Interactions of Insomnia and Sedative-Hypnotic Drug Use Associated with Frailty Over Time Among Older Adults

Am J Geriatr Psychiatry. 2023 Jun;31(6):438-448. doi: 10.1016/j.jagp.2023.01.028. Epub 2023 Feb 8.


Background: Insomnia and frailty are prevalent in older adults. This study aimed to elucidate the impact of insomnia and sedative-hypnotic use on the frailty rate over time.

Methods: We used data from community-dwelling older adults (mean ± SD age = 69.4 ± 8.2 years) from the Healthy Aging Longitudinal Study in Taiwan (HALST). A total of 4,744 participants were included in the study and were followed up for an average of 3.2 years. Frailty was assessed using the Fried criteria. Self-reported sleep problems, sedative-hypnotic use, and claims records from the National Health Insurance database were used. The generalized equation estimation (GEE) approach was applied to account for correlations between repeated measures. The average impact of insomnia and drug use on frailty over time was estimated by adjusting for potential confounding factors using the logic link in the GEE approach.

Results: The adjusted odds ratio (OR) of frailty was 1.41 (95% CI: [1.16, 1.72], Z-test statistics Z = 3.39, p <0.001) for insomnia and 1.52 ([1.16, 2.00], Z = 3.00, p = 0.0027) for sedative-hypnotic use. Interactions between insomnia and sedative-hypnotic use with frailty were not statistically significant. Long sleep duration > 8 hours, daytime sleepiness, and sleep apnea was also associated with an increased likelihood of developing frailty. Notably, a dose-response relationship between sedative-hypnotic drug use and frailty was observed.

Conclusions: Insomnia and sedative-hypnotic use were independently associated with increased frailty. The implementation of nonpharmacological treatments to attenuate insomnia may reduce frailty rates.

Keywords: Sleep disturbance; benzodiazepine receptor agonist; frailty.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Frailty* / epidemiology
  • Humans
  • Hypnotics and Sedatives / adverse effects
  • Longitudinal Studies
  • Sleep
  • Sleep Initiation and Maintenance Disorders* / drug therapy
  • Sleep Initiation and Maintenance Disorders* / epidemiology


  • Hypnotics and Sedatives