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J Stroke Cerebrovasc Dis. 2014 Sep;23(8):2110-2116. doi: 10.1016/j.jstrokecerebrovasdis.2014.03.025. Epub 2014 Aug 10.

Over-the-counter and prescription sleep medication and incident stroke: the REasons for Geographic and Racial Differences in Stroke study.

Author information

1
College of Nursing & Health Innovation, Arizona State University, Phoenix, Arizona. Electronic address: Megan.Petrov@asu.edu.
2
Department of Epidemiology, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.
3
Department of Neurology & Rehabilitation Medicine, University of Cincinnati College of Medicine, Cincinnati, Ohio.
4
Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania.
5
Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama.

Abstract

BACKGROUND:

Preliminary evidence suggests sleep medications are associated with risk of vascular events; however, the long-term vascular consequences are understudied. This study investigated the relation between sleep medication use and incident stroke.

METHODS:

Within the REasons for Geographic And Racial Differences in Stroke study, 21,678 black participants and white participants (≥45 years) with no history of stroke were studied. Participants were recruited from 2003 to 2007. From 2008 to 2010, participants self reported their prescription and over-the-counter sleep medication use over the past month. Suspected stroke events were identified by telephone contact at 6-month intervals and associated medical records were retrieved and physician-adjudicated. Proportional hazards analysis was used to estimate hazard ratios for incident stroke associated with sleep medication use (0, 1-14, and 15+ days per month) controlling for sociodemographics, stroke risk factors, mental health symptoms, and sleep apnea risk.

RESULTS:

At the sleep assessment, 9.6% of the sample used prescription sleep medication and 11.1% used over-the-counter sleep aids. Over an average follow-up of 3.3 ± 1.0 years, 297 stroke events occurred. Over-the-counter sleep medication use was associated with increased risk of incident stroke in a frequency-response relationship (P = .014), with a 46% increased risk for 1-14 days of use per month (hazards ratio [HR] = 1.46; 95% confidence interval [CI], .99-2.15) and a 65% increased risk for 15+ days (HR = 1.65; 95% CI, .96-2.85). There was no significant association with prescription sleep medications (P = .80).

CONCLUSIONS:

Over-the-counter sleep medication use may independently increase the risk of stroke beyond other risk factors in middle-aged to older individuals with no history of stroke.

KEYWORDS:

REGARDS Study; Sleep medication; over-the-counter; sleeping pills; stroke

[Indexed for MEDLINE]
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