The study drew on claims data from AOK – Die Gesundheitskasse, one of Germany’s largest statutory health insurers, allowing the investigators to identify 99,415 patients hospitalized for peripheral arterial disease between January 1, 2019 and December 31, 2020. This scale matters. Most previous studies of mental health in vascular disease have been small, single-center efforts that often conflated depression, anxiety, and cognitive impairment into a single category of psychological comorbidity. By contrast, the German dataset offered the statistical power to compare these disorders head to head, using multivariable-adjusted analyses and Cox regression models to account for age, sex, disease severity, and other cardiovascular risk factors.

The headline finding is striking in its simplicity: 47 percent of patients hospitalized for peripheral arterial disease had at least one of the three mental disorders. That figure alone should reshape how vascular teams think about their patient population. Patients with these conditions were more frequently female, presented with more advanced stages of arterial disease, and carried a heavier overall cardiovascular risk profile. In other words, the sickest patients with the most compromised circulation were also the ones most likely to be living with a mental health diagnosis, a convergence that sets the stage for the treatment disparities the study went on to document.

When the researchers disaggregated the three conditions, the picture became far more nuanced than the conventional wisdom suggests. Dementia stood out as the condition associated with the most pronounced disparities in care. Patients with dementia underwent revascularization, the procedures that restore blood flow to blocked leg arteries, at substantially lower rates than their peers. They also received statin therapy, the cornerstone guideline-recommended cholesterol-lowering treatment for atherosclerotic disease, far less often, despite presenting with more advanced disease at the time of hospitalization. This pattern of undertreatment in the face of greater need represents what the authors describe as an important and underrecognized gap in vascular care.

The prognostic consequences of dementia were equally dramatic. In the Cox regression models, dementia emerged as a strong independent predictor of all-cause mortality, with hazard ratios ranging from 1.57 to 1.62, meaning that patients with dementia faced a roughly 60 percent higher risk of death during follow-up compared with otherwise similar patients. Dementia also predicted the composite outcome of amputation and/or death, with hazard ratios between 1.49 and 1.56, and both associations were highly statistically significant. For a condition that is often treated as a background characteristic rather than a clinical variable, these numbers place dementia firmly in the category of major prognostic factors in peripheral arterial disease.

Depression, by contrast, told a quieter story. Although depression was the most prevalent of the three conditions and has been the focus of most prior research linking mental health to vascular outcomes, its association with adverse outcomes in this cohort was only modest after full statistical adjustment. Anxiety disorders fared even worse as prognostic markers, showing no consistent association with increased risk once the models accounted for other clinical variables. The authors conclude that mental disorders in peripheral arterial disease are not prognostically homogeneous, a phrase that carries real weight for trial designers, guideline writers, and clinicians who have traditionally bundled these conditions together under a single comorbidity flag.

Why might dementia exert such a disproportionate influence? The study itself points toward a combination of biological and systems-level mechanisms. On the biological side, dementia and peripheral arterial disease share deep vascular roots: atherosclerosis, endothelial dysfunction, and chronic inflammation injure both the brain and the limbs, and prior nationwide studies have shown that the risk of dementia differs across cardiovascular diseases and dementia subtypes. On the systems side, cognitive impairment complicates every step of vascular care. Patients with dementia may report claudication symptoms late or not at all, may struggle to adhere to complex medication regimens including statins and antiplatelet agents, and may be deemed poor candidates for revascularization by clinicians weighing procedural risk against limited expected benefit. Previous work in vascular surgery populations has documented that cognitive impairment is common and frequently undiagnosed in older patients undergoing vascular procedures, and that patients with dementia undergoing major limb amputation have particularly poor outcomes.

The treatment disparities documented in the study echo a pattern seen in other cardiovascular fields. Research on stroke care has shown that dementia is associated with poorer quality of care and worse outcomes after stroke, and the new findings suggest that a similar dynamic operates in the peripheral circulation. Whether the lower rates of revascularization and statin therapy in patients with dementia reflect explicit clinical judgment, implicit bias, communication barriers, or patient and family preferences cannot be determined from claims data alone. But the result is a vulnerable population that receives less of the therapy that guidelines recommend for everyone with atherosclerotic disease, while simultaneously bearing the highest risk of dying or losing a limb.

