Positive Airway Pressure Therapy Initiation and Continued Benzodiazepine Use Among Chronic Drug Users

Treating obstructive sleep apnea (OSA) has been shown to improve concomitant insomnia symptoms, but whether treating OSA translates into reducing sedative medication use is unknown. We evaluated the association between initiating incident positive airway pressure (PAP) therapy and continued benzodiazepine drug receipt among chronic benzodiazepine users. This was a retrospective, population-based cohort study, analysing Ontario health administrative data from January 1, 2012-March 31, 2020. Persons aged 18 years and older, who were chronic benzodiazepine users, were included. The association of new PAP receipt on benzodiazepine drug discontinuation was evaluated at 3-9 months. Propensity score matching was used to account for potential differences in 40 relevant covariates between new and non-PAP users to minimise bias. We identified 249,516 chronic benzodiazepine users, of whom 10,688 (4.3%) newly received PAP. In the matched cohort, there was no significant difference in benzodiazepine discontinuation between new PAP and non-PAP users at 3-9 months follow-up (8.2% vs. 8.3%, relative risk [RR] 0.98, 95% confidence interval [CI] 0.90-1.07). New PAP receipt was not observed to influence stopping benzodiazepines at 3-9 months after PAP initiation. Therefore, our findings raise some uncertainty about the potential effectiveness of administering PAP therapy to improve concomitant insomnia.