The effect of frequent use of hypnotics on HRQOL in patients receiving LTOT and/or long-term NIV

Background and Aims: Most hypnotics are avoided in patients with severe chronic respiratory failure. Those patients however complain insomnia and need hypnotics. To clarify the effect of hypnotics on those patients' HRQOL, clinical stability, and prognosis are necessary. Methods: We have started a 5-years prospective, multi-center, observational study including 355 patients receiving LTOT or/and long-term NIV. Patients' characteristics, laboratory data including ABGs, usage of hypnotics, and their HRQOL (SRI, HAD, PSQI, AIS, MRC, ESS, and categorized LSEQ) were examined. Results: 117 patients took some hypnotics frequently (more than ten times per month). There were no differences in patients' characteristics and laboratory data including ABGs between those using hypnotics and the other patients. Their SRI total score was lower (p<0.001). They were more anxious (p=0.002), and more depressed (p<0.0001). Their sleep was more disordered (PSQI total score, p<0.0001; AIS, p<0.0001). Their daytime perceived dyspnea was similar (MRC, p=0.89). Their daytime sleepiness was less (ESS, p=0.004). During the night with hypnotics, getting to sleep was easier and quicker, sleep was more restful and fewer wakeful, awakening was easier, and feeling on waking was more alert (categorized LSEQ) in patients taking hypnotics frequently. Conclusions: The rate of patients frequently taking hypnotics was more than 30%. Their HRQOL was significantly lower than the other patients. However, their exertional dyspnea was same, and their sleepiness was less. Hypnotics could improve their sleep. Long-term prospective study has started to elucidate the effect of frequent use of hypnotics.