The study’s methodology deserves attention as well. Claims data offer unmatched scale and the ability to capture real-world treatment patterns across an entire country, but they also carry limitations inherent to administrative records. Diagnoses depend on coding practices, the severity of dementia and depression cannot be graded, and over-the-counter medications and care delivered outside the hospital may escape detection. The authors also note that the data are held by the Wissenschaftliches Institut der AOK in Berlin and are not publicly available, with access governed by contractual and data protection regulations. The work was funded as part of the LINCARE project by the Innovation Fund of the Federal Joint Committee, the German body that steers innovation in statutory health care.

For clinicians, the practical message is that screening for cognitive impairment should become as routine in vascular clinics as measuring the ankle-brachial index. For researchers, the findings argue for disaggregating mental health comorbidities in future trials and registries rather than collapsing them into a single variable. And for health systems, the study highlights a population in which coordinated care, involving vascular specialists, geriatricians, psychiatrists, and primary care physicians working together, could plausibly change outcomes that are currently among the worst in cardiovascular medicine. As the authors put it, dementia identifies a particularly vulnerable and undertreated peripheral arterial disease population, and recognizing that distinction is the first step toward closing a gap in care that has remained invisible for far too long.

Subject of Research: The differential impact of depression, anxiety, and dementia on prognosis and treatment patterns in patients hospitalized for peripheral arterial disease

Article Title: Not all mental disorders matter equally in peripheral arterial disease: Dementia drives prognosis and care disparities

Article References: Not all mental disorders matter equally in peripheral arterial disease: Dementia drives prognosis and care disparities. (n.d.). https://doi.org/10.1007/s00392-026-03027-w

Image Credits: AI Generated

DOI: 10.1007/s00392-026-03027-w

Keywords: peripheral arterial disease, dementia, depression, anxiety disorders, revascularization, statin therapy, amputation, mortality, claims data, health care disparities, cardiovascular risk, vascular care

The research, led by Michelle S. Rockwell of the Department of Family and Community Medicine at Virginia Tech Carilion School of Medicine together with colleagues across Virginia Tech, Carilion Clinic, the Virginia Center for Health Innovation, the University of Michigan, UCLA, and the RAND Corporation, took an unusual comparative approach. Rather than surveying a random sample of primary care clinicians, the team deliberately sought out the extremes. Within a large health system in the southeastern United States, they ranked 48 primary care practices according to their historical rate of low-value acute low back pain imaging, determined using insurance claims data. From that ranking, they identified the six highest-performing practices, meaning those with the least low-value imaging, and the six lowest-performing practices, meaning those with the most.

From those twelve practices, the researchers invited 93 clinicians, including both physicians and advanced practice providers, to complete a survey. The response rate was 66 percent, a solid figure for clinician survey research. The questionnaire probed several distinct domains: attitudes and beliefs about low-value imaging for back pain, perceptions of the clinicians’ own performance relative to peers, views on what drives low-value imaging and how to fix it, and personal characteristics, including whether the clinician had personally experienced low back pain. The design’s key strength was the linkage of these self-reported attitudes and beliefs to objective, claims-based utilization data, allowing the researchers to see which subjective factors actually tracked with measured performance.

To analyze the results, the team used LASSO regression, a statistical technique well suited to situations where many candidate predictor variables must be winnowed down to a parsimonious set. The method applies a penalty that shrinks the coefficients of less informative variables toward zero, effectively selecting the responses most strongly associated with membership in a highest- versus lowest-performing practice, while controlling for clinician demographics. This approach matters because clinician surveys generate dozens of potential correlates, and naive comparisons can easily produce spurious associations. LASSO’s built-in variable selection provides a more disciplined filter.

The baseline findings were, in some ways, reassuring. Across all respondents, clinicians reported strong agreement with low back pain imaging guidelines, scoring 9.1 out of 10 on average with a standard deviation of 1.7. In other words, almost nobody in the sample believed the guidelines were wrong. Trust in the claims-based performance data used to rank practices was more lukewarm, averaging 4.1 out of 10 with a standard deviation of 1.9. That moderate skepticism is itself informative, because any de-implementation strategy that relies on clinicians accepting feedback from administrative data will have to contend with the fact that many of them do not fully trust that data in the first place.

The statistically significant differences between the groups were more surprising, and arguably more consequential. Two clinician characteristics were associated with lower odds of belonging to a highest-performing practice. The first was a personal history of low back pain, with an odds ratio of 0.70 and a 95 percent confidence interval of 0.64 to 0.76. The second was a greater number of years in practice, with an odds ratio of 0.87 and a 95 percent confidence interval of 0.79 to 0.96. Both confidence intervals exclude one, indicating associations unlikely to be due to chance. The direction of these effects is striking: clinicians who had personally suffered back pain, and clinicians with more experience, were more likely to work in practices that ordered more low-value imaging, not less.

