| Matsumura (2019) |
An observational study of 149 suspected OSA patients, who did not have insomnia at home, were studied whilst undergoing overnight polysomnography in-lab. Patients who experienced difficulty falling asleep (n=84) were given an optional one-time dose of suvorexant, followed by an add-on dose of zolpidem if still wakeful 1 hour after suvorexant’s administration. |
Of the 149 patients student, 65 were placed in the “no insomnia group. Of the remaining 84 patients who had difficulty falling asleep, 52.4% of the patients achieved sleep sufficient for PSG analysis with a single dose of suvorexant, while the remaining 47.6% required the addition of zolpidem 1 hour later. There was no significant change between the insomnia and no insomnia groups in regard to sleep time or quality, according to a subjective survey, and no adverse events occurred. |
Suvorexant is a mild hypnotic that may be utilized for suspected OSA patients when they experience in-laboratory insomnia during PSG. |
| Herring (2020) |
A randomized, double-blind, 4 week trial of 1:1 placebo: suvorexant treatment was studied in patients (n=285) between the ages of 50-90 who met the DSM-5 criteria for Alzheimer’s disease dementia (determined via investigator interview of the patient) and insomnia (determined via interview and PSG as a mean total sleep time of<6 hours per night). Patients were required to have a trial partner who resided with the patient overnight.
Treatment /placebo was administered 30 minutes prior to the patient’s bedtime, and mean total sleep time and wake after sleep onset time were assessed by PSG. Subjective assessment of patient and partner sleep was given by the trial partner. |
Baseline mean sleep time for patients was 77 minutes in the suvorexant group (n=142) and 84 minutes in the placebo group (n=143) at the beginning of this trial. At week 4 of the trial, greater than or equal to 50-minute improvement in mean sleep time was seen in 62% of the suvorexant group and 45% of the placebo group; greater than or equal to 60-minute improvement in mean sleep time was seen in 55% of the suvorexant group and 40% of the placebo group.
Baseline mean wake after sleep onset was 60 minutes for suvorexant patients and 61 minutes for the placebo group. At 4 weeks, mean change from baseline was -45 for the suvorexant group and -29 minutes for the placebo group, and this was pronounced during the last third of the night.
Partners of the patient noted a significant improvement in sleep quality for the suvorexant group as compared to the placebo group.
There were no differences between the groups in partner-rated assessment of the patient’s sleep or clinician impression of the degree of patient insomnia. |
Suvorexant improved mean total sleep time in patients with probable Alzheimer’s dementia and insomnia. |
| Hamuro (2018) |
Clinical trial of 6 patients with dementia due to AD and insomnia (defined as sleeping for <4 hours continuously). Patients were evaluated at baseline with mini mental status exam (MMSE), physical self-maintenance scale (PSMS), and neuropsychiatric inventory (NPI). Patients were then given a daily dose of suvorexant and evaluated at weeks 1,2,3, and 4. |
Baseline scores for the MMSE and PSMS were 5.7 ± 5.89 and 10.8 ± 5.53 respectively. There were no significant changes in NPI scores. All patients reported being able to sleep continuously for >6 hours per night at trial’s completion. |
Suvorexant is adequate in treating insomnia in Alzheimer’s dementia patients |
| Kawada (2019) |
Retrospective cohort study of sleep quality and delirium in patients with acute stroke where patients were given ramelteon plus a GABAR agonist (n= 104) or ramelteon plus suvorexant (n= 128). |
Sleep quality was improved with the addition of suvorexant to ramelteon therapy as opposed to the addition of a GABAR agonist. Delirium was less frequent in the suvorexant group as compared with the GABAR agonist group, as was a reduced recurrence of delirium.
The addition of suvorexant to ramelteon therapy was associated with shorter hospital stays ([15-29], 21 days) in comparison to the addition of GABAR to ramelteon therapy ([18-33], 25 days). |
Addition of suvorexant to ramelteon therapy in patients with acute stroke improves their quality of sleep without inducing delirium. |
| Toi 2019 |
Single-arm, open-label interventional trial with 18 patients who had type 2 diabetes mellitus (T2DM) and insomnia; pt were monitored without treatment for days 1-3 and with treatment with suvorexant for days 4-6. Outcomes were monitored via continuous glucose monitoring (daily glucose levels), single-channel electroencephalography (sleep architecture), and accelerometry (autonomic nervous system function). |
Treatment of the patients with suvorexant for 3 days improved sleep time from 340.3 minutes to 360.0 min. REM time was increased from 72.8min to 96.5 min. non-REM increased from 260.3 min to 272.0 min. The 24-mean glucose level of patients decreased significantly from 157.7 ± 22.9 during days 1-3 to 152.3 ± 17.8 mg/dL on days 4-6. |
Suvorexant treatment of insomnia in patients with T2DM improved their glycemic control in addition to their quality of sleep. |
