ベンゾジアゼピン系・非ベンゾジアゼピン系睡眠導入薬を慢性的に服用している急性期脳卒中発症患者における安全な睡眠薬選択の検討

抄録

The present study aims to investigate the safe selection of sleeping medications for patients with acute stroke who were chronic users of benzodiazepine/non-benzodiazepine (BZD/Z-drugs). In this retrospective cohort study, we investigated sleep disturbances and delirium in patients with acute stroke who were chronic users of BZD/Z-drugs; these patients were treated with a BZD/Z-drug or a new type of sleep medication (ramelteon alone or in combination with suvorexant) in April 2013-March 2017. Overall, 155 patients were recruited, of whom 75 were prescribed a BZD/Z-drug and 80 were prescribed a new type of sleep medication. Patient characteristics showed no significant difference between the two groups. Subjective sleep quality was significantly improved in the patients receiving the new type of sleep medication compared with those receiving a BZD/Z-drug (difficulty in falling asleep: 25％ vs 10％, P = 0.019; difficulty staying asleep: 29％ vs 6.3％, P < 0.001). Further, a multivariable logistic regression analysis revealed that BZD/Z-drug use was significantly associated with sleep disturbance (OR 4.5, 95％ CI 2.1-9.6, P < 0.001). Delirium was significantly less frequent in patients receiving the new type of sleep medication compared with those receiving a BZD/Z-drug (16％ vs 3.8％, P = 0.013). Switching to the new type of sleep medication can improve subjective sleep quality without inducing delirium in patients with acute stroke who were chronic users of BZD/Z-drugs.