The interpretation of these associations is not settled by the study’s cross-sectional design, which captures a snapshot rather than tracking change over time. One plausible reading is that clinicians who have endured back pain themselves develop a stronger intuitive sense of their patients’ distress and a greater desire to rule out structural causes, even when guidelines say imaging is unnecessary. Similarly, longer-tenured clinicians trained in an era when routine imaging was more accepted may carry ingrained habits that resist guideline updates. Alternatively, the associations could reflect sorting effects, in which clinicians with particular styles gravitate toward particular practices. The study cannot disentangle these mechanisms, but it does establish that experience and personal history are not protective factors against low-value care, and may even be risk factors.

Perhaps the most humbling result concerned self-assessment. Clinicians from the lowest-performing practices were significantly more likely to rate their own performance as better than that of other clinicians in their practice, compared with clinicians from the highest-performing practices, at 57 percent versus 40 percent, a difference the authors report as statistically significant with a p-value of 0.031. This is a textbook illustration of a well-documented cognitive bias: clinicians who order the most low-value care tend to believe they order less than their peers. The finding suggests that simply telling clinicians their raw performance numbers may not be enough, because many will assume the numbers are wrong or that their cases were exceptional. Notably, the overall trust in claims data was only moderate, which compounds the problem of getting accurate self-perceptions to stick.

When asked what drives low-value imaging in the first place, clinicians across both groups converged on the same answer: patient demand was the most frequently identified driver. This attribution is common in the literature on medical overuse, and it frames the clinician as a gatekeeper responding to external pressure rather than an independent decision-maker. Interestingly, the two groups diverged on solutions. Clinicians from the highest-performing practices more frequently recommended health system-focused strategies, such as changes to workflows, decision support, or institutional policies, whereas clinicians from the lowest-performing practices more frequently recommended patient education. That split may reflect a self-serving logic, with lower performers locating the fix outside themselves, but it also carries practical weight: the strategies clinicians are willing to endorse are the strategies most likely to be implemented successfully in their own practices.

The study was conducted as part of the Virginia Center for Health Innovation’s Smarter Care Virginia initiative and a participating health system’s intervention to reduce low-value back pain imaging, both registered on ClinicalTrials.gov, with funding support in part from Arnold Ventures, which had no role in the study’s design, data collection, analysis, or manuscript preparation. The authors conclude that clinician characteristics, perceptions of performance, and preferred de-implementation strategies differ systematically by practice performance, and that these differences can help inform the selection and targeting of strategies to reduce low-value imaging. For health systems, the practical implication is that a one-size-fits-all campaign is unlikely to work. High-performing practices may respond best to system-level nudges, while low-performing practices may need interventions that confront the overconfidence gap directly, build trust in performance data, and address the patient-demand dynamic that clinicians themselves identify as the central pressure. As health systems worldwide grapple with the challenge of de-implementing low-value care, this study offers a reminder that the barriers are not ignorance of guidelines, which clinicians overwhelmingly endorse, but the subtler terrain of personal experience, habit, and self-perception.

Subject of Research: Clinician-level determinants of low-value acute back pain imaging in primary care

Article Title: Clinician-Level determinants of low-value acute back pain imaging in primary care

Article References: Rockwell, M. S., King, M., Mercogliano, E. H., Bortz, B. A., Karanjeet, R., Stewart, J., Fendrick, A. M., Mafi, J. N., & Epling, J. W. (2026). Clinician-Level determinants of low-value acute back pain imaging in primary care. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15609-5

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15609-5

Keywords: low-value care, acute low back pain, primary care, medical imaging, de-implementation, clinician survey, claims data, LASSO regression, health services research, patient demand, guideline adherence, overuse

The research team, led by Reina Taguchi of the Institute for Health Economics and Policy in Tokyo along with colleagues at the University of Tokyo and other Japanese institutions, asked a deceptively simple question: does the size of a pharmacy’s visiting practice shape the kind of patients it serves, the resources it deploys, and the medication outcomes those patients experience? To answer it, the investigators turned to an unusually rich data source — linked medical and long-term care insurance claims from a single city in Tokyo, allowing them to track both health care use and care needs for the same individuals over time.

