Third World Quarterly最新文献

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Relationships of Hypnotics with Incident Dementia and Alzheimer's Disease: A Longitudinal Study and Meta-Analysis. 催眠药与痴呆症和阿尔茨海默病的关系：一项纵向研究和 Meta 分析。

IF 6.4 2区经济学 Q2 DEVELOPMENT STUDIES

Third World Quarterly

Pub Date : 2024-01-01 DOI: 10.14283/jpad.2023.78

J-H Hou, S-L Sun, C-C Tan, Y-M Huang, L Tan, W Xu

Background: Evidence describing the association between hypnotics use and dementia risk is conflicting. It is unknown if the controversy is related to the type or dose of hypnotics or if hypnotics affect different populations.

Objectives: We sought to derive lessons learned and future projections based on evidence from longitudinal studies.

Measurements: In the Alzheimer's Disease Neuroimaging Initiative (ADNI) cohort, 1,543 older adults without dementia (mean age = 73.3 years, female = 45%) were followed for four years. The association between hypnotics and the risk of Alzheimer's disease (AD) was investigated using Cox proportional hazards regressions. Next, electronic databases were searched until March 2022 to conduct the evidence synthesis of the associations of hypnotics with incident risk of dementia.

Results: In the ADNI cohort, ever use of hypnotics was associated with an increased risk of AD (hazard ratio = 1.96, 95% confidence intervals = 1.23-3.11, p < 0.01). This association was significant for benzodiazepines and Z-drugs but not for melatonin. The association was stronger in long-term (more than one year) users and those with high cumulative doses. A meta-analysis of 26 longitudinal studies with 3,942,018 participants revealed a correlation between the use of hypnotics and the risk of dementia (relative risk = 1.23, 95% confidence intervals = 1.13-1.33, p < 0.001, median risk difference = 4%). It is a linear dose-response relationship, if a person takes the daily recommended dose for 100 days, their risk of developing dementia increases by 5% relative to non-users. According to subgroup analyses, neither association was significant among patients with a history of insomnia.

Conclusions: Individuals who use hypnotics, especially high-dose or long-term users, are at a higher risk of dementia and AD. The main issue with conclusion credibility is heterogeneity.

背景：描述使用催眠药与痴呆症风险之间关系的证据相互矛盾。目前尚不清楚这种争议是否与催眠药的类型或剂量有关，或者催眠药是否会影响不同的人群：我们试图根据纵向研究的证据得出经验教训和未来预测：在阿尔茨海默病神经影像学倡议（ADNI）队列中，对1543名未患痴呆症的老年人（平均年龄=73.3岁，女性=45%）进行了为期四年的跟踪调查。采用 Cox 比例危险度回归法研究了催眠药与阿尔茨海默病（AD）发病风险之间的关系。随后，对电子数据库进行了检索，直至2022年3月，以便对催眠药与痴呆症发病风险的关系进行证据综述：在ADNI队列中，曾经使用催眠药与AD风险增加有关（危险比=1.96，95%置信区间=1.23-3.11，P<0.01）。苯二氮卓类药物和Z类药物与这一关系显著，但褪黑素与这一关系不显著。长期（一年以上）服用者和高累积剂量者的相关性更强。一项对 26 项纵向研究 3,942,018 名参与者进行的荟萃分析显示，使用催眠药与痴呆症风险之间存在相关性（相对风险 = 1.23，95% 置信区间 = 1.13-1.33，p < 0.001，中位风险差异 = 4%）。这是一种线性剂量-反应关系，如果一个人连续100天服用每日推荐剂量，那么他患痴呆症的风险就会比不服用者增加5%。根据亚组分析，在有失眠病史的患者中，这两种关系都不显著：结论：使用催眠药的人，尤其是大剂量或长期使用催眠药的人，患痴呆症和注意力缺失症的风险较高。结论可信度的主要问题在于异质性。

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