Risk Predictors for Hypnosedative-Related Complex Sleep Behaviors in Elderly Psychiatric Outpatients

Tzung-Jeng Hwang ； Chih-Yun Hsu ； Hsi-Chung Chen ； Ming H. Hsieh ； Chien-An Yao ； Chen-Chung Liu ； Wen-Jing Liu ； Chih-Min Liu ； Shih-Cheng Liao

《台灣老年醫學暨老年學雜誌》 9卷2期 (2014/05) Pp. 44-44(2)

並列摘要

Objective: To explore the risk predictors for complex sleeprelated behaviors (CSBs) in elderly psychiatric outpatients taking hypnosedative drugs. Methods: A total of 312 subjects using hypnosedatives were enrolled from the psychiatric outpatient clinics of a medical center in Taiwan from June 2011 to November 2012. The inclusion criteria were 1) 55-85 years of age, 2) having been exposed to hypnotics (including benzodiazepine and NBRAs) for more than 3 months within 2 years, 3) diagnosis of a depressive disorder, anxiety disorder, adjustment disorder, somatoform disorder, sleep disorder, schizophrenia or bipolar affective disorder, and 4) a cohabitant such as a family member or partner. The exclusion criteria were dementia, delirium, amnestic and other cognitive disorders, organic brain syndrome, seizure disorder, head injury, eating disorder, substance use disorder (other than hypnosedatives use disorders) and unstable medical disease. CSBs included somnambulism with object manipulation, SRED and other less frequent amnestic complex behavior. All subjects completed a questionnaire that included (1) demographic data, body height, body weight and medical history; (2) usual sleep habits, including sleep schedule and bedtime routine; (3) childhood sleep habits and behaviors, and (4) sleep-related behaviors. An experienced research assistant contacted each subject's cohabitant by telephone for further clarification of the information given and confirmation of true CSBs. Demographic and clinical variables were compared in those with CSBs and those without in total sample and in zolpidem users. Then multiple logistic regression analyses were performed in order to identify significant risk predictors for CSBs. Results: Out of the 312 elderly subjects, 113 (36.2%) took zolpidem, 19 (6.1%) had CSBs and 15 (78.9%) of those having CSBs took zolpidem. Univariate analysis showed that those with CSBs were significantly more likely to take zolpidem (P＜.001) and to have fewer medical comorbidities (P=0.035). Multiple logistic regression analyses revealed that taking zolpidem (OR=9.8; 95% CI, 3.1-31.1; P＜.001) and having fewer medical comorbidities (OR=1.3; 95% CI, 1.2-1.6; P=0.009) were the significant predictors of CSBs. When we focused on the 113 elderly zolpidem users, univariate analysis showed that those with CSBs were significantly more likely to take higher dose of zolpidem (P=0.001) and to have fewer medical comorbidities (P=0.008). Multiple logistic regression analyses revealed that zolpidem≧15 mg/day (OR=4.2; 95% CI, 1.1-16.3; P=0.038) and having fewer medical comorbidities (OR=1.4; 95% CI, 1.1- 1.7; P=0.019) were the significant predictors of CSBs. Conclusion: This study suggests that a higher dosage of zolpidem (≧10 mg/day) is the key risk predictor for CSBs in elderly psychiatric outpatients.