The study population consisted of adults aged 65 and older who began using visiting pharmacist services between fiscal years 2015 and 2018. In total, 2,699 older adults were identified. Rather than treating all pharmacies as interchangeable, the researchers grouped them into tertiles according to their annual patient volume, creating low-, medium-, and high-volume categories. This design allowed the team to compare patient characteristics, medication profiles, and pharmacy attributes across the spectrum of practice scale, and then to follow medication counts over time using sophisticated statistical modeling.

The first striking finding concerns who ends up on the caseloads of busy pharmacies. High-volume pharmacies were not simply scaled-up versions of their smaller counterparts; they served a categorically different patient population. Their patients were younger but clinically far more complex, and the proportion of patients with terminal cancer was dramatically higher — 21.2 percent at high-volume pharmacies compared with just 6.3 percent at low-volume ones, a difference that was highly statistically significant. In other words, the largest visiting pharmacy practices have become de facto hubs for patients at the most fragile and medically demanding end of the home care spectrum.

That concentration of complexity is mirrored, and quite plausibly enabled, by the pharmacies’ staffing. High-volume pharmacies employed a median of nine full-time pharmacists, compared with a median of just three at low-volume practices — again a difference that reached statistical significance at p less than 0.001. This is not a trivial distinction in a field where round-the-clock availability, rapid response to symptom changes, and coordination with physicians and home nurses all demand substantial personnel. The pattern suggests a structural division of labor: larger practices, with deeper staffing reserves, absorb the patients whose conditions change fastest and whose medication regimens are most demanding to manage.

The longitudinal heart of the study focused on a subset of 2,005 participants for whom complete medication trajectory data were available. The researchers modeled the number of medications each patient was taking over time using linear mixed-effects models — a statistical framework well suited to repeated measures nested within individuals, who are themselves nested within pharmacies. The models included random intercepts at both levels and adjusted for recent hospitalization, a critical control because hospital discharges are precisely the moments when medication lists balloon. Potentially inappropriate medications were assessed with tools including the Japanese Anticholinergic Risk Scale, reflecting the particular risks of anticholinergic burden in older adults.

What the trajectories revealed is perhaps the study’s most consequential result. Before visiting pharmacist services began, patients’ medication counts were climbing steadily, at a rate of roughly 0.16 additional drugs per month — a familiar and worrying pattern of prescribing cascade in deteriorating patients. After service initiation, that climb all but stopped: medication counts rose by only about 0.03 drugs per month. The change in slope, a reduction of 0.13 drugs per month with a 95 percent confidence interval of −0.16 to −0.10, was statistically robust. In plain terms, the introduction of a visiting pharmacist marked a turning point at which runaway polypharmacy was brought under control.

Equally important is what did not differ. This stabilization effect held consistently across all three pharmacy volume groups, from the smallest practices to the largest hubs. Whatever advantages scale confers in staffing and patient mix, the fundamental benefit of a pharmacist regularly entering the home — reconciling medication lists, deprescribing where appropriate, coordinating with prescribers after hospitalizations — appears to operate regardless of practice size. The authors interpret this as evidence that visiting pharmacists engage at key care-transition points, the moments when patients are most vulnerable to medication errors and accumulation.

The findings arrive at a moment when health systems worldwide are scrambling to design sustainable home care workforces. Japan, one of the fastest-aging societies on Earth, has built an elaborate architecture of home medical care including home care support clinics and hospitals, and visiting pharmacist services are an explicit pillar of that system. By showing that patient volume is strongly associated with case complexity and staffing depth, the study provides empirical input for workforce planning: reimbursement models that assume all visiting pharmacies are interchangeable may systematically undervalue the high-volume hubs that shoulder the most complex, end-of-life cases.

There are limits worth keeping in mind. The study is retrospective and draws on claims data from a single Japanese city, Hachioji, whose data infrastructure made the analysis possible; generalization to other health systems requires care. Claims data also capture what was dispensed rather than every nuance of clinical decision-making. Yet the core message stands on solid ground: in aging societies, the pharmacies that visit the most patients tend to care for the sickest, and they do it with proportionally larger full-time teams — while the act of bringing a pharmacist into the home reliably halts the relentless growth of medication burden. As other nations expand home-based care, that combination of structural insight and clinical reassurance is exactly the kind of evidence policy will need.

