Association Between Sleep-Related Medication Use and Recurrent Falls Among Inpatients: A Five-Year Retrospective Observational Study at a University Hospital

Objective: The aim of this study is to examine associations between sleep-related medication use at the first inpatient fall and recurrent falls, focusing on drug classes and concurrent use of multiple classes. Methods: We conducted a single-center retrospective observational study of 2587 inpatient fall events involving 1830 patients at our hospital between January 2021 and December 2025. Patients were classified as single fallers (one fall) or recurrent fallers (two or more falls). At the first fall, we assessed benzodiazepine use for insomnia or anxiety, non-benzodiazepine hypnotics (Z-drugs), orexin receptor antagonists, and ramelteon. Modified Poisson regression with a log link and a robust sandwich variance estimator was used to estimate adjusted risk ratios (RRs), with adjustment for age, sex, activity at the first fall, dementia, and total medication count. Results: There were 1394 single fallers and 436 recurrent fallers. In Model 1, adjusted for age, sex, and activity, benzodiazepines (adjusted RR, 1.56; 95% confidence interval [CI], 1.25–1.95), Z-drugs (RR, 1.49; 95% CI, 1.13–1.95), and orexin receptor antagonists (RR, 1.39; 95% CI, 1.16–1.66) were associated with recurrent falls. These associations persisted in Model 2 after additional adjustment for dementia and total medication count: benzodiazepines (RR, 1.54; 95% CI, 1.22–1.94), Z-drugs (RR, 1.46; 95% CI, 1.11–1.92), and orexin receptor antagonists (RR, 1.37; 95% CI, 1.14–1.64). Ramelteon was not significantly associated with recurrent falls (RR, 1.29; 95% CI, 0.96–1.74). Any sleep-related medication use (RR, 1.53; 95% CI, 1.30–1.82) and concurrent use of two or more classes (RR, 1.83; 95% CI, 1.46–2.29) were associated with recurrent falls. Conclusions: Sleep-related medication use, particularly concurrent use of multiple classes, was associated with recurrent inpatient falls. Sleep-related medications should be reviewed at hospital admission and reassessed after an index fall, with particular attention to their indications and concurrent use.