title: Risk of Type 2 Diabetes in Patients With Nonapnea Sleep Disorders in Using Different Types of Hypnotics: A Population-Based Retrospective Cohort Study.
abstract: There has been insufficient evidence on whether exposure to hypnotics affects the risk of type 2 diabetes (T2DM). The aim of this study was to examine patients with nonapnea sleep disorders using zolpidem, benzodiazepines (BZDs), or a combination of both, and their risk of T2DM. This was a population-based retrospective cohort study using data from 1997 to 2011. Data from the Taiwan National Health Insurance Research Database were employed for this study. A total of 45,602 patients with nonapnea sleep disorders and use of hypnotics were identified as the study cohort. The control cohort comprised 40,799 age- and sex-matched patients. We conducted a Cox proportional hazard regression analysis to estimate the effects of hypnotics on risk of T2DM. The overall incidence of T2DM was 20.1 per 1000 person-years for patients using zolpidem, which was significantly higher than that of the control group (11.9 per 1000 person-years). Overall, patients with nonapnea sleep disorders using zolpidem had a higher risk of T2DM compared with patients not using zolpidem and the control cohort (adjusted hazard ratio [HR] = 1.41, 95% confidence interval [CI] = 1.35-1.48). We also observed a significantly higher risk of T2DM in patients with both zolpidem and BZD use (adjusted HR = 1.77, 95% CI = 1.64-1.91) than that of those without zolpidem use and BZD use. Compared with patients not using hypnotics, patients using zolpidem had a higher risk of developing T2DM; the risk was particularly pronounced in those using both zolpidem and BZDs.
authors.affiliation: From the School of Nursing, College of Medicine, National Taiwan University (C-LL); Department of Nursing, Chang Gung University of Science and Technology (C-LL); Department of Nursing, College of Medicine, National Taiwan University (M-CY); Department of Neurosurgery, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation (TH), College of Medicine, Tzu Chi University, Hualien (TH); College of Medicine, China Medical University (C-LL); Management Office for Health Data, China Medical University Hospital (C-LL); Department of Nuclear Medicine and PET Center, China Medical University Hospital (C-HK); and Graduate Institute of Clinical Medical Science, School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan (C-HK).
authors.forename: Chia-Ling
authors.initials: CL
authors.lastname: Lin
authors.forename: Mei-Chang
authors.initials: MC
authors.lastname: Yeh
authors.forename: Tomor
authors.initials: T
authors.lastname: Harnod
authors.forename: Cheng-Li
authors.initials: CL
authors.lastname: Lin
authors.forename: Chia-Hung
authors.initials: CH
authors.lastname: Kao
mesh_terms: D000328:Adult; D000368:Aged; D001569:Benzodiazepines / Q000009:adverse effects*; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced*; D004347:Drug Interactions; D005260:Female; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011725:Pyridines / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D012893:Sleep Wake Disorders / Q000150:complications / Q000188:drug therapy*; D000077334:Zolpidem
chemical_list: D006993:Hypnotics and Sedatives; D011725:Pyridines; D001569:Benzodiazepines; D000077334:Zolpidem