{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:53:07Z","timestamp":1760143987597,"version":"build-2065373602"},"reference-count":46,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2022,6,11]],"date-time":"2022-06-11T00:00:00Z","timestamp":1654905600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004700","name":"Taipei Medical University","doi-asserted-by":"publisher","award":["TMU110-AE1-B11","MOST109-2314-B-038-024"],"award-info":[{"award-number":["TMU110-AE1-B11","MOST109-2314-B-038-024"]}],"id":[{"id":"10.13039\/501100004700","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology","doi-asserted-by":"publisher","award":["TMU110-AE1-B11","MOST109-2314-B-038-024"],"award-info":[{"award-number":["TMU110-AE1-B11","MOST109-2314-B-038-024"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Sedative\u2013hypnotic misuse is associated with psychiatric diseases and overdose deaths. It remains uncertain whether types of anesthesia affect the occurrence of new postoperative uses of sedative\u2013hypnotics (NPUSH). We used reimbursement claims data of Taiwan\u2019s National Health Insurance and conducted propensity score matching to compare the risk of NPUSH between general and neuraxial anesthesia among surgical patients who had no prescription of oral sedative\u2013hypnotics or diagnosis of sleep disorders within the 12 months before surgery. The primary outcome was NPUSH within 180 days after surgery. Multivariable logistic regression models were used to calculate the adjusted odds ratio (aOR) and 95% confidence interval (CI). A total of 92,222 patients were evaluated after matching. Among them, 15,016 (16.3%) had NPUSH, and 2183 (4.7%) were made a concomitant diagnosis of sleep disorders. General anesthesia was significantly associated both with NPUSH (aOR: 1.17, 95% CI: 1.13\u20131.22, p &lt; 0.0001) and NPUSH with sleep disorders (aOR: 1.11, 95% CI: 1.02\u20131.21, p = 0.0212) compared with neuraxial anesthesia. General anesthesia was also linked to NPUSH that occurred 90\u2013180 days after surgery (aOR: 1.12, 95% CI: 1.06\u20131.19, p = 0.0002). Other risk factors for NPUSH were older age, female, lower insurance premium, orthopedic surgery, specific coexisting diseases (e.g., anxiety disorder), concurrent medications (e.g., systemic steroids), postoperative complications, perioperative blood transfusions, and admission to an intensive care unit. Patients undergoing general anesthesia had an increased risk of NPUSH compared with neuraxial anesthesia. This finding may provide an implication in risk stratification and prevention for sedative\u2013hypnotic dependence after surgery.<\/jats:p>","DOI":"10.3390\/jcm11123360","type":"journal-article","created":{"date-parts":[[2022,6,12]],"date-time":"2022-06-12T09:26:48Z","timestamp":1655026008000},"page":"3360","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["The Association between General Anesthesia and New Postoperative Uses of Sedative\u2013Hypnotics: A Nationwide Matched Cohort Study"],"prefix":"10.3390","volume":"11","author":[{"given":"Chen-Yu","family":"Tai","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsin-Yi","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan P.","family":"Cata","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 409, Houston, TX 77030, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3279-4509","authenticated-orcid":false,"given":"Ying-Xiu","family":"Dai","sequence":"additional","affiliation":[{"name":"Department of Dermatology, Taipei Veterans General Hospital, Taipei 11217, Taiwan"},{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mu-Hong","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Psychiatry, Taipei Veterans General Hospital, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jui-Tai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8350-0232","authenticated-orcid":false,"given":"Tzeng-Ji","family":"Chen","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans General Hospital, Taipei 11217, Taiwan"},{"name":"Department of Family Medicine, Taipei Veterans General Hospital, Hsinchu Branch, Hsinchu 31064, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hsiang-Ling","family":"Wu","sequence":"additional","affiliation":[{"name":"School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan"},{"name":"Department of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0201-4380","authenticated-orcid":false,"given":"Yih-Giun","family":"Cherng","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chun-Cheng","family":"Li","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chien-Wun","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5210-6873","authenticated-orcid":false,"given":"Ying-Hsuan","family":"Tai","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, Taiwan"},{"name":"Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei 11031, Taiwan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,6,11]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"519","DOI":"10.1007\/s40261-016-0397-8","article-title":"Benzodiazepine Use, Misuse, and Harm at the Population Level in Canada: A Comprehensive Narrative Review of Data and Developments Since 1995","volume":"36","author":"Murphy","year":"2016","journal-title":"Clin. Drug Investig."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1016\/j.drugalcdep.2019.02.033","article-title":"The epidemiology of benzodiazepine misuse: A systematic review","volume":"200","author":"Votaw","year":"2019","journal-title":"Drug Alcohol Depend."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.amepre.2015.03.040","article-title":"Emergency department visits and overdose deaths from combined use of opioids and benzodiazepines","volume":"49","author":"Jones","year":"2015","journal-title":"Am. J. Prev. Med."