Abstract：
BACKGROUND: New sleep-inducing drugs (eg, ramelteon, suvorexant, and lemborexant) have been shown to prevent delirium in high-risk groups. However, no single study has simultaneously evaluated the delirium-preventing effects of all novel sleep-inducing drugs in hospitalized patients. Therefore, this study aimed to clarify the relationship between sleep-inducing drugs and delirium prevention in patients hospitalized in general medical-surgical settings for nonpsychiatric conditions who underwent liaison interventions for insomnia.
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.
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.
摘要：
背景：新的睡眠诱导药物（例如，Ramelteon,suvorexant,和lemborexant）已被证明可以预防高危人群的谵妄。然而,没有一项研究同时评估所有新型睡眠诱导药物对住院患者的谵妄预防作用.因此,本研究旨在阐明在接受失眠联络干预的普通内科-外科非精神病住院患者中,睡眠诱导药物与谵妄预防之间的关系.
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。
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。
