Prescription patterns of sleep medications for critically ill patients: A nationwide retrospective observational cohort study in Japan

INTRODUCTION: Sleep disturbance is associated with adverse outcomes, yet evidence guiding its prevention and the real-world use of emerging hypnotics remains limited, underscoring the need to clarify contemporary prescribing patterns in the intensive care unit (ICU) and at discharge. OBJECTIVE: This study investigated real-world usage patterns of sleep medications during ICU stay and their prescribing activity at hospital discharge in Japan. METHODS: This retrospective cohort study analysed data from the Japanese Diagnosis Procedure Combination inpatient database (April 2012-March 2021). Adult patients who stayed in the ICU for more than 1 day were included. Sleep medications were categorised as benzodiazepines (BZDs), nonbenzodiazepine hypnotics (Z-drugs), orexin receptor antagonists (OXs), and melatonin receptor agonists (MLTs). Annual prescription trends, patient characteristics, and factors associated with sleep medication use during ICU stay and at discharge were analysed. RESULTS: Among 1,595,351 ICU patients, 30.8% received sleep medications during their ICU stay. From 2012 to 2020, BZD use declined from 22.1% to 11.1%, whereas OX and MLT use increased markedly from 0% to 18.0% and from 1.3% to 10.7%, respectively. Patients receiving sleep medications underwent invasive treatments more frequently and had higher prescribing rates at discharge than nonusers (47.0% vs. 11.3%, respectively; standardised mean difference: 85.5%). Sleep medication use during ICU stay was strongly associated with sleep medication prescription at hospital discharge (odds ratio: 6.90; 95% confidence interval: 6.59-7.23). CONCLUSIONS: Use of sleep medications, particularly OX and MLT, has increased substantially among ICU patients in Japan, and their strong correlation with sleep medication prescription at hospital discharge highlights the need for careful medication review and deprescribing to prevent unnecessary continuation after ICU care.