Suvorexant and Lemborexant exhibit fruitful results for delirium in critically ill adult patients

A recent study found that Suvorexant and Lemborexant may be effective in preventing delirium in critically ill adult patients in an advanced critical care center. The study results were published in The Journal of Clinical Psychiatry. 

Delirium is a syndrome that is characterized by an acute onset of deficits in attention, awareness, and cognition that fluctuate in severity over a short period. It is a common symptom in critically ill patients in the intensive care unit. Literature shows that suvorexant and lemborexant are the dual orexin receptor antagonists (DORAs) which are used for sleep disturbances can also be used to prevent delirium in critically ill patients. Hence researchers conducted an observational study in the advanced emergency and critical care center at Saga University Hospital to understand the efficacy of suvorexant and lemborexant in preventing delirium in critically ill patients. 

Patients 18 years of age or older who were admitted to the emergency center between July 2018 and November 2021 with a hospitalization duration of at least 72 h were included in the study. Kaplan-Meier curves and log-rank tests were performed to compare patients with and without DORA treatment. Cox regression analyses adjusting for factors associated with delirium risk were also performed. 

Results: 

• Out of the 633 enrolled patients, 82 were treated with suvorexant and 41 with lemborexant.
• The hazard ratios for the development of delirium were 0.56 for patients treated with suvorexant and 0.26 for those treated with lemborexant as per the cox regression analysis without any adjustment.
• After adjustment for delirium risk factors, the hazard ratios remained low at 0.34 (0.20–0.58) for suvorexant and 0.21 (0.08–0.52) for lemborexant. 

This study is the first of its kind to suggest that both suvorexant and lemborexant may have a preventive effect against delirium in critically ill patients requiring intensive care in an emergency department. 

Further reading: Matsuoka A, Tobita S, Sogawa R, et al. Evaluation of suvorexant and lemborexant for the prevention of delirium in adult critically ill patients at an advanced critical care center: a single-center, retrospective, observational study. J Clin Psychiatry. 2023;84(1):22m14471