title: The Use of Benzodiazepine Receptor Agonists and Risk of Respiratory Failure in Patients with Chronic Obstructive Pulmonary Disease: A Nationwide Population-Based Case-Control Study.
abstract: OBJECTIVE
  Insomnia is prevalent in patients with chronic obstructive pulmonary disease (COPD), and benzodiazepine receptor agonists (BZRAs) are the most commonly used drugs despite their adverse effects on respiratory function. The aim of this study was to investigate whether the use of BZRAs was associated with an increased risk of respiratory failure (RF) in COPD patients.
  
  
  METHODS
  Matched case-control study.
  
  
  METHODS
  National Health Insurance Research Database (NHIRD) in Taiwan.
  
  
  METHODS
  The case group consisted of 2,434 COPD patients with RF, and the control group consisted of 2,434 COPD patients without RF, matched for age, sex, and date of enrollment.
  
  
  RESULTS
  Exposure to BZRAs during the 180-day period preceding the index date was analyzed and compared in the case and control groups. Conditional logistic regression was performed, and the use of BZRAs was associated with an increased risk of RF (adjusted odds ratio [aOR] 1.56, 95% confidence interval [CI] 1.14-2.13). In subgroup analysis, we found that the benzodiazepine (BZD) users had a higher risk of RF (aOR 1.58, 95% CI 1.14-2.20), whereas the risk in non-benzodiazepine (non-BZD) users was insignificant (aOR 0.85, 95% CI 0.51-1.44). A greater than 2-fold increase in risk was found in those who received two or more kinds of BZRAs and those using a combination of BZD and non-BZD medications.
  
  
  CONCLUSIONS
  The use of benzodiazepine receptor agonists was a significant risk factor for respiratory failure in patients with chronic obstructive pulmonary disease (COPD). Compared to benzodiazepine, the prescription of non-benzodiazepine may be safer for the management of insomnia in COPD patients.
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Medicine, Taipei Veterans General Hospital Su-Ao and Yuan-Shan Branch, I-Lan, Taiwan.|Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Su-Jung
authors: SJ
authors: Chen
authors: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Chiu-Mei
authors: CM
authors: Yeh
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan.
authors: Tze-Fan
authors: TF
authors: Chao
authors: Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.|Division of Hematology and Oncology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Department of Internal Medicine, National Yang-Ming University Hospital, I-Lan, Taiwan.
authors: Chia-Jen
authors: CJ
authors: Liu
authors: Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang-Ming University, Taiwan.
authors: Kang-Ling
authors: KL
authors: Wang
authors: Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
authors: Tzeng-Ji
authors: TJ
authors: Chen
authors: Community Medicine Research Center and Institute of Public Health, National Yang-Ming University, Taipei, Taiwan.
authors: Pesus
authors: P
authors: Chou
authors: Division of Infectious Diseases, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.|Institute of Public Health and School of Medicine, National Yang-Ming University, Taipei, Taiwan.
authors: Fu-Der
authors: FD
authors: Wang
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use*; D016022:Case-Control Studies; D016208:Databases, Factual; D005260:Female; D058785:GABA-A Receptor Agonists / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications* / Q000503:physiopathology; D011963:Receptors, GABA-A / Q000378:metabolism; D012131:Respiratory Insufficiency / Q000139:chemically induced* / Q000150:complications* / Q000503:physiopathology; D012306:Risk; D000068776:Sleep Aids, Pharmaceutical / Q000009:adverse effects / Q000627:therapeutic use; D007319:Sleep Initiation and Maintenance Disorders / Q000150:complications* / Q000188:drug therapy*; D013624:Taiwan
chemical_list: D058785:GABA-A Receptor Agonists; D011963:Receptors, GABA-A; D000068776:Sleep Aids, Pharmaceutical; D001569:Benzodiazepines
keywords: Taiwan National Health Insurance Research Database; benzodiazepine receptor agonists; chronic obstructive pulmonary disease; respiratory failure