Impact of Positive Airway Pressure (PAP) Therapy Initiation on Future Benzodiazepine Drug Use Among Chronic Benzodiazepine Users
Notice bibliographique
Résumé
Abstract Rationale: Obstructive sleep apnea and insomnia frequently overlap in individuals. There is some evidence to support that treating sleep breathing disorder can improve concomitant patient-reported insomnia symptoms. Whether treating sleep breathing disorder in the setting of insomnia translates into a reduction in recurrent sedative drug use is unknown, and this is a meaningful knowledge gap to fill, given that sedatives are associated with a broad range of potential side-effects. Our purpose was evaluate the impact of initiating PAP therapy on future benzodiazepine drug receipt among chronic benzodiazepine users. Methods: This was a retrospective, population-based cohort study, analyzing Ontario health administrative databases for the period January 1, 2012-March 31, 2020. Our study included Ontarians ages 18+ years old, who were chronic benzodiazepine drug users (defined, using a previously developed approach, as receipt of ≥4 prescriptions for any benzodiazepine or Z-drug in any 6-month period or ≥120 consecutive days of receiving any benzodiazepine or Z-drug). Individuals were classed as exposed if they newly received PAP (either continuous or bi-level) between January 1, 2012-December 31, 2018. Individuals entered a comparison control group if they did not receive any PAP therapy, nor undergo any in-lab polysomnography. Benzodiazepine drug discontinuation was evaluated at 3-9 months following PAP receipt (main analysis), and separately, at 9-15 months following PAP initiation (sensitivity analysis). Logistic regression was used to estimate odds ratios (OR) with associated 95% confidence intervals (CIs) in a 1:1 propensity score matched cohort, balancing on 41 covariates to minimize potential confounding. Results: There were 249,415 chronic benzodiazepine users, of whom 10,688 (4.3%) newly received PAP therapy. From this group, 10,460 (97.9%) were propensity-score matched to an equal number of non-PAP users. In the matched cohort, there was no significant difference in benzodiazepine discontinuation between PAP users and non-PAP users during the 3-9 month follow-up period (8.2% vs. 8.3%, OR 0.99, 95% 0.89-1.09). However, during the 9-15 month follow-up period, PAP users were significantly less likely to discontinue benzodiazepines versus non-PAP users (12.5% vs. 13.6%, OR 0.91, 0.84-0.99). Conclusions: There was no significant association between new PAP use and odds of benzodiazepine discontinuation at 3-9 months out following PAP therapy receipt. When considering a 9-15 month follow-up period, there was surprisingly a small, but significant, lower odds of benzodiazepine discontinuation associated PAP receipt. Our findings highlight a potentially important drug safety issue linked with PAP receipt.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,005 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».