A recent study has found that Chronic obstructive pulmonary disease (COPD) patients newly prescribed non-benzodiazepine benzodiazepine receptor agonists (NBZRAs) such as zolpidem did not have an increased risk of exacerbations requiring hospitalizations or of death than those prescribed other types of hypnotics, according to research published at the ATS 2023 International Conference. The study aimed to compare the risk of death or inpatient exacerbations for COPD patients who were given new prescriptions for NBZRAs with patients given other drugs that were hypnotics but were not NBZRAs. Among the other hypnotics were melatonin, ramelteon, trazodone and doxepin.
NBZRAs are a class of hypnotic drugs prescribed for insomnia and have been associated with respiratory depression and even death in patients with COPD. Studies have found this to be the case, however, these studies have not compared NBZRAs with other hypnotic drugs. This can be a confounding factor given that insomnia itself is associated with these risks for COPD patients.
To tease out the role of NBZRAs, the researchers designed a study that used thousands of medical records from the Veterans Health Administration to compare the risk of death or inpatient exacerbations for COPD patients who were given new prescriptions for NBZRAs with patients given other drugs that were hypnotics but were not NBZRAs.
They matched patients receiving NBZRAs and other hypnotics on 40 variables, such as demographics, medical and sleep disorders, and COPD severity. They also matched patients taking NBZRAs with those taking no hypnotic drugs.
The scientists identified 1,276 COPD patients who received new NBZRA prescriptions in the Veterans Health Administration records, and 3,372 who received new prescriptions for other hypnotics. When the NBZRA patients were matched with the same number of patients prescribed other hypnotics, the researchers found no difference in mortality or inpatient exacerbation risk. When matched with the same number of COPD patients who were not prescribed NBZRAs or other hypnotics, they observed greater risks of both death and exacerbation from the drugs.
“The greater risk of hypnotic drugs may reflect residual, unmeasured confounding related to insomnia. It may also represent true adverse events from hypnotics that cut across hypnotic classes. We need additional research so that we may better understand the risks of hypnotics among patients with COPD, and then optimize strategies to safely improve symptoms,” said lead author Dr. Jason Castaneda, an internal medicine resident at the University of Washington.
The study was done at the VA Puget Sound Health Care System and supported by Health Services Research & Development. A number of the researchers, including senior author Dr. Lucas Donovan, have dual appointments with the VA health care system and the University of Washington.
COPD is a chronic inflammatory lung disease that causes obstructed airflow from the lungs, making it difficult to breathe. Symptoms include coughing, shortness of breath, wheezing, and chest tightness. It is a leading cause of death worldwide. According to the American Lung Association, 16 million people in the United States have been diagnosed with COPD and millions more may have the disease without knowing it.
