Sleep medication use and higher odds of cognitive impairment in older adults: insights from the community-based YAHABA Study

Sleep medications are widely prescribed to older adults, but their effects on cognitive health remain a concern. Prior studies often relied on self-report or administrative data, which may limit clinical accuracy. This study aimed to examine the association between sleep medication use and cognitive impairment among community-dwelling older adults using direct clinical assessment. Current sleep medication of participants was verified using personal medication record booklets. Cognitive function was assessed through face-to-face structured interviews and neuropsychological testing. Sleep disturbance was assessed using the Pittsburgh sleep quality index. Statistically, trend and binomial logistic regression analyses were conducted to examine the association between benzodiazepine (BZD) and/or Z-drug (ZD) use and cognitive impairment. A total of 869 participants were enrolled, and 12.5% of them were taking sleep medications. Cognitive impairment, including mild cognitive impairment or dementia, was present in 35.1%. Trend analysis showed no association between sleep disturbance and cognitive impairment, but BZD and/or ZD use was significantly associated (p = 0.003). Multivariable-adjusted analysis showed that BZD and/or ZD users had 1.66-fold higher odds of cognitive impairment (95% confidence interval: 1.07 - 2.56, p = 0.023). BZD and/or ZD use was independently associated with cognitive impairment in this community-based cohort. Even with direct clinical evaluation and face-to-face assessment, this relationship remained consistent with previous studies, reinforcing the evidence that sleep medication use is associated with cognitive impairment in older adults.