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1007\/s40268-017-0207-7","article-title":"Benzodiazepines and Z-Drugs: An Updated Review of Major Adverse Outcomes Reported on in Epidemiologic Research","volume":"17","author":"Brandt","year":"2017","journal-title":"Drugs R&D"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"629","DOI":"10.3389\/fneur.2020.00629","article-title":"Sleep Disturbances After General Anesthesia: Current Perspectives","volume":"11","author":"Luo","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_6","first-page":"33","article-title":"The effect of opioids on sleep architecture","volume":"3","author":"Dimsdale","year":"2007","journal-title":"J. Clin. Sleep Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1097\/ALN.0000000000000041","article-title":"Factors Associated with Postoperative Exacerbation of Sleep-disordered Breathing","volume":"120","author":"Chung","year":"2014","journal-title":"Anesthesiology"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2086","DOI":"10.1097\/j.pain.0000000000001600","article-title":"Opioid use, pain intensity, age, and sleep architecture in patients with fibromyalgia and insomnia","volume":"160","author":"Curtis","year":"2019","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"702","DOI":"10.1097\/ALN.0b013e31822ddd72","article-title":"Rapid eye movement sleep debt accrues in mice exposed to volatile anesthetics","volume":"115","author":"Pick","year":"2011","journal-title":"Anesthesiology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"395","DOI":"10.5664\/jcsm.2032","article-title":"The impact of quality of sleep on recovery from fast-track abdominal hysterectomy","volume":"8","author":"Nilsson","year":"2012","journal-title":"J. Clin. Sleep Med."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"39","DOI":"10.1093\/sleep\/24.1.39","article-title":"Postoperative sleep disturbance: Influences of opioids and pain in humans","volume":"24","author":"Cronin","year":"2001","journal-title":"Sleep"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1093\/bja\/aes252","article-title":"Sleep disturbances after fast-track hip and knee arthroplasty","volume":"109","author":"Krenk","year":"2012","journal-title":"Br. J. Anaesth."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"939","DOI":"10.1213\/ANE.0b013e3182860e58","article-title":"Occurrence of Rapid Eye Movement Sleep Deprivation after Surgery under Regional Anesthesia","volume":"116","author":"Dette","year":"2013","journal-title":"Anesthesia Analg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e2112478","DOI":"10.1001\/jamanetworkopen.2021.12478","article-title":"Association of New Perioperative Benzodiazepine Use with Persistent Benzodiazepine Use","volume":"4","author":"Wright","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1136\/bmj.39335.541782.AD","article-title":"STROBE Initiative. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies","volume":"335","author":"Altman","year":"2007","journal-title":"BMJ"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.sleep.2020.06.015","article-title":"Bidirectional association between alopecia areata and sleep disorders: A population-based cohort study in Taiwan","volume":"75","author":"Dai","year":"2020","journal-title":"Sleep Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4103\/ds.ds_14_21","article-title":"Statins did not reduce the mortality risk in patients with bullous pemphigoid: A population-based cohort study","volume":"39","author":"Wu","year":"2021","journal-title":"Dermatol. Sin."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"41","DOI":"10.4103\/ds.ds_52_20","article-title":"Increased risk of alopecia areata among patients with endometriosis: A longitudinal study in Taiwan","volume":"39","author":"Dai","year":"2021","journal-title":"Dermatol. Sin."},{"key":"ref_19","unstructured":"National Health Insurance Research Database (2022, June 01). Data Subsets. Available online: https:\/\/nhird.nhri.org.tw\/en\/Data_Subsets.html."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1057","DOI":"10.1002\/sim.6004","article-title":"A comparison of 12 algorithms for matching on the propensity score","volume":"33","author":"Austin","year":"2013","journal-title":"Stat. Med."},{"key":"ref_21","first-page":"448","article-title":"Identifying Cases of Sleep Disorders through International Classification of Diseases (ICD) Codes in Administrative Data","volume":"3","author":"Jolley","year":"2018","journal-title":"Int. J. Popul. Data Sci."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1027","DOI":"10.1093\/sleep\/32.8.1027","article-title":"Incidence and Risk Factors of Insomnia in a Population-Based Sample","volume":"32","author":"Leblanc","year":"2009","journal-title":"Sleep"},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.ejca.2020.09.004","article-title":"The association of non-small-cell lung cancer recurrence with allogenic blood transfusion following surgical resection: A propensity score analysis of 1803 patients","volume":"140","author":"Tai","year":"2020","journal-title":"Eur. J. Cancer"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"464","DOI":"10.1111\/anae.14862","article-title":"The association of allogeneic blood transfusion and the recurrence of hepatic cancer after surgical resection","volume":"75","author":"Tai","year":"2019","journal-title":"Anaesthesia"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.jsmc.2018.02.001","article-title":"Drug-induced insomnia and excessive sleepiness","volume":"13","year":"2018","journal-title":"Sleep Med. Clin."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"3083","DOI":"10.1002\/sim.3697","article-title":"Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples","volume":"28","author":"Austin","year":"2009","journal-title":"Stat. Med."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"969","DOI":"10.2147\/CIA.S59927","article-title":"Sleep disturbance in older ICU patients","volume":"9","author":"Sterniczuk","year":"2014","journal-title":"Clin. Interv. Aging"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1506","DOI":"10.1253\/circj.71.1506","article-title":"Follow-up with Objective and Subjective Tests of the Sleep Characteristics of Patients after Cardiac Surgery","volume":"71","author":"Yilmaz","year":"2007","journal-title":"Circ. J."