title: Use of Sleep Medications and Mortality: The Hordaland Health Study.
abstract: BACKGROUND
  Previous research suggests a possible link between the use of sleep medications and mortality, but findings are mixed and well-controlled community-based studies are lacking.
  
  
  OBJECTIVE
  The aim of the current study was to examine the prospective association between sleep medications and all-cause mortality.
  
  
  METHODS
  Using a cohort design with 13-15 years of follow-up, we linked self-reported medication use and data on possible confounders from the Hordaland Health Study (HUSK N = 21,826) obtained over the period 1997-1999 to mortality data from the Norwegian Cause of Death Registry. Users of sleep medications (n = 159) were defined as those reporting intake of any prescribed sleep medication (coded according to the Anatomical Therapeutic Chemical [ATC] classification system) on the day before participation in HUSK. Users of sleep medications were also asked if their intake was on a daily or a non-daily basis. Analyses presented are adjusted for sociodemographic and lifestyle factors, mental and physical health, and other medication use.
  
  
  RESULTS
  We found that both type and frequency of sleep medication use were associated with increased general mortality risk. Compared with participants not using sleep medications, those who reported any use had a twofold risk for mortality (95 % confidence interval [CI] 1.1-3.7); the hazard ratio (HR) was 2.9 (95 % CI 1.4-5.9) for daily and 1.1 (95 % CI 0.3-3.4) for non-daily users. Mortality risk was higher for benzodiazepines (HR 3.1; 95 % CI 1.3-7.6), but not significant for short-acting benzodiazepine agonists (HR 1.5; 95 % CI 0.7-3.5).
  
  
  CONCLUSIONS
  Community dwellers who use sleep medications, particularly benzodiazepines, had a significantly increased risk of dying during the 13-15 years of follow-up. The low numbers of individuals reporting chronic usage indicate that the data should be interpreted with great caution, and more well-controlled studies with registry-based information on sleep medication use are needed to further examine the potential harmful effects of sleep medications.
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, 5018, Bergen, Norway. borge.sivertsen@fhi.no.|Regional Centre for Child and Youth Mental Health and Child Welfare, Uni Research Health, Bergen, Norway. borge.sivertsen@fhi.no.|Department of Psychiatry, Helse Fonna HF, Haugesund, Norway. borge.sivertsen@fhi.no.
authors.forename: Børge
authors.initials: B
authors.lastname: Sivertsen
authors.affiliation: National Research Centre for the Working Environment, Copenhagen, Denmark.
authors.forename: Ida E H
authors.initials: IE
authors.lastname: Madsen
authors.affiliation: Finnish Institute of Occupational Health, Helsinki, Finland.
authors.forename: Paula
authors.initials: P
authors.lastname: Salo
authors.affiliation: Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
authors.forename: Grethe S
authors.initials: GS
authors.lastname: Tell
authors.affiliation: Division of Mental Health, Norwegian Institute of Public Health, Kalfarveien 31, 5018, Bergen, Norway.
authors.forename: Simon
authors.initials: S
authors.lastname: Øverland