METHODS: This retrospective cohort study included patients treated in general medical-surgical settings for nonpsychiatric conditions with consultation-liaison psychiatry consult for insomnia. Delirium was diagnosed by fully certified psychiatrists using the Diagnostic and Statistical Manual of Mental Disorders 5 th edition. The following items were retrospectively examined from medical records as factors related to delirium development: type of sleep-inducing drugs, age, sex, and delirium risk factors. The risk factors of delirium development were calculated using adjusted odds ratios (aORs) via multivariate logistic regression analysis.
RESULTS: Among the 710 patients analyzed, 257 (36.2%) developed delirium. Suvorexant (aOR, 0.61; 95% confidence interval [CI], 0.40-0.94; P = 0.02) and lemborexant (aOR, 0.23; 95% CI, 0.14-0.39; P < 0.0001) significantly reduced the risk of developing delirium. Benzodiazepines (aOR, 1.90; 95% CI, 1.15-3.13; P = 0.01) significantly increased this risk. Ramelteon (aOR, 1.30; 95% CI, 0.84-2.01; P = 0.24) and Z-drugs (aOR, 1.27; 95% CI, 0.81-1.98; P = 0.30) were not significantly associated with delirium development.
CONCLUSIONS: The use of suvorexant and lemborexant may prevent delirium in patients with a wide range of medical conditions.
方法:这项回顾性队列研究包括在非精神病的普通内科-外科治疗中接受咨询-联络精神病学咨询的失眠患者。谵妄是由完全认证的精神病医生使用《精神障碍诊断和统计手册》第5版诊断的。从医疗记录中回顾性检查了以下项目,作为与谵妄发展相关的因素:睡眠诱导药物的类型,年龄,性别,和谵妄的危险因素。通过多变量逻辑回归分析,使用调整的比值比(aORs)计算谵妄发展的危险因素。
结果:在分析的710名患者中,257例(36.2%)发生谵妄。Suvorexant(aOR,0.61;95%置信区间[CI],0.40-0.94;P=0.02)和lemborexant(aOR,0.23;95%CI,0.14-0.39;P<0.0001)显著降低发生谵妄的风险。苯二氮卓类药物(aOR,1.90;95%CI,1.15-3.13;P=0.01)显着增加了这种风险。Ramelteon(aor,1.30;95%CI,0.84-2.01;P=0.24)和Z-药物(aOR,1.27;95%CI,0.81-1.98;P=0.30)与谵妄发展无显著相关性。
结论:使用suvorexant和lemborexant可以预防患有多种疾病的患者的谵妄。