Subject of Research: Visiting pharmacist services and medication management among older adults receiving home-based care in Japan

Article Title: Pharmacy patient volume and visiting Pharmacist services: variation in patient characteristics, pharmacy attributes, and medication changes

Article References: Taguchi, R., Okada, A., Tsuchiya-Ito, R., Kitamura, S., Ishikawa, T., & Hamada, S. (2026). Pharmacy patient volume and visiting Pharmacist services: variation in patient characteristics, pharmacy attributes, and medication changes. BMC Health Services Research. https://doi.org/10.1186/s12913-026-15673-x

Image Credits: AI Generated

DOI: 10.1186/s12913-026-15673-x

Keywords: visiting pharmacist services, polypharmacy, home-based care, aging population, long-term care, potentially inappropriate medications, pharmacy patient volume, claims data, care transitions, Japan, health services research, medication management

The research, led by Kentaro Matsui of the National Center of Neurology and Psychiatry in Tokyo and the Japan Somnology Center, together with colleagues including senior author Yuichi Inoue, took advantage of a uniquely valuable resource: the Dokenpo health insurance claims database, which covers a large, anonymous Japanese population from 2019 through 2024. The investigators identified 605 patients who had been continuously using benzodiazepines or benzodiazepine receptor agonists, which include the so-called Z-drugs such as zolpidem, for at least six months before starting either suvorexant or lemborexant, the two dual orexin receptor antagonists available in Japan. To qualify, patients had to continue the orexin antagonist for at least six months, ensuring that the analysis captured sustained treatment rather than brief trials. All bedtime sedative doses were converted into diazepam equivalents, a standard metric that allows the potency of very different hypnotics to be compared on a single scale.

The study’s design is its methodological strength. Rather than comparing one group of patients against another, the researchers used a mirror-image, self-controlled approach in which each patient served as his or her own control. Dose trajectories in the six months and more before orexin antagonist initiation were compared directly with dose trajectories afterward. This design elegantly neutralizes a major source of bias in observational drug research: the stable confounders that differ between people who switch medications and those who do not. Genetics, personality, severity of insomnia, socioeconomic circumstances, and dozens of other variables that could otherwise distort results are held perfectly constant, because every patient contributes data to both sides of the comparison. What remains vulnerable to bias is primarily time-related change, such as natural fluctuation in insomnia severity or secular trends in prescribing practice, which the authors acknowledge as a limitation of the method.

The findings are striking. Before starting the orexin antagonists, the 605 patients were taking an average of 1.9 different sedative medications simultaneously, at a mean total bedtime dose of 8.2 milligrams of diazepam equivalent. After at least six months of adjunctive treatment with suvorexant or lemborexant, 42.1 percent of patients had cut their bedtime benzodiazepine or benzodiazepine receptor agonist dose by at least half, and 21.3 percent had discontinued these drugs entirely. The mean bedtime dose fell from 7.2 to 5.2 milligrams of diazepam equivalent in the suvorexant group and from 8.3 to 5.2 milligrams in the lemborexant group. For a population in which dose reduction has historically proven so difficult that many patients remain on stable hypnotic doses for a decade or more, these numbers represent a clinically meaningful shift rather than a marginal one.

The statistical modeling behind the study adds important nuance. Using logistic regression with adjustment for potential confounders, the team identified a constellation of factors that predicted success. The most powerful was age: patients aged 65 years or older had roughly two and a half times the odds of achieving a 50 percent or greater dose reduction compared with younger patients, with an odds ratio of 2.485 and a 95 percent confidence interval of 1.190 to 5.192. The same group showed similarly elevated odds of full discontinuation, at an odds ratio of 2.636. This result carries particular public health weight, because older adults are precisely the population in which benzodiazepine-related harms, from hip fractures to accelerated cognitive decline, are most devastating. A pharmacological strategy that works best in the most vulnerable patients inverts the usual risk calculus of sedative prescribing.

Two additional predictors emerged from the adjusted analyses. Patients who began with lower total benzodiazepine doses were more likely to succeed in tapering, a pattern consistent with pharmacological intuition, since lighter users face weaker physical dependence and less severe withdrawal when doses fall. And lemborexant use was independently associated with both dose reduction and discontinuation compared with suvorexant, hinting that the choice of orexin antagonist may matter. The authors caution, however, that this observational finding cannot establish that one drug is intrinsically superior; prescribing patterns, patient characteristics, and physician preferences may all have influenced which patients received which agent. Still, the signal aligns with emerging trial data, including the SUNRISE 2 study, which demonstrated the long-term efficacy and tolerability of lemborexant, and with network meta-analyses that have compared the orexin antagonists head to head.

