Longevity
New sleep drugs not linked to falls or fractures in insomnia patients
By Life and Health Today Staff, . Life and Health Today.
A meta-analysis led by Arianna Paolone of Royal College of Surgeons in Ireland found that adults with insomnia who used dual orexin receptor antagonists did not have increased odds of falls or fractures. The study was published on September 26 in the Journal of the American Geriatrics Society.
Dual orexin receptor antagonists, sometimes called DORAs, are a class of sleep drugs that work by blocking orexin, a brain chemical that promotes wakefulness. They include medications approved in recent years as alternatives to older sedative-hypnotics, the traditional sleeping pills that have long been associated with falls, particularly in older adults.
The American Geriatrics Society's Beers Criteria, a widely used guide that flags medications considered potentially inappropriate for older adults, lists sedative-hypnotics as a concern. As the researchers wrote in the Journal of the American Geriatrics Society, "if truly safer and effective, DORAs would represent an important alternative to sedative-hypnotics, which continue to be prescribed despite recommendations as being potentially inappropriate in older adults according to the American Geriatrics Society (AGS) Beers Criteria."
The certainty of the evidence, however, is only moderate. According to Medscape, which reported on the study, the analysis was constrained by a low number of events, meaning falls and fractures were relatively rare across the studies examined. A large proportion of the underlying data came from Japan, which limits how confidently the findings can be applied to other populations. Drug dosages and treatment durations also varied across the studies included in the analysis.
What this meta-analysis does not establish is that DORAs are safe for all older adults, or that they are free of fall risk at every dose or in every clinical context. A meta-analysis pools results from existing studies rather than generating new trial data, and the quality of its conclusions depends on the quality and consistency of those underlying studies. The researchers themselves described the evidence as limited.
No specific funding source was declared for the study, and the authors reported no conflicts of interest, according to Medscape.
The open question is whether larger, longer trials with more consistent dosing and broader geographic representation would confirm the absence of a fall signal, or reveal one that the current data were too sparse to detect. For anyone weighing sleep treatment options, particularly older adults or those with a history of falls, that is a conversation that belongs with a clinician who knows their full history.