Increased Mortality Risk and Shorter Life Expectancy Associated With Sleeping Pills

Yu Sun, MD, PhD

Data from a nationwide study of nearly 500,000 adults in Taiwan identified an association between sleeping pills and an increased risk of mortality and shortened life expectancy, especially in extreme sleepers. Investigators concluded that strategies to raise public and clinician awareness of the potential harms are needed, considering the increasing trends in long-term hypnotic/sedative prescriptions worldwide.

The study featured 484,916 community-dwelling adults in Taiwan who were categorized by daily sleep duration into 4 groups: extremely short (<4 h), short (4-6 h), medium (6-8 h), and long (>8 h). With 6-8 hours of daily sleep, sleeping pill nonusers had the lowest mortality risk. Sleeping pill users, even with this optimal amount of sleep, had a 55% (95% CI, 1.38-1.73; P <.001) higher mortality risk than nonusers.

"The mechanisms underling the association between sleeping pill use and causes of death are likely to be multifactorial, including potentially lethal morbidities such as cancer, infection, depression, suicide, falling, fracture, automobile accidents, suppressed respiration, and dementia,” lead investigator Yu Sun, MD, PhD, Institute of Preventive Medicine, National Taiwan University, and colleagues, wrote. To the authors’ knowledge, this was the first study to investigate the joint effects of sleep duration and sleep quality with sleeping pill use.

Over a median follow-up period of 10 years, 16,927 (3.5%) deaths occurred, with cancer (39.1%), cardiovascular diseases (19.6%), and respiratory diseases (7.1%) as the leading causes. Compared with sleeping pill nonusers with medium sleep time, the reference group, the HRs for sleeping pill users were 1.37 (95% CI, 1.19-1.59), 1.55 (95% CI, 1.38-1.73), and 2.23 (95% CI, 1.89-2.26) in groups with short, medium, and long sleep durations, respectively. For extremely short sleepers, the HR of sleeping pills on mortality was 1.33 but was not significant after adjustment for aforementioned confounders.

Psychiatric medications were taken by a small portion (n = 2858; 0.5%) of study participants. After adjusting psychiatric medication use, sleeping pill users had 10%, 11%, and 31% higher risk of all-cause mortality in those with medium, short, and extremely short sleep durations, respectively. Although these were not statistically significant, investigators did observed a 96% (95% CI, 1.52-2.54) increased mortality risk among long sleepers than the reference group. Of note, sensitivity analyses excluding these patients continued to show significant increase in the risk of mortality in extreme short and long sleepers.

READ MORE: Gaining a Better Understanding of Idiopathic Hypersomnia, Uses of Low-Sodium Oxybate

Patients who complained of dreaming frequently during sleep had the lowest mortality risk, while those who had difficulty falling asleep had higher mortality risk than those who reported no problems during sleep. Mortality odds were higher in sleeping pill users who reported no sleep problems than in nonusers who reported sleep quality problems, after adjustment for the aforementioned demographic characteristics, lifestyle factors, and comorbidities. These results were consistent overall and for nonusers after adjusting for psychiatric medication use.

On average, sleeping pill users had 5.3 years and 5.7 years shorter life expectancy among men and women, respectively. Among men, at age 50, sleeping pill users with extreme sleep duration had 3.9 years (<4 h) and 5.4 years (>8 h) shorter life expectancy. For male extreme sleepers at age 30, taking sleeping pills was associated with approximately 9 years reduction in life expectancy, resulting in a reduction of life expectancy by up to 12.6 years compared with sleeping pill nonusers with 6-8 hours of sleep.

Among women, significantly shorter life expectancy was found in sleeping pill users with long sleep times (>8 h), compared with the medium sleepers without taking sleeping pills at the same age. Few women who used sleeping pills had sleep durations of less than 4 hours at age 40 (n = 0), 50 years (n = 1), 60 years (n = 6), or 70 years (n = 5) of age, so the results in these groups might not be meaningful, the study authors noted.

REFERENCE
1. Sun Y, Tsai MK, Wen CP. Association of sleep duration and sleeping pill use with mortality and life expectancy: a cohort study of 484,916 adults. Sleep Health. 2023;9(3):354-362. doi:10.1016/j.sleh.2023.01.017