Hypnotics Use Is Associated with Elevated Incident Atrial Fibrillation: A Propensity-Score Matched Analysis of Cohort Study

Hu, Xiang; Jong, Gwo‐Ping; Wang, Liang; Lin, Mei‐Chen; Gong, Shaoqing; Zhang, Xuehong; Lin, Jiun-Jie; Adeniran, Esther; Liu, Yanlong; Chen, Hung-Yi; Yang, Bo

doi:10.3390/jpm12101645

Cited by 3 publications

(1 citation statement)

References 23 publications

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“…Certain medications can be used to augment nonpharmacologic interventions to manage insomnia. Nonbenzodiazepine hypnotics, including zolpidem, are commonly prescribed by physicians [12]. Clinically, zolpidem is widely used in patients with insomnia, including DMD patients.…”

Section: Discussionmentioning

confidence: 99%

Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Li,

Jin

2023

Preprint

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Background: Zolpidem is a non-benzodiazepine hypnotics widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. Case presentation: A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril valsartan sodium tablets 25 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started on zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no obvious change. The night before admission, the patient attempted suicide by overdose with 40 mg of zolpidem after an argument, which resulted in severe lethargy. At admission, his ECG revealed new-onset AF, so zolpidem was stopped immediately. 9 hours into admission, AFspontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that no AF was detected. Conclusions: Zolpidem is a frequent first choice of medication for insomnia. However, this case suggests zolpidem overdose could increase the risk of AF in patients with cardiomyopathy. Zolpidem could have caused AF via respiratory depression, which leads to acute atrial distension and hypercapnia. These acute transient arrhythmogenic changes during zolpidem overdose can increase vulnerability to AF in patient with pre-existing cardiomyopathy. Thus, the heart rhythm should be monitored when zolpidem is prescribed in patients with cardiomyopathy.

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Section: Discussionmentioning

confidence: 99%

Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Li,

Jin

2023

Preprint

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Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Li,

Jin

2024

BMC Cardiovasc Disord

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Background Zolpidem is a non-benzodiazepine hypnotic widely used to manage insomnia. Zolpidem-triggered atrial fibrillation (AF) in patients with cardiomyopathy has never been reported before. Case presentation A 40-year-old man with Duchenne muscular dystrophy-related cardiomyopathy attempted suicide and developed new-onset AF after zolpidem overdose. One year before admission, the patient visited our clinic due to chest discomfort and fatigue after daily walks for 1 month; both electrocardiography (ECG) and 24-hour Holter ECG results did not detect AF. After administration of cardiac medication (digoxin 0.125 mg/day, spironolactone 40 mg/day, furosemide 20 mg/day, bisoprolol 5 mg/day, sacubitril/valsartan 12/13 mg/day), he felt better. AF had never been observed before this admission via continuous monitoring during follow-up. Sixteen days before admission, the patient saw a sleep specialist and started zolpidem tartrate tablets (10 mg/day) due to insomnia for 6 months; ECG results revealed no significant change. The night before admission, the patient attempted suicide by overdosing on 40 mg of zolpidem after an argument, which resulted in severe lethargy. Upon admission, his ECG revealed new-onset AF, necessitating immediate cessation of zolpidem. Nine hours into admission, AF spontaneously terminated into normal sinus rhythm. Results from the ECG on the following days and the 24-hour Holter ECG at 1-month follow-up showed that AF was not detected. Conclusions This study provides valuable clinical evidence indicating that zolpidem overdose may induce AF in patients with cardiomyopathy. It serves as a critical warning for clinicians when prescribing zolpidem, particularly for patients with existing heart conditions. Further large-scale studies are needed to validate this finding and to explore the mechanisms between zolpidem and AF.

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Gender differences in spontaneous adverse event reports associated with zolpidem in South Korea, 2015–2019

Joung

2023

Front. Pharmacol.

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Study objectives: While zolpidem is considered as an example of a gender effect on drug response, there is insufficient evidence to reach a consensus. This study aimed to investigate gender differences in adverse events (AEs) of zolpidem.Methods: We estimated the difference between the reporting odds ratios (RORs) calculated in gender subgroups for the AEs signals detected in data mining using 2015–2019 Korea voluntary adverse drug events reporting system (KAERS) data. Different reporting risk by gender was evaluated by using the log RORs being significantly different by gender at the 5% significance level and the 95% confidence intervals of the gender ROR.Results: A total of 94 AE signals were detected. Among these, 35 signals showed significant disparities by gender at the 5% level or were detected only in one gender. When categorized by similarity of AEs, parasomnia including somnambulism and paroniria, and cardiovascular disorders including coronary thrombosis had higher reporting risks in women. Men were more likely to report cognitive disorders such as delirium, insomnia related disorders, and movement disorders. Among all AEs with gender differences in reporting risk, the difference in somnambulism was the most consistent and substantial.Conclusion: For several AEs associated with zolpidem, gender-based reporting disparities were evident. Notably, women exhibited a higher susbeptibility to somnambulism, potentially serious adverse effects of zolpidem. This underscores the need for further investigation into the underlying factors influencing these gender-specific reporting patterns.

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Hypnotics Use Is Associated with Elevated Incident Atrial Fibrillation: A Propensity-Score Matched Analysis of Cohort Study

Cited by 3 publications

References 23 publications

Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Zolpidem-triggered atrial fibrillation in a patient with cardiomyopathy: a case report

Gender differences in spontaneous adverse event reports associated with zolpidem in South Korea, 2015–2019

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