Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients

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Meyers Primary Care Institute; Department of Medicine

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Clinical Epidemiology | Health Services Administration | Health Services Research | Pharmacy and Pharmaceutical Sciences | Sleep Medicine


STUDY OBJECTIVES: To investigate the risk of in-hospital falls among patients receiving medications commonly used for insomnia in the hospital setting.

METHODS: Retrospective cohort study of all adult hospitalizations to a large academic medical center from January, 2007 to July, 2013. We excluded patients admitted for a primary psychiatric disorder. Medication exposures of interest, defined by pharmacy charges, included benzodiazepines, non-benzodiazepine benzodiazepine receptor agonists, trazodone, atypical antipsychotics, and diphenhydramine. In-hospital falls were ascertained from an online patient safety reporting system.

RESULTS: Among the 225,498 hospitalizations (median age = 57 years; 57.9% female) in our cohort, 84,911 (37.7%) had exposure to at least one of the five medication classes of interest; benzodiazepines were the most commonly used (23.5%), followed by diphenhydramine (8.3%), trazodone (6.6%), benzodiazepine receptor agonists (6.4%), and atypical antipsychotics (6.3%). A fall occurred in 2,427 hospitalizations (1.1%). The rate of falls per 1,000 hospital days was greater among hospitalizations with exposure to each of the medications of interest, compared to unexposed: 3.6 versus 1.7 for benzodiazepines (adjusted hazard ratio [aHR] 1.8, 95%CI 1.6-1.9); 5.4 versus 1.8 for atypical antipsychotics (aHR 1.6, 95%CI 1.4-1.8); 3.0 versus 2.0 for benzodiazepine receptor agonists (aHR 1.5, 95%CI 1.3-1.8); 3.3 versus 2.0 for trazodone (aHR 1.2, 95%CI 1.1-1.5); and 2.5 versus 2.0 for diphenhydramine (aHR 1.2, 95%CI 1.03-1.5).

CONCLUSIONS: In this large cohort of hospitalizations at an academic medical center, we found an association between each of the sedating medications examined and in-hospital falls. Benzodiazepines, benzodiazepine receptor agonists, and atypical antipsychotics had the strongest associations.


falls, hospitalization, insomnia, pharmacoepidemiology, sedatives

DOI of Published Version



Herzig SJ, Rothberg MB, Moss CR, Maddaleni G, Bertisch SM, Wong J, Zhou W, Ngo L, Anderson TS, Gurwitz JH, Marcantonio ER. Risk of in-hospital falls among medications commonly used for insomnia in hospitalized patients. Sleep. 2021 Sep 13;44(9):zsab064. doi: 10.1093/sleep/zsab064. PMID: 33710329; PMCID: PMC8436133. Link to article on publisher's site

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