Risks of Zolpidem among Patients with Chronic Obstructive Pulmonary Disease

Area of Science:

• Pulmonary Medicine
• Pharmacology
• Clinical Research

Background:

• Nonbenzodiazepine benzodiazepine receptor agonists (NBZRAs) like zolpidem are common insomnia treatments for COPD patients.
• Observational studies suggest NBZRAs increase mortality and respiratory risks in COPD, but lack active comparators, risking confounding by indication.

Purpose of the Study:

• To compare the risks of death or inpatient COPD exacerbation between zolpidem and other hypnotics in COPD patients.
• To assess risks associated with zolpidem versus no hypnotic use in COPD patients.

Main Methods:

• Utilized nationwide Veterans Health Administration data for COPD patients with new zolpidem or alternative hypnotic (melatonin, trazodone, doxepin) prescriptions.
• Employed propensity-matching on 32 variables to compare zolpidem users with other hypnotic users and non-users.
• Assessed the composite outcome of death or inpatient COPD exacerbation over a 1-year period.

Main Results:

• In a 1:1 propensity-matched comparison, zolpidem use did not significantly increase the risk of death or inpatient COPD exacerbation versus other hypnotics (HR, 0.97; 95% CI, 0.77-1.23).
• Compared to matched non-users, zolpidem use was associated with a higher risk of the composite outcome (HR, 1.40; 95% CI, 1.09-1.81).

Conclusions:

• Zolpidem use in COPD patients did not elevate risks compared to alternative hypnotics.
• The increased risk observed when comparing zolpidem to no hypnotic use may stem from unmeasured confounding or genuine adverse effects of hypnotics across classes.
• Further research is necessary to elucidate the risks of hypnotics in the COPD population.