AI Article Synopsis

  • Non-benzodiazepine hypnotics, known as "Z-drugs," are medications used for treating insomnia, but they may increase the risk of motor vehicle crashes (MVC) in older adults due to extended drowsiness and slower reaction times.
  • A study analyzed data from New Jersey driver licensing and Medicare claims over a 10-year span to evaluate how starting Z-drug treatment affected MVC risks within 12 weeks.
  • Results indicated a slightly increased risk of MVC with Z-drug treatment overall, but consistent use showed a potential reduction in MVC risk, suggesting that these medications should be prescribed carefully but not completely avoided for older patients.

Article Abstract

Non-benzodiazepine hypnotics ( "Z-drugs") are prescribed for insomnia, but might increase risk of motor vehicle crash (MVC) among older adults through prolonged drowsiness and delayed reaction times. We estimated the effect of initiating Z-drug treatment on the 12-week risk of MVC in a sequential target trial emulation. After linking New Jersey driver licensing and police-reported MVC data to Medicare claims, we emulated a new target trial each week (July 1, 2007 - October 7, 2017) in which Medicare fee-for-service beneficiaries were classified as Z-drug-treated or untreated at baseline and followed for an MVC. We used inverse probability of treatment and censoring weighted pooled logistic regression models to estimate risk ratios (RR) and risk differences with 95% bootstrap confidence limits (CLs). There were 257,554 person-trials, of which 103,371 were Z-drug-treated and 154,183 untreated, giving rise to 976 and 1,249 MVCs, respectively. The intention-to-treat RR was 1.06 (95%CLs 0.95, 1.16). For the per-protocol estimand, there were 800 MVCs and 1,241 MVCs among treated and untreated person-trials, respectively, suggesting a reduced MVC risk (RR 0.83 [95%CLs 0.74, 0.92]) with sustained Z-drug treatment. Z-drugs should be prescribed to older patients judiciously but not withheld entirely over concerns about MVC risk.

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Source
http://dx.doi.org/10.1093/aje/kwae168DOI Listing

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