Are Sleep Medications Associated With Higher Parasomnia Risk?

Nonbenzodiazepines and orexin receptor antagonists may increase the risk for parasomnia, according to study results published in the Journal of Sleep Research.

Irregular nocturnal behavior has been linked with zolpidem, quetiapine, and paroxetine which are classified as a nonbenzodiazepine sleep medication, an antipsychotic, and an antidepressant, respectively. However, the relationship between parasomnia and sleep medications remains unclear.

Researchers conducted a study using data from the Japanese Adverse Drug Event Report (JADER) database to examine the link between benzodiazepines, nonbenzodiazepines, melatonin-receptor agonists, and orexin receptor antagonists with parasomnias. The researchers included data from April 2004 to March 2022. They employed a logistic regression model for statistical analysis.

A total of 673,845 reports were included for analysis, with 189 reports of parasomnia as an adverse event (AE). Most reports of parasomnias (n=38) occurred in individuals aged 70 to 79 years, while the highest percentage of reports was observed in those aged 10 to 19 years. Reports of parasomnia AEs were most common with nonbenzodiazepines (n=57), while orexin receptor antagonists were associated with the highest number of parasomnia AEs.

The highest use of benzodiazepines was reported in individuals aged 20 to 59 years, and melatonin-receptor agonists and orexin receptor antagonists had the highest proportion of use those aged 60 years and older.

The unadjusted reporting odds ratios (ROR) were significant for benzodiazepines (ROR, 3.55; 95% CI, 2.39-5.27), nonbenzodiazepines (ROR, 14.21; 95% CI, 10.41-19.39), melatonin-receptor agonists (ROR, 6.79; 95% CI, 2.79-16.51), and orexin receptor antagonists (ROR, 18.40; 95% CI, 10.66-31.75). After adjustments, nonbenzodiazepines (ROR, 9.75; 95% CI, 6.71-14.2) and orexin receptor antagonists (ROR, 8.65; 95% CI, 4.56-16.4) were statistically significant.

Study limitations included potential reporting bias.

“… [P]arasomnias induced by sleep medications are likely caused by multiple mechanisms. However, given the detected association between sleep medications and parasomnias, we should [recognize] that the use of sleep medications is associated with the potential risk of parasomnias,” the researchers concluded.