Factors Associated with Benzodiazepines Prolonged-Term Use in Post-Stroke Subjective Sleep Disturbance: A Single-Centre Retrospective Study from China

Abstract

Purpose

To investigate the prevalence of short- and long-term benzodiazepine and z-drugs (BZD) for the treatment of post-stroke subjective sleep disturbance (SSD) and to evaluate the risk factors associated with prolonged BZD treatment in this patient body.

Patients and Methods

Between 1st January 2018 and 1st December 2018, we identified 542 inpatients suffering from acute stroke in Heyuan People’s Hospital. Of these, 290 inpatients were included in our final analysis. These patients were divided into three groups according to the treatment they received: non/occasional BZD (non-BZD), short-term BZD (short-term) and prolonged-term BZD (prolonged-term) treatment. We investigated the prevalence of each BZD treatment term and identified differences between the groups. Univariate logistic regression analysis was used to identify potential predictors for the prolonged use of BZD. Multinomial logistic regression analysis was used to assess the correlation between the prolonged use of BZD and potential predictors.

Results

The prevalence of cases receiving short and prolonged BZD treatments were 40.35% and 31.72%, respectively; none of the patients received polysomnography (PSG) screening from obstructive sleep apnoea (OSP). Treatment strategies were limited to BZD and traditional Chinese medicine; none of the patients received cognitive-behavioral treatment (CBT) or other forms of treatment. Logistic regression analysis showed that the short-term use was associated with z-drugs (odds ratio [OR]: 2.189, 95% confidence interval [CI]: 1.419–3.378), non-communication barriers (OR =0.535, 95% CI: 0.325–0.880) and posterior circulation infarct (POCI) (OR =2.199, 95% CI: 1.112–4.349). The prolonged-term use was associated with z-drugs (OR =3.012, 95% CI: 1.637–5.542), non-communication barriers (OR =0.530, 95% CI: 0.307–0.916), partial anterior circulation infarct (PACI) (OR =0.455, 95% CI: 0.250–0.827), and non pain after stroke (OR =0.315, 95% CI: 0.207–0.480).

Conclusion

The status of BZD abuse for post-stroke SSD is worrying. Additional research attention and treatment options are needed for the treatment of post-stroke SSD. In particular, the potential combination of stroke and OSP appears to be underestimated and neglected. Post-stroke SSD patients should receive more comprehensive assessment and rigid follow-up to avoid the prolonged use of BZD. Additional and effective therapeutic strategies (such as positive pressure ventilation treatment or CBT) are urgently needed for cause-specific intervention.

Keywords:

• benzodiazepine and z-drugs
• BZD
• prolonged-use
• post-stroke
• subjective sleep disturbance
• SSD
• risk factors
• obstructive sleep apnea
• OSP
• China

Acknowledgments

This study was supported by the Heyuan City Government under Science and Technology Plan Project of Heyuan City (Reference: 200707171500645) and the Innovation Research Team Project of the Natural Science Foundation of Hainan (Reference: 2018CXTD348).

Disclosure

None of the authors have any conflicts of interest to declare.