Department of Psychiatry, Faculty of Medicine, Shimane University, Izumo, Shimane, Japan.
Department of Psychiatry, Shimane Prefectural Psychiatric Medical Center, Izumo, Shimane, Japan.
J Clin Psychiatry. 2020 Oct 6;81(6):20m13362. doi: 10.4088/JCP.20m13362.
This study aimed to examine the effects of suvorexant on delirium prevention in a real-world setting. Previous studies have demonstrated the efficacy of suvorexant for delirium prevention in limited randomized clinical trial settings; however, its effectiveness in everyday clinical settings remains unknown.
A single-center, retrospective cohort study was conducted in the intensive care unit of an academic hospital. Patients (aged ≥ 3 years) admitted from January 2016 to December 2018 were eligible if they stayed in the intensive care unit for at least 72 hours. Suvorexant was prescribed by the attending physician for insomnia as part of everyday clinical practice. A Cox proportional hazards regression analysis was conducted on delirium-free survival for suvorexant users, adjusting for delirium-related covariates. As part of routine clinical practice, the Confusion Assessment Method for the Intensive Care Unit was used to detect the existence of delirium at least twice daily throughout the intensive care unit stay.
There were 699 patients-84 suvorexant users and 615 suvorexant nonusers. Delirium was detected in 214 patients. Delirium prevalence was significantly lower in suvorexant users than in nonusers (17.9% vs 32.4%, respectively; P = .007). Cox regression analysis revealed a significantly lower hazard ratio (0.472; 95% CI, 0.268-0.832; P = .009) of delirium in suvorexant users than in nonusers. Trazodone also had a preventive effect on delirium (hazard ratio 0.345; 95% CI, 0.149-0.802; P = .013).
The present study extends to real-world settings previous findings that suvorexant is effective for delirium prevention.
本研究旨在检验苏沃雷生在真实环境中预防谵妄的效果。先前的研究表明苏沃雷生在有限的随机临床试验环境中对预防谵妄有效；然而，其在日常临床环境中的效果尚不清楚。
这是一项在学术医院的重症监护病房进行的单中心、回顾性队列研究。符合以下条件的患者（年龄≥3 岁）入选：从 2016 年 1 月至 2018 年 12 月入住重症监护病房至少 72 小时。根据日常临床实践，主治医生将苏沃雷生开给有失眠症的患者。对苏沃雷生使用者的谵妄无生存时间进行 Cox 比例风险回归分析，调整了与谵妄相关的协变量。作为常规临床实践的一部分，使用重症监护室谵妄评估方法（Confusion Assessment Method for the Intensive Care Unit），在整个重症监护病房住院期间至少每天两次检测谵妄的存在。
共有 699 名患者-84 名苏沃雷生使用者和 615 名苏沃雷生非使用者。214 名患者被诊断为谵妄。苏沃雷生使用者的谵妄发生率明显低于非使用者（分别为 17.9%和 32.4%；P=0.007）。Cox 回归分析显示，苏沃雷生使用者的谵妄风险比（0.472；95%CI，0.268-0.832；P=0.009）明显低于非使用者。曲唑酮对谵妄也有预防作用（风险比 0.345；95%CI，0.149-0.802；P=0.013）。
本研究将先前的研究结果扩展到真实环境中，表明苏沃雷生对预防谵妄有效。
