使用安眠藥物導致睡眠障礙老人骨折的風險

Abstract

由於持續攀升的死亡率、發生率及在骨折醫療照護上的花費不斷的增加，骨折的已變成現今重要的議題。為了能夠及早預防，骨折的相關危險因子已變成重要的因素，若能了解危險因子，可用於日後做於預測及分析。 由於benzodiazepine及zolpidem為短效藥物，比較先前發表過的研究皆用病例對照研究，而在短效藥物方面卻需要使用病例交叉研究來證實疾病與藥物之間的短效關聯性，在本研究運用健保局資料庫，此資料庫為台灣衛生研究院所發行，資料庫內容包含病患的住院紀錄、看病紀錄、用藥紀錄及門診紀錄，比較先前發表過的醫學研究本研究擁有最大的資料庫及最多的實驗組。 在未校正共病的干擾因子時Benzodiazepine(OR=1.17(1.06-1.30) p<0.05)而校正後OR下降為1.08(0.97-1.22) p=0.14，Zolpidem未校正藥物的OR為1.27(1.09-1.48) p<0.05)，校正干擾因子後下降為1.13(0.96-1.34) p=0.14，研究結果顯示校正高血壓、骨關節炎、骨質疏鬆、類風濕性關節炎及憂鬱症後皆顯示為不顯著，表示藥物並非主要影響骨折的因素，其共病對骨折也有影響，導致在校正完共病後為不顯著。在分層分析上而校正共病干擾因素後所有的年齡區間皆與骨折不相關，表示在各年齡層上，共病也會影響骨折，並非是年齡及藥物。 本篇研究首先以病例交叉研究發現24小時內服用無論zolpidem 和benzodiazepine兩者藥物皆和骨折皆無顯著相關，清楚描述短效藥物適用於病例交叉研究設計並以條件邏輯分析做分析。未來在研究上可在針對各安眠藥物劑量做進一步的相關研究。

In nowadays fracture becomes an important issue because of the incidence rate of death increasing and the highly cost of physical therapy treatment. In order to do the prevention earlier, it is urgent to know the correct predictors of fracture. Since benzodiazepine and zolpidem are short-acting drugs, compared existing studies using case control design studies this study using case crossover design to know the risk of benzodiazepine and zolpidem in insomnia elderly. By using National Health Insurance Research Database (NHIRD) which including patient demographics, primary and secondary diagnoses of disease, procedures, prescriptions, and medical expenditures, it has much larger dataset (n=6010) and complete information than previous studies. After adjusting comorbidities (hypertension, osteoarthritis, osteoporosis, rheumatoid arthritis and depression) benzodiazepine (OR=1.08 (0.97-1.22), p=0.14) and zolpidem (OR=1.13 (0.96-1.34), p=0.14) have non-significant with fracture so it mean both drugs are not direct impact fracture but comorbidities. In stratified analysis, among patients without depression, there is 1.23, p<0.001 hazards of fracture. This study shows that the case crossover design is more suitable for studying transient risk factors for sudden-onset fracture. Patients with zolpidem or benzodiazepine would not cause fracture in elderly insomnia and the study suggest that patients without depression would have highly risk have fracture after inducing benzodiazepine than with depression in insomnia elderly it could provide for further investigation.