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"396","DOI":"10.1097\/ALN.0000000000000952","article-title":"Impact of perioperative epidural placement on postdischarge opioid use in patients undergoing abdominal surgery","volume":"124","author":"Ladha","year":"2016","journal-title":"Anesthesiology"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"103490","DOI":"10.1016\/j.ebiom.2021.103490","article-title":"Effects of general versus subarachnoid anaesthesia on circadian melatonin rhythm and postoperative delirium in elderly patients undergoing hip fracture surgery: A prospective cohort clinical trial","volume":"70","author":"Song","year":"2021","journal-title":"eBioMedicine"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1539","DOI":"10.1016\/j.jpain.2013.08.007","article-title":"The Association of Sleep and Pain: An Update and a Path Forward","volume":"14","author":"Finan","year":"2013","journal-title":"J. Pain"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1016\/j.jpainsymman.2008.03.010","article-title":"Disrupted Sleep the Night Before Breast Surgery Is Associated with Increased Postoperative Pain","volume":"37","author":"Wright","year":"2009","journal-title":"J. Pain Symptom Manag."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1016\/j.bjae.2017.10.002","article-title":"Regional anaesthesia and outcomes","volume":"18","author":"Hutton","year":"2018","journal-title":"BJA Educ."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1093\/bja\/aet213","article-title":"Regional anaesthesia to prevent chronic pain after surgery: A Cochrane systematic review and meta-analysis","volume":"111","author":"Andreae","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1016\/j.psychres.2016.01.040","article-title":"Continuation and discontinuation of benzodiazepine prescriptions: A cohort study based on a large claims database in Japan","volume":"237","author":"Takeshima","year":"2016","journal-title":"Psychiatry Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"949","DOI":"10.1111\/jgs.14685","article-title":"Sleep Disruption at Home as an Independent Risk Factor for Postoperative Delirium","volume":"65","author":"Todd","year":"2017","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_37","first-page":"1026","article-title":"Disturbances in the circadian pattern of activity and sleep after laparoscopic versus open abdominal surgery","volume":"23","author":"Bisgaard","year":"2008","journal-title":"Surg. Endosc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"225","DOI":"10.5664\/jcsm.5490","article-title":"Effect of Melatonin on Sleep in the Perioperative Period after Breast Cancer Surgery: A Randomized, Double-Blind, Placebo-Controlled Trial","volume":"12","author":"Madsen","year":"2016","journal-title":"J. Clin. Sleep Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"118","DOI":"10.1016\/j.jclinane.2016.10.022","article-title":"Effects of dexmedetomidine administered for postoperative analgesia on sleep quality in patients undergoing abdominal hysterectomy","volume":"36","author":"Chen","year":"2016","journal-title":"J. Clin. Anesth."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"375","DOI":"10.2147\/NSS.S300803","article-title":"Effects of Intravenous Anesthetics vs. Inhaled Anesthetics on Early Postoperative Sleep Quality and Complications of Patients After Laparoscopic Surgery Under General Anesthesia","volume":"13","author":"Li","year":"2021","journal-title":"Nat. Sci. Sleep"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1093\/bja\/aet068","article-title":"Inflammatory response, immunosuppression, and cancer recurrence after perioperative blood transfusions","volume":"110","author":"Cata","year":"2013","journal-title":"Br. J. Anaesth."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1164\/rccm.201411-2099CI","article-title":"Sleep in the intensive care unit","volume":"191","author":"Pisani","year":"2015","journal-title":"Am. J. Respir. Crit. Care Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1186\/s13613-018-0408-4","article-title":"Association of intensive care unit delirium with sleep disturbance and functional disability after critical illness: An observational cohort study","volume":"8","author":"Altman","year":"2018","journal-title":"Ann. Intensiv. Care"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"196","DOI":"10.4103\/0970-9185.155148","article-title":"Preoperative anxiety in patients selecting either general or regional anesthesia for elective cesarean section","volume":"31","author":"Maheshwari","year":"2015","journal-title":"J. Anaesthesiol. Clin. Pharmacol."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1007\/s12325-019-01171-6","article-title":"Factors Determining the Choice of Spinal Versus General Anesthesia in Patients Undergoing Ambulatory Surgery: Results of a Multicenter Observational Study","volume":"37","author":"Capdevila","year":"2019","journal-title":"Adv. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.jclinane.2016.03.025","article-title":"Preoperative use of anxiolytic-sedative agents; are we on the right track?","volume":"33","author":"Bucx","year":"2016","journal-title":"J. Clin. Anesth."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3360\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T23:28:11Z","timestamp":1760138891000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/11\/12\/3360"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,6,11]]},"references-count":46,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,6]]}},"alternative-id":["jcm11123360"],"URL":"https:\/\/doi.org\/10.3390\/jcm11123360","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2022,6,11]]}}}