Sleep Medication Use and Risk of Fractures in Breast Cancer Survivors

Abstract

\n Purpose: Sleep problems are more common in breast cancer survivors than those without a cancer history. Our goal was to examine the risk of fractures among breast cancers survivors who used prescription sleep aids. Methods: We conducted a retrospective cohort study of 21,346 adult women diagnosed with stage 0-III breast cancerbetween 2009-2016and followed them through 2017. We examined person-year rates of fracturesby sleep medication use and calculated adjusted hazard ratios (HR) and 95% confidence intervals (CI)with Cox proportional hazards models using time-dependent variables for sleep medications and covariate medications (antidepressants, anti-anxiety medications, and bisphosphonates) adjusted for demographics, comorbidities, and tumor characteristics and cancer treatments.Results: The sleep medication use was common (40%) in breast cancer survivors and was associated with a 33% increased risk of fractures(adjusted HR=1.33, 95% CI: 1.20-1.49). Bisphosphonateuse did not mitigate this risk. Further, in a sensitivity analysis based on new use of sleep medication, the fracture risk was even stronger (adjusted HR=1.44, 95% CI: 1.26-1.64).Conclusion:Given the high use of sleep medicationsand the high risk of fractures in breast cancer survivors, this study suggests that non-pharmacologic management of sleep problems might be considered as alternative therapy.