苏沃雷生治疗入睡和睡眠维持困难（失眠）。
Suvorexant in the Treatment of Difficulty Falling and Staying Asleep (Insomnia).
机构信息
Berger, MD, PhD, Sottosanti, MD, Hasoon, MD, Beth Israel Deaconess Medical Center, Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA. Winnick, MA, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel, School of Optometry, University of California, Berkeley, Berkeley, CA. Keefe, BM, Gilbert, BS, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel. Thase, MD, Kaye, MD, PhD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Department of Anesthesiology, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Health Physicians Group Pain Medicine, Wareham, MA.
出版信息
Psychopharmacol Bull. 2022 Feb 25;52(1):68-90.
PURPOSE OF REVIEW
Insomnia affects more than 10% of the population and causes significant discomfort and disability. Suvorexant is an orexin receptor antagonist that specifically targets the wake-sleep cycle. This review summarizes recent and seminal evidence in the biological and physiological evidence of insomnia, the mechanism of action of suvorexant in treating insomnia, and clinical evidence regarding its use.
RECENT FINDINGS
There is no single clear diagnosis for insomnia, and thus prevalence is not entirely clear, but it is estimated to affect 10%-30% of the adult population. Comorbidities include obesity, diabetes, and various psychiatric conditions, and insomnia likely has a contributing role in these conditions. Insomnia, by definition, impacts sleep quality and also wakefulness, including academic success and work efficiency. Insomnia is likely related to genetic susceptibility and a triggering event, leading to hyper-arousal states and functional brain disturbances. This leads to hyperactivity of the hypothalamic-pituitary-adrenal axis, over-secretion of corticotropin-releasing factor, and aberrancy in neurotransmitter release. Though several pharmacological options exist for the treatment of insomnia, there is equivocal data regarding their efficacy or limits to their use due to side effects and contraindications. Suvorexant is a novel dual orexin receptor antagonist, which is shown to improve sleep by reducing arousals. Unlike classical therapeutics, suvorexant does not alter the sleep profile; it prolongs the time spent in each sleep state. Though it may cause some somnolence, it is milder than reported with other drugs.
SUMMARY
Multiple clinical studies support the use of suvorexant in insomnia. In primary insomnia, suvorexant is effective (over placebo), as measured by polysomnography and reported by patients, in both attaining and maintaining sleep. Similar, albeit to a smaller degree, results were found in secondary insomnia. Suvorexant carries two significant advantages over existing therapies; it has a much better safety profile in approved doses, and it preserves natural sleep architecture, thus promoting more restful sleep and recovery. Unfortunately, data exists mostly for suvorexant versus placebo, and head-to-head trials with common hypnotics are needed to assess the true efficacy of suvorexant over the alternatives. And while tolerance is less likely to develop, close monitoring of post-marketing data is required to evaluate for long term adverse events and efficacy.
目的综述
失眠影响超过 10%的人群，并导致显著的不适和残疾。苏沃雷生是一种食欲素受体拮抗剂，专门针对睡眠-觉醒周期。本文综述了失眠的生物学和生理学证据、苏沃雷生治疗失眠的作用机制以及其使用的临床证据。
最近的发现
失眠没有明确的单一诊断，因此其患病率并不完全清楚，但据估计，失眠影响 10%-30%的成年人口。合并症包括肥胖、糖尿病和各种精神疾病，而失眠可能在这些疾病中起到了促成作用。失眠从定义上讲，会影响睡眠质量和清醒状态，包括学业成功和工作效率。失眠可能与遗传易感性和触发事件有关，导致过度觉醒状态和功能性脑紊乱。这会导致下丘脑-垂体-肾上腺轴的过度活跃、促肾上腺皮质释放因子的过度分泌以及神经递质释放的异常。尽管有几种药物可用于治疗失眠，但由于副作用和禁忌症，它们的疗效或使用限制存在争议。苏沃雷生是一种新型双重食欲素受体拮抗剂，可通过减少觉醒来改善睡眠。与经典疗法不同，苏沃雷生不会改变睡眠模式；它延长了每个睡眠状态的时间。虽然它可能会引起一些嗜睡，但比其他药物报告的嗜睡要轻。
总结
多项临床研究支持苏沃雷生在失眠中的应用。在原发性失眠中，苏沃雷生与安慰剂相比，在多导睡眠图和患者报告中都有效，在获得和维持睡眠方面都有效。在继发性失眠中也发现了类似的结果，尽管程度较小。与现有的治疗方法相比，苏沃雷生有两个显著的优势；在批准剂量下，它具有更好的安全性，并且它保留了自然的睡眠结构，从而促进更宁静的睡眠和恢复。不幸的是，数据主要是关于苏沃雷生与安慰剂相比，需要进行与常见催眠药物的头对头试验，以评估苏沃雷生相对于其他药物的真正疗效。虽然不太可能产生耐受性，但需要密切监测上市后数据，以评估长期不良反应和疗效。
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