title: Sedative Hypnotic Medication Use and the Risk of Motor Vehicle Crash.
abstract: OBJECTIVE
  We sought to estimate the association between sedative hypnotic use and motor vehicle crash risk.
  
  
  METHODS
  We conducted a new user cohort study of 409 171 adults in an integrated health care system. Health plan data were linked to driver license and collision records. Participants were aged 21 years or older, licensed to drive in Washington State, had at least 1 year of continuous enrollment between 2003 and 2008, and were followed until death, disenrollment, or study end. We used proportional hazards regression to estimate the risk of crash associated with 3 sedatives.
  
  
  RESULTS
  We found 5.8% of patients received new sedative prescriptions, with 11 197 person-years of exposure. New users of sedatives were associated with an increased risk of crash relative to nonuse: temazepam hazard ratio (HR) = 1.27 (95% confidence interval [CI] = 0.85, 1.91), trazodone HR = 1.91 (95% CI = 1.62, 2.25), and zolpidem HR = 2.20 (95% CI = 1.64, 2.95). These risk estimates are equivalent to blood alcohol concentration levels between 0.06% and 0.11%.
  
  
  CONCLUSIONS
  New use of sedative hypnotics is associated with increased motor vehicle crash risk. Clinicians initiating sedative hypnotic treatment should consider length of treatment and counseling on driving risk.
authors.affiliation: Ryan N. Hansen, Denise M. Boudreau, and Sean D. Sullivan are with the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle. Denise M. Boudreau is also with and David C. Grossman is with the Group Health Research Institute, Seattle. Beth E. Ebel is with the Harborview Injury Prevention and Research Center, Seattle, and the Departments of Pediatrics and Epidemiology, and Health Services, University of Washington. David C. Grossman and Sean D. Sullivan are also with the Department of Health Services, University of Washington.
authors.forename: Ryan N
authors.initials: RN
authors.lastname: Hansen
authors.affiliation: Ryan N. Hansen, Denise M. Boudreau, and Sean D. Sullivan are with the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle. Denise M. Boudreau is also with and David C. Grossman is with the Group Health Research Institute, Seattle. Beth E. Ebel is with the Harborview Injury Prevention and Research Center, Seattle, and the Departments of Pediatrics and Epidemiology, and Health Services, University of Washington. David C. Grossman and Sean D. Sullivan are also with the Department of Health Services, University of Washington.
authors.forename: Denise M
authors.initials: DM
authors.lastname: Boudreau
authors.affiliation: Ryan N. Hansen, Denise M. Boudreau, and Sean D. Sullivan are with the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle. Denise M. Boudreau is also with and David C. Grossman is with the Group Health Research Institute, Seattle. Beth E. Ebel is with the Harborview Injury Prevention and Research Center, Seattle, and the Departments of Pediatrics and Epidemiology, and Health Services, University of Washington. David C. Grossman and Sean D. Sullivan are also with the Department of Health Services, University of Washington.
authors.forename: Beth E
authors.initials: BE
authors.lastname: Ebel
authors.affiliation: Ryan N. Hansen, Denise M. Boudreau, and Sean D. Sullivan are with the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle. Denise M. Boudreau is also with and David C. Grossman is with the Group Health Research Institute, Seattle. Beth E. Ebel is with the Harborview Injury Prevention and Research Center, Seattle, and the Departments of Pediatrics and Epidemiology, and Health Services, University of Washington. David C. Grossman and Sean D. Sullivan are also with the Department of Health Services, University of Washington.
authors.forename: David C
authors.initials: DC
authors.lastname: Grossman
authors.affiliation: Ryan N. Hansen, Denise M. Boudreau, and Sean D. Sullivan are with the Pharmaceutical Outcomes Research and Policy Program, School of Pharmacy, University of Washington, Seattle. Denise M. Boudreau is also with and David C. Grossman is with the Group Health Research Institute, Seattle. Beth E. Ebel is with the Harborview Injury Prevention and Research Center, Seattle, and the Departments of Pediatrics and Epidemiology, and Health Services, University of Washington. David C. Grossman and Sean D. Sullivan are also with the Department of Health Services, University of Washington.
authors.forename: Sean D
authors.initials: SD
authors.lastname: Sullivan
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D055553:Prescription Drugs / Q000009:adverse effects; D016016:Proportional Hazards Models; D011725:Pyridines / Q000009:adverse effects; D012307:Risk Factors; D013693:Temazepam / Q000009:adverse effects; D014196:Trazodone / Q000009:adverse effects; D014861:Washington / Q000453:epidemiology; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D055553:Prescription Drugs; D011725:Pyridines; D000077334:Zolpidem; D013693:Temazepam; D014196:Trazodone