■谵妄在住院的老年人中很常见。除了提出即时管理问题外,谵妄会增加痴呆的长期风险,制度化,和死亡率。谵妄与睡眠中断有关,和先前的研究表明,一些特定的睡眠促进剂可以减少谵妄。
■评价食欲素受体拮抗剂suvorexant对住院后发生谵妄高危老年人的谵妄作用。
■这种双盲,安慰剂对照,3期随机临床试验于2020年10月22日至2022年12月23日在日本50家医院进行.研究人群包括65至90岁的日本成年人,他们患有谵妄(轻度认知障碍或轻度痴呆,住院前的谵妄病史,或两者兼而有之),并因急性疾病或择期手术住院。数据分析于2023年1月23日至3月13日进行。
■在医院期间,参与者在就寝时间以1:1随机接受suvorexant(15mg)或安慰剂,为期7天。
■谵妄,主要终点,根据精神疾病诊断和统计手册诊断,第五版标准,参与者住院。分析患者谵妄比例的治疗差异。
■这项研究包括203名参与者:101名接受suvorexant治疗(平均[SD]年龄,81.5[4.5];年;52名男性[51.5%]和49名女性[48.5%])和102名接受安慰剂(平均[SD]年龄,82.0[4.9]岁;45名男性[44.1%]和57名女性[55.9%])。suvorexant组中有17名参与者发生谵妄(16.8%),而安慰剂组中有27名(26.5%)(差异,-8.7%[95%CI,-20.1%至2.6%];P=.13)。两组的不良事件相似。
■在这项针对住院后谵妄高危老年人的苏沃雷生随机临床试验中,与安慰剂相比,服用suvorexant的参与者减少了谵妄,但差异无统计学意义。需要进一步的研究来确定suvorexant是否有助于减少谵妄,特别是有过度活跃成分的谵妄,在这个人口中。
■ClinicalTrials.gov标识符:NCT04571944。
UNASSIGNED: Delirium is common among older hospitalized adults. In addition to presenting immediate management issues, delirium can increase the long-term risk of dementia, institutionalization, and mortality. Delirium is associated with disrupted sleep, and prior studies suggest that some specific sleep-promoting agents may reduce delirium.
UNASSIGNED: To evaluate the orexin receptor antagonist suvorexant for reducing delirium in older adults at high risk for delirium after hospitalization.
UNASSIGNED: This double-blind, placebo-controlled, phase 3 randomized clinical trial was conducted at 50 hospitals in Japan between October 22, 2020, and December 23, 2022. The study population included Japanese adults aged 65 to 90 years who were at high risk for delirium (mild cognitive impairment or mild dementia, history of delirium at prior hospitalization, or both) and had been hospitalized for acute disease or elective surgery. Data analysis was performed between January 23 and March 13, 2023.
UNASSIGNED: Participants were randomized 1:1 to suvorexant (15 mg) or placebo taken at bedtime for up to 7 days while in the hospital.
UNASSIGNED: Delirium, the primary end point, was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria while participants were hospitalized. The treatment difference in the proportion of participants with delirium was analyzed.
UNASSIGNED: This study included 203 participants: 101 were treated with suvorexant (mean [SD] age, 81.5 [4.5]; years; 52 men [51.5%] and 49 women [48.5%]) and 102 received placebo (mean [SD] age, 82.0 [4.9] years; 45 men [44.1%] and 57 women [55.9%]). There were 17 participants with delirium (16.8%) in the suvorexant group compared with 27 (26.5%) in the placebo group (difference, -8.7% [95% CI, -20.1% to 2.6%]; P = .13). Adverse events were similar between the 2 groups.
UNASSIGNED: In this randomized clinical trial of suvorexant in older adults at high risk for delirium after hospitalization, fewer participants taking suvorexant had delirium compared with placebo, but the difference was not statistically significant. Further studies are needed to determine whether suvorexant may be useful for reducing delirium, particularly delirium with a hyperactive component, in this population.
UNASSIGNED: ClinicalTrials.gov Identifier: NCT04571944.