THE USE OF ZOLPIDEM AND THE RISK OF ARRHYTHMIA: INSIGHTS FROM A NATIONAL SURVEY

Abstract Background Insomnia, a prevalent sleep disorder with significant health implications, is commonly treated with medications such as zolpidem. Zolpidem, a non-benzodiazepine medication, has advantages over traditional sedative-hypnotics, but its widespread use raises concerns about potential side effects. Aims & Objectives This study focuses on investigating the correlation between zolpidem use and cardiac arrhythmias, considering the increasing prevalence of zolpidem consumption and its association with comorbidities. Method This population-based, matched-cohort cohort study used Taiwan’ s National Health Insurance Research Database. Participants included those using zolpidem for at least 7 days between the years January 1, 2000, and December 31, 2015. The study focused on patients who used zolpidem and classified them as the exposed cohort. The exposed and unexposed groups were selected in a ratio of 1:2, matching for sex, age, and index year. We used a logistic regression model to investigate the association between zolpidem exposure and the risk of arrhythmia. Results We identified 152,652 zolpidem use cases and 305,304 matched controls. Participants with zolpidem use exhibited higher rates of comorbidities compared to the control group. Cox regression analysis revealed a significant association between zolpidem use and incident cardiac arrhythmia (adjusted hazard ratio [aHR] = 1.983, 95% CI: 1.149 – 2.76, P <0.001). Subgroup analyses confirmed the elevated risk of arrhythmia in zolpidem users across various demographic and comorbidity subgroups. Specific cardiac arrhythmias, including paroxysmal ventricular tachycardia, atrial fibrillation, ventricular fibrillation, and cardiac arrest, showed higher adjusted hazard ratios than other types of arrhythmia in patients who used zolpidem. Discussion & Conclusion The study suggests a heightened risk of cardiac arrhythmias associated with zolpidem use. While acknowledging the limitations of observational studies, these findings emphasize the need for further research to elucidate underlying mechanisms and establish causality. Healthcare practitioners should consider these risks when prescribing zolpidem, particularly in individuals with predisposing comorbidities.