Impact of central nervous system depressants on prognosis in obesity hypoventilation syndrome-the population-based DISCOVERY study.

RATIONALE: Benzodiazepines, gabapentinoids, hypnotics, and opioids can depress respiration, alter sleep, and potentially affect outcomes in individuals treated with home mechanical ventilation (HMV) for obesity hypoventilation syndrome (OHS).

OBJECTIVES

To analyze the association of benzodiazepines, gabapentinoids, hypnotics, and opioid use with hospitalization-free survival and mortality after starting HMV for OHS.

METHODS

Population-based longitudinal study on patients with OHS starting HMV in the DISCOVERY cohort between 2005 and 2022, cross-linked with data on dispensed outpatient drugs, hospitalizations, comorbidities, and socioeconomics. The primary outcome was a composite of all-cause hospitalization or death within 1 year. Secondary outcomes were hospitalization and death, respectively. Associations with hospitalization and mortality were analyzed using Cox regression models, adjusting for age, sex, body mass index, place of birth (Sweden), Charlson Comorbidity Index, civil status, education level, and use of other drugs.

MEASUREMENTS AND MAIN

RESULTS

Of 3004 included patients (50% female; mean age 63.3 ± 12.7 years), 15% were using benzodiazepines, 10% gabapentinoids, 26% hypnotics, and 25% opioids. Drug treatments associated with a higher risk of hospitalization or death were benzodiazepines (adjusted hazard ratio, 1.23; 95% CI, 1.08-1.41), gabapentinoids (1.17; 1.00-1.36), and opioids (1.25; 1.12-1.40), while hypnotics (1.07; 0.96-1.21) were not clearly associated. The associations were mainly driven by increased risks of hospitalizations, with a similar pattern as for the primary outcome. None of the drug treatments was associated with mortality.

CONCLUSIONS

The use of benzodiazepines, gabapentinoids, and opioids was associated with increased risk of hospitalization or mortality in patients with OHS starting treatment with HMV.