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      Mortality Risk of Hypnotics: Strengths and Limits of Evidence.

      1 , 2
      Drug safety

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          Abstract

          Sleeping pills, more formally defined as hypnotics, are sedatives used to induce and maintain sleep. In a review of publications for the past 30 years, descriptive epidemiologic studies were identified that examined the mortality risk of hypnotics and related sedative-anxiolytics. Of the 34 studies estimating risk ratios, odds ratios, or hazard ratios, excess mortality associated with hypnotics was significant (p < 0.05) in 24 studies including all 14 of the largest, contrasted with no studies at all suggesting that hypnotics ever prolong life. The studies had many limitations: possibly tending to overestimate risk, such as possible confounding by indication with other risk factors; confusing hypnotics with drugs having other indications; possible genetic confounders; and too much heterogeneity of studies for meta-analyses. There were balancing limitations possibly tending towards underestimates of risk such as limited power, excessive follow-up intervals with possible follow-up mixing of participants taking hypnotics with controls, missing dosage data for most studies, and over-adjustment of confounders. Epidemiologic association in itself is not adequate proof of causality, but there is proof that hypnotics cause death in overdoses; there is thorough understanding of how hypnotics euthanize animals and execute humans; and there is proof that hypnotics cause potentially lethal morbidities such as depression, infection, poor driving, suppressed respiration, and possibly cancer. Combining these proofs with consistent evidence of association, the great weight of evidence is that hypnotics cause huge risks of decreasing a patient's duration of survival.

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          Author and article information

          Journal
          Drug Saf
          Drug safety
          1179-1942
          0114-5916
          Feb 2016
          : 39
          : 2
          Affiliations
          [1 ] UCSD, 8437 Sugarman Drive, La Jolla, CA, 92037-2226, USA. dkripke1@san.rr.com.
          [2 ] Scripps Clinic Viterbi Family Sleep Center, La Jolla, USA. dkripke1@san.rr.com.
          Article
          10.1007/s40264-015-0362-0
          10.1007/s40264-015-0362-0
          26563222
          7aff5c93-1be8-48db-bf4b-ffd9f78a4fc3
          History

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