Understanding why the strategy works requires a brief tour of sleep neurobiology. Orexin, also called hypocretin, is a neuropeptide produced by a small population of neurons in the lateral hypothalamus that stabilizes wakefulness. The loss of orexin neurons causes narcolepsy, and conversely, blocking orexin receptors promotes sleep by damping down the brain’s arousal system rather than by globally suppressing neural activity. Benzodiazepines and Z-drugs, by contrast, work through the GABA-A receptor, the same broad braking mechanism recruited by alcohol and barbiturates, which explains their sedative potency but also their liability for tolerance, dependence, respiratory effects, and next-morning impairment. Because dual orexin receptor antagonists act on an entirely separate pathway, they can maintain sleep quality while the GABAergic sedative is tapered, theoretically smoothing the transition and preventing the rebound insomnia that so often defeats deprescribing attempts. Earlier work, including the SLIM study of lemborexant switching and clinical case reports, had suggested this feasibility in smaller and more selected samples; the new claims-based analysis extends the evidence to routine clinical practice at scale.

The broader context makes the findings urgent. Prevalence studies have documented widespread hypnotic use in Japan and globally, and cohort analyses have shown that a substantial fraction of users continue these drugs for years, often at escalating doses and in risky combinations. Deprescribing guidelines recommend gradual tapering combined with cognitive behavioral therapy for insomnia, the gold standard non-pharmacological treatment, but access to behavioral therapy remains limited in many health systems, and tapering without an adequate sleep substitute frequently fails. Previous pharmacological substitution attempts, using melatonin or trazodone, produced mixed results. What the mirror-image analysis adds is real-world evidence that a systematic switching strategy with orexin antagonists can move the needle in ordinary insurance claims data, not just in carefully curated clinical trials.

Caveats remain, and the authors are careful to enumerate them. The mirror-image design cannot fully exclude secular trends or regression to the mean; patients who initiate and sustain a new medication for six months are, by definition, a selected and possibly more motivated group; and claims data cannot capture insomnia severity, cognitive behavioral therapy receipt, or the clinical reasoning behind dose changes. The database also cannot distinguish whether dose reductions were driven primarily by physician advice or patient initiative. Randomized controlled trials of DORA-assisted tapering remain the logical next step, and the odds ratios and effect sizes reported here provide exactly the kind of signal that justifies such trials. Funding for the study came from the Japan Society for the Promotion of Science KAKENHI program, and the data provider’s restrictions mean the underlying claims cannot be shared publicly.

Even with these qualifications, the study’s practical implication is hard to overstate. For clinicians confronting the entrenched problem of long-term benzodiazepine use, particularly in older patients, the results support a concrete, testable protocol: initiate suvorexant or lemborexant, stabilize sleep for several weeks, and then begin a structured taper of the GABAergic hypnotic, monitoring for withdrawal and rebound. More than four in ten patients may halve their dose, and one in five may stop entirely. Given that the alternative is often indefinite exposure to medications associated with falls, fractures, cognitive decline, and dependence, those odds transform a discouraging clinical stalemate into a genuine treatment opportunity, and they position orexin receptor antagonism as a central tool in the global effort to make sleep medicine safer.

Subject of Research: Dual orexin receptor antagonist-assisted dose reduction of benzodiazepines and benzodiazepine receptor agonists in long-term users with chronic insomnia

Article Title: Dual orexin receptor antagonist-assisted dose reduction of benzodiazepines and benzodiazepine receptor agonists: a mirror-image analysis of insurance claims data

Article References: Matsui, K., Sugiura, K., Shimura, A., Takagi, S., Kurihara, K., Takaesu, Y., & Inoue, Y. (2026). Dual orexin receptor antagonist-assisted dose reduction of benzodiazepines and benzodiazepine receptor agonists: a mirror-image analysis of insurance claims data. Journal of Clinical Sleep Medicine, 22(1), Article 163. https://doi.org/10.1007/s44470-026-00164-x

Image Credits: AI Generated

DOI: 10.1007/s44470-026-00164-x

Keywords: insomnia, benzodiazepines, dual orexin receptor antagonists, lemborexant, suvorexant, deprescribing, hypnotics, sleep medicine, mirror-image study, claims data, older adults, drug tapering