title: The association between benzodiazepine use and sleep quality in residential aged care facilities: a cross-sectional study.
abstract: Benzodiazepines are commonly prescribed in residential aged care facilities (RACFs) for their sedative and anxiolytic effects. The objective of this study was to investigate the association between benzodiazepine use and sleep quality in residents of RACFs.
  
  
  
  A cross-sectional study involving 383 participants was conducted in six Australian RACFs. Night-time sleep quality, day-time drowsiness and day-time napping behavior were assessed using a validated questionnaire. Logistic regression was used to compute adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the association between benzodiazepine use and sleep quality. Covariates included pain, dementia severity, depression, insomnia and other sedative use.
  
  
  
  Of the 383 residents (mean age 87.5 years, 77.5% female), 96(25.1%) used a benzodiazepine on a regular basis. Residents who used long-acting benzodiazepines on a regular basis had higher night-time sleep quality than non-users (AOR = 4.00, 95%CI 1.06 - 15.15). Residents who used short-acting benzodiazepines on a PRN only basis had longer daytime napping times than non-users (AOR = 1.77, 95%CI 1.01 - 3.08). No benzodiazepine category was associated with day-time drowsiness.
  
  
  
  The association between benzodiazepine use and sleep quality is dependent on the half-life and prescribing pattern of the benzodiazepine. Short-acting PRN benzodiazepines were associated with lower night time sleep quality and longer day-time napping compared to long-acting regular benzodiazepines. Longitudinal studies are needed to determine whether these findings reflect channeling of short-acting agents to residents at higher risk of sleep disorders.
authors.affiliation: Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
authors.forename: Lynna
authors.initials: L
authors.lastname: Chen
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Melbourne, Parkville Victoria, 3052, Australia.|NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia.|Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia.
authors.forename: J Simon
authors.initials: JS
authors.lastname: Bell
authors.affiliation: Discipline of Medicine, University of Adelaide, Adelaide, Australia.|Aged and Extended Care Services, The Queen Elizabeth Hospital and Adelaide Geriatrics Training and Research with Aged Care (GTRAC) Centre, School of Medicine, University of Adelaide, Adelaide, Australia.
authors.forename: Renuka
authors.initials: R
authors.lastname: Visvanathan
authors.affiliation: NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, Australia.|Kolling Institute of Medical Research, Departments of Clinical Pharmacology and Aged Care, Royal North Shore Hospital, Sydney Medical School, The University of Sydney, Sydney, Australia.
authors.forename: Sarah N
authors.initials: SN
authors.lastname: Hilmer
authors.affiliation: Resthaven Limited, Adelaide, Australia.
authors.forename: Tina
authors.initials: T
authors.lastname: Emery
authors.affiliation: Resthaven Limited, Adelaide, Australia.
authors.forename: Leonie
authors.initials: L
authors.lastname: Robson
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Melbourne, Parkville Victoria, 3052, Australia.
authors.forename: Jessica M
authors.initials: JM
authors.lastname: Hughes
authors.affiliation: Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, 381 Royal Parade, Melbourne, Parkville Victoria, 3052, Australia. edwin.tan@monash.edu.|Aging Research Center, Center for Alzheimer Research, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden. edwin.tan@monash.edu.
authors.forename: Edwin C K
authors.initials: EC
authors.lastname: Tan
mesh_terms: D000369:Aged, 80 and over; D001007:Anxiety / Q000188:drug therapy* / Q000453:epidemiology; D040561:Assisted Living Facilities / Q000706:statistics & numerical data; D001315:Australia / Q000453:epidemiology; D001569:Benzodiazepines / Q000493:pharmacokinetics / Q000627:therapeutic use; D001682:Biological Availability; D003430:Cross-Sectional Studies; D003704:Dementia / Q000188:drug therapy; D006970:Disorders of Excessive Somnolence / Q000139:chemically induced / Q000175:diagnosis; D005260:Female; D006207:Half-Life; D006801:Humans; D006993:Hypnotics and Sedatives / Q000493:pharmacokinetics / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D010146:Pain / Q000188:drug therapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012890:Sleep / Q000187:drug effects*; D011795:Surveys and Questionnaires
chemical_list: D006993:Hypnotics and Sedatives; D001569:Benzodiazepines
keywords: Benzodiazepines; Homes for the aged; Hypnotics and sedatives; Nursing homes; Sleep; Sleep disorders; Sleep quality