• Hironao Hozumi, Yoshinari Endo, Masato Kono, Hirotsugu Hasegawa, Koichi Miyashita, Hyogo Naoi, Yuya Aono, Yoichiro Aoshima, Yusuke Inoue, Kazutaka Mori, Hideki Yasui, Yuzo Suzuki, Masato Karayama, Kazuki Furuhashi, Noriyuki Enomoto, Tomoyuki Fujisawa, Naoki Inui, Koshi Yokomura, and Takafumi Suda.
• Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: hozumi@hama-med.ac.jp.
• Chest. 2024 Nov 5.

BackgroundPatients with idiopathic pulmonary fibrosis (IPF) may experience insomnia and use hypnotics. However, the effect of the use of hypnotics on their clinical course remains unclear.Research QuestionIs the use of hypnotics associated with an increased risk of mortality in patients with IPF?Study Design And ParticipantsThis study included 99 patients with IPF from the Hamamatsu hospital-based cohort and 123 patients with IPF from the Seirei hospital-based cohort, as well as 30,218 patients with IPF from the National Database of Health Insurance Claims and Specific Health Checkups of Japan (the NDB cohort). To analyze the association of hypnotics use with outcomes avoiding immortal time bias, multivariable Cox models with time-dependent covariates and target trial emulation with a new user design were used for the hospital- and NDB-based cohorts.ResultsIn the cohorts studied, the 3-year cumulative incidence of new use of hypnotics following the IPF diagnosis ranged from 13.4% to 24.1%. In both hospital-based cohorts, the continuous use of hypnotics was associated with an increased risk of all-cause mortality and disease progression. In the NDB cohort, the continuous use of hypnotics was also associated with an increased risk of all-cause mortality. Subgroup analysis found associations between the continuous use of hypnotics and increased mortality regardless of sex and comorbidities, excluding certain subpopulations.InterpretationThis study found that continuous use of hypnotics was associated with an increased risk of mortality in patients with IPF. Given the relatively high cumulative incidence of hypnotics use in this population, there is an urgent need to reassess the appropriate use of hypnotics for patients with IPF.Copyright © 2024 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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