: Tsai
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D015331:Cohort Studies; D018672:Community Health Planning; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000706:statistics & numerical data; D010300:Parkinson Disease / Q000453:epidemiology* / Q000209:etiology*; D016016:Proportional Hazards Models; D011725:Pyridines / Q000009:adverse effects*; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000188:drug therapy* / Q000453:epidemiology*; D013624:Taiwan; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D000077334:Zolpidem
keywords: Insomnia; Parkinson's disease; Risk; Sleep disturbance; Zolpidem