Article Text

Download PDFPDF
Anticholinergic burden and revisit risk in frail patients with pharmacological sleepiness
  1. Jesus Ruiz-Ramos1,
  2. Laia López-Vinardell1,
  3. Leopoldo Higa-Sansone2,
  4. Berta Torrecilla-Vall-LLossera1,
  5. Mireia Puig-Campmany2,
  6. Maria Antònia Mangues-Bafalluy1,
  7. Ana Juanes-Borrego1
  1. 1 Pharmacy Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
  2. 2 Emergency Department, Hospital Santa Creu i Sant Pau, Barcelona, Spain
  1. Correspondence to Jesus Ruiz-Ramos, Pharmacy, Hospital de la Santa Creu i Sant Pau, Barcelona 08041, Spain; jrzrms{at}


Objective Drug-induced sleepiness is a frequent cause of emergency department (ED) visits for frail patients. The aim of this study was to assess the impact of anticholinergic burden on 90-day revisitation risk for frail patients who visit the ED due to drug-induced sleepiness.

Methods This was a retrospective study in which patients treated at a fragility care area of an ED who sought consultation for drug-associated sleepiness from June 2020 to June 2021 were included. To evaluate the 90-day revisitation risk factors, a multivariate analysis was performed, including those factors with a p<0.200 from a previous univariate model. A Cox regression model was performed to assess the impact of a high burden on the time until 90-day ED revisitation.

Results One hundred and forty-eight patients were included (mean age 80.7±12.3 years). The median number of drugs that patients were currently on at emergency admission was eight (range 2–19), while at hospital discharge it was nine (range 2–20), with the median number of central nervous system (CNS) depressant drugs on admission being three (range 1–6). Thirty-five (23.6%) patients revisited the ED 90 days after discharge for sleepiness or agitation. In the multivariate model, a significant association was observed between a high anticholinergic burden during treatment at discharge (OR 3.74, 95% CI 1.36 to 9.71), chronic kidney disease (OR 2.87, 95% CI 1.19 to 6.81), and the risk of 90-day revisitation. Patients with high anticholinergic burden had a shorter time to revisit than those with medium or low anticholinergic burden (HR 1.96, 95% CI 1.05 to 3.99).

Conclusions Patients with pharmacological sleepiness and a high anticholinergic burden in their chronic treatment carry a greater risk of revisitation to EDs, and should be considered candidates for specific interventions after visiting these units.

  • Safety

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.