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Gastric bypass surgery may increase use of sleep medications

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July 12, 2017

Adults with obesity who underwent gastric bypass surgery were twice as likely to initiate or increase their use of sleep medications in the 3 years after the procedure vs. matched adults who initiated intensive lifestyle modification instead of surgery, according to published findings.

“Obesity has been associated with sleep disorders, such as obstructive sleep apnea, insomnia and restless leg syndrome,” Winda L. Ng, BMedSc, a PhD student in the department of epidemiology and preventive medicine at Monash University, Australia, and colleagues wrote. “Perhaps as a consequence, individuals with obesity have also been found to use more hypnotics and/or sedatives than individuals without obesity. Weight-loss interventions have been shown to improve a range of sleep parameters, mostly those associated with obstructive sleep apnea, but their effect on use of hypnotics and sedatives is unclear. This is an important area to address, as use of hypnotics and sedatives has been associated with vehicle accidents, fall-related injuries, cognitive decline and mortality.”

Ng and colleagues analyzed data from 20,626 adults with obesity who underwent gastric bypass surgery and 11,973 adults with obesity who initiated intensive lifestyle modification between 2007 and 2012, identified through the Scandinavian Obesity Surgery Registry, a nationwide prospective registry of bariatric surgery patients, and the Itrim Health Database, a Swedish commercial weight-loss database (77% women; mean age, 41 years; mean baseline BMI, 41 kg/m²). Lifestyle participants underwent a 3-month dietary weight-loss phase with a low-calorie or very low-calorie diet, followed by a 9-month weight maintenance phase. Participants had available prescription data from 2 years before treatment until 3 years after treatment initiation; prescription data were obtained through linking with the nationwide Swedish Prescription Drug Register, health registers with the National Board of Health and Welfare, and Statistics Sweden. The two cohorts were matched on BMI, age, sex, education, history of hypnotics or sedatives use, and treatment year. The proportion of participants with filled hypnotics and/or sedatives prescriptions was compared yearly for 3 years.

At 1 year, mean weight loss for the surgery cohort was 37 kg; mean weight loss for the lifestyle group was 18 kg. The three most commonly prescribed hypnotics and sedatives were zopiclone, zolpidem and propiomazine, accounting for 96% of sleep aid prescriptions in both cohorts.

During follow-up, the risk for having filled a prescription for hypnotics or sedatives was higher in the surgery vs. the intensive lifestyle group, with the RR increasing with longer follow-up and peaking at 3 years, according to researchers.

In the matched treatment cohorts, 4% filled prescriptions for hypnotics and/or sedatives during the year before treatment. At 1 year, this proportion increased to 7% in the surgery cohort, but remained at 4% in the intensive lifestyle cohort (RR = 1.7; 95% CI, 1.4-2.1). At 2 years, the proportion increased to 11% vs. 5% (RR = 2; 95% CI, 1.7-2.4); at 3 years, the proportion increased to 14% vs. 6% (RR = 2.2; 95% CI, 1.9-2.6).

Researchers found no evidence in either treatment cohort of a dose-response relationship between percent-BMI change at 1 year and change in use of hypnotics and/or sedatives at 3 years.

“It is likely that the increased use was driven by the undertaking of gastric bypass surgery and not by weight loss per se,” the researchers wrote. “While we cannot identify the cause of this phenomenon through our study, a number of plausible explanations can be identified in the literature.”

The researchers noted that further studies are needed to identify the underlying mechanisms behind the increase in sleep medication use and whether these results are observable after other bariatric surgery types. – by Regina Schaffer

Disclosures: Ng reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.