Department of Psychiatry, Nagoya Ekisaikai Hospital, Nagoya, Japan.
Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Psychogeriatrics. 2021 May;21(3):324-332. doi: 10.1111/psyg.12672. Epub 2021 Feb 28.
The use of benzodiazepines (BZDs) causes delirium, especially in elderly people. For this reason, suvorexant has been recommended as the first-line hypnotic in elderly patients. The aim of this study was to determine whether the first-line use of suvorexant, instead of BZDs, decreases referrals for delirium in elderly patients.
Since May 2016 at Nagoya Ekisaikai Hospital, suvorexant has been recommended as the first-line hypnotic instead of BZDs. In May 2017, suvorexant was adopted as the first-line hypnotic. The number of delirium cases referred to psychiatry was compared among three consecutive periods: period A (May 2015-April 2016), during which BZDs were mainly used for insomnia; period B (May 2016-April 2017), during which the use of suvorexant was recommended instead of BZDs; and period C (May 2017-April 2018), during which suvorexant was principally adopted as the first-line hypnotic for insomnia. Potential confounding factors that may affect the development of delirium were also examined during the three periods.
The number of delirium referral cases in elderly patients in each period decreased, from 133 in period A to 86 in period B and 53 in period C. The rate of delirium referral cases decreased significantly every year (P = 9.02 × 10 ). Almost no significant confounding factors other than hypnotics were detected during the three periods.
The referrals for delirium in elderly patients decreased significantly after the hypnotic was changed from BZDs to suvorexant.
苯二氮䓬类药物（BZDs）的使用会导致谵妄，尤其是在老年人中。出于这个原因，苏沃雷生被推荐为老年患者的一线催眠药。本研究的目的是确定是否使用苏沃雷生作为一线催眠药（而非 BZDs）可以减少老年患者谵妄的转诊。
自 2016 年 5 月起，名古屋荣生会医院开始推荐苏沃雷生作为一线催眠药，而非 BZDs。2017 年 5 月，苏沃雷生被采用为一线催眠药。比较了三个连续时期（A 期：2015 年 5 月至 2016 年 4 月，主要使用 BZDs 治疗失眠；B 期：2016 年 5 月至 2017 年 4 月，推荐使用苏沃雷生代替 BZDs；C 期：2017 年 5 月至 2018 年 4 月，苏沃雷生主要作为治疗失眠的一线催眠药）中谵妄转诊病例的数量。在三个时期中，还检查了可能影响谵妄发展的潜在混杂因素。
每个时期老年患者谵妄转诊病例的数量均减少，从 A 期的 133 例减少至 B 期的 86 例和 C 期的 53 例。每年谵妄转诊病例的发生率均显著下降（P=9.02×10-3）。在三个时期内，几乎没有发现除催眠药以外的其他显著混杂因素。
催眠药从 BZDs 改为苏沃雷生后，老年患者谵妄的转诊显著减少。
