Impact of Positive Airway Pressure (PAP) Therapy Initiation on Future Benzodiazepine Drug Use Among Chronic Benzodiazepine Users
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".