To the Editor We read with great interest the recently published Special Communication by Soong and colleagues.1 They persuasively showed why the initiation of sedative-hypnotic medications should be minimized along with the strategies that can be exploited. However, we raise 2 concerns, which were not adequately mentioned in the article.
First, the evidence regarding the harmful effects of sedative-hypnotic drug use and the effectiveness of nonpharmacological strategies relied too much on results from studies on the elderly population. By sheer numbers alone, 27 of 45 (60%) references in the article1 predominantly focused on the elderly. Regarding the nonpharmacological interventions, which are used to reduce sedative-hypnotic use among inpatients, 10 of 13 (77%) studies were based on elderly patients. This biased content naturally leads to a question of whether the suggested evidence can be generalized to all adults. Unfortunately, the limitations resulting from these unbalanced citations were not mentioned in the Discussion section. In addition, several studies involving elderly people were cited without being mentioned, which may mislead the readers about the generalizability of the results. For example, Choosing Wisely Canada2 recommended against the use of sedative-hypnotic medications as a first-line therapy for elderly patients. It is an overgeneralization to interpret such recommendations as indications to avoid the use of sedative-hypnotic drugs and to consider them unnecessary in all adults.
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Cho S, Kang S, Na K. An Elderly Bias, Nocturia, and Adverse Effects of Sedative-Hypnotic Medication. JAMA Intern Med. 2019;179(10):1443–1444. doi:10.1001/jamainternmed.2019.4024
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