{"doi":"10.1111/jgs.18528","title":"Sleep characteristics and use of multiple benzodiazepine receptor agonists in older adults","abstract":"Long-term use of benzodiazepines or z-drugs (benzodiazepine receptor agonists; BZAs) is not advised for older adults due to adverse outcomes.1, 2 While studies of BZA prescribing patterns show increasing rates of co-prescribing of BZAs (e.g., benzodiazepines with z-drugs),3 to our knowledge, studies examining patient-reported rates of use of more than one BZA (multi-BZA) are lacking. This study aims to estimate rates of patient-reported multi-BZA use among older adults and to examine associations between multi-BZA use and sleep characteristics. Telephone screening surveys were conducted for an ongoing BZA deprescribing clinical trial (NCT03687086)4 to recruit adults aged ≥55 in California who were receiving care through the Department of Veterans Affairs or University of California, Los Angeles and were prescribed at least one of five targeted BZAs (alprazolam, clonazepam, lorazepam, temazepam, zolpidem) chosen for practicality for the dose reduction component of the trial. Screeners between February 2019 and October 2022 were analyzed. Our institutional review boards approved the study, including a waiver of documented consent. Participants reported whether they used each targeted BZA for sleep over the past 3 months (yes/no for each) and were classified as multi-BZA (>1), single-BZA (1), or non-BZA (0) users based on the number of “yes” responses. BZA use frequency was estimated by asking participants how many nights in a typical week during the past month they had taken each BZA. We did not assess for concurrent use in the multi-BZA group. Participants were asked if their sleep problems have lasted <3, 3–12, or >12 months (dichotomized as ≤3 months and >3 months) and if their sleep quality in the last month was “very good,” “fairly good,” “fairly bad,” or “very bad” (dichotomized as “very/fairly good” and “very/fairly bad”). Self-reported time asleep and time in bed were used to compute sleep efficiency (time asleep/time in bed), which was categorized as excellent (≥90%), good (≥85%), and fair (≥80%).5, 6 Analyses compared sleep characteristics between multi-, single-, and non-BZA users in unadjusted and adjusted (for site, age, gender, race, ethnicity) logistic and linear regression models (alpha = 0.05). Pairwise comparisons and predicted margins for comparisons (multi- versus single-BZA or non-BZA) were estimated and adjusted predicted margins from adjusted models plotted using Stata/SE 17.0 (StataCorp LLC, College Station, Texas). We screened 793 of 8514 potential participants (see Table 1 for sample characteristics). Multi-BZA was reported by 13.9% of participants in the past 3 months. Among multi-BZA participants, 87.3% reported taking 2 BZAs, most commonly alprazolam-zolpidem (28.1%) and lorazepam-zolpidem (25.0%). Most participants (96.5%) reported sleep problems greater than 3 months and fairly/very bad sleep (68.0%). Mean sleep efficiency was 67.7% (SD = 18.3%). Only 10.5% had high sleep efficiency (≥90%). In unadjusted models, multi- versus single-BZA status was associated with a 9.8% increase in poor sleep quality (p = 0.03). There were no other significant differences in sleep characteristics for multi- versus single- or non-BZA users (p-values ≥0.51). No differences were observed for multi- versus single- or non-BZA users for categorical sleep efficiency variables (p-values ≥0.07). In adjusted logistic and linear regression models, predictive margins for multi- versus single- or non-BZA were not significant for sleep problem chronicity, sleep quality, and sleep efficiency as a continuous variable (p-values ≥0.07). Figure 1 summarizes these findings. We found 1 in 8 older patients prescribed a BZA for sleep reported multi-BZA use over the past 3 months. Multi-BZA use was unrelated to chronicity of sleep problems, sleep quality, or sleep efficiency, suggesting that multi-BZA use was not associated with improved or worse sleep. The findings reflect patient reported use of BZA medications rather than prescriptions","journal":"Journal of the American Geriatrics Society","year":2023,"id":386544,"datarank":0.11355216006734065,"base_score":0.6931471805599453,"endowment":0.6931471805599453,"self_citation_contribution":0.10397207708399181,"citation_network_contribution":0.009580082983348837,"self_endowment_contribution":0.10397207708399181,"citer_contribution":0.009580082983348837,"corpus_percentile":null,"corpus_rank":null,"citation_count":1,"citer_count":1,"citers_with_citation_signal":1,"citers_with_endowment":1,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.959,"is_data_producer":true,"deposit_databanks":{"ClinicalTrials.gov":["NCT03687086"]},"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2023-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":696208,"name":"Austin Grinberg","orcid":null,"position":1,"is_corresponding":false},{"id":322169,"name":"Michael Mitchell","orcid":null,"position":2,"is_corresponding":false},{"id":321245,"name":"Cathy Alessi","orcid":"0000-0002-0396-9066","position":3,"is_corresponding":false},{"id":338720,"name":"Alison Moore","orcid":"0000-0003-2989-4346","position":4,"is_corresponding":false},{"id":321251,"name":"Jennifer L. Martin","orcid":"0000-0003-0849-3391","position":5,"is_corresponding":false},{"id":278413,"name":"Joseph M. Dzierzewski","orcid":"0000-0002-9788-8813","position":6,"is_corresponding":false},{"id":695702,"name":"Mónica Kelly","orcid":"0000-0002-4713-7210","position":7,"is_corresponding":false},{"id":420590,"name":"M. Safwan Badr","orcid":"0000-0001-5769-5243","position":8,"is_corresponding":false},{"id":1155472,"name":"Andrew T. Guzmán","orcid":null,"position":9,"is_corresponding":false},{"id":321066,"name":"Jason P. Smith","orcid":"0000-0002-2688-0988","position":10,"is_corresponding":false},{"id":321249,"name":"Michelle Zeidler","orcid":"0000-0003-0997-9713","position":11,"is_corresponding":false},{"id":321246,"name":"Constance H. Fung","orcid":"0000-0002-0140-7932","position":12,"is_corresponding":false},{"id":1155096,"name":"Sara Ghadimi","orcid":"0009-0001-4676-1652","position":0,"is_corresponding":true}],"reference_count":7,"raw_metadata":null,"created_at":"2026-07-19T01:18:00.717763Z","pmid":"37526436","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}