Department of Psychiatry, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
Medical Headquarters, Eisai Co, Ltd, Tokyo, Japan.
Transl Psychiatry. 2024 Sep 14;14(1):374. doi: 10.1038/s41398-024-03087-4.
Insomnia is highly comorbid in patients with psychiatric disorders, including depression, bipolar disorder, and substance use disorders, and should be treated as an independent condition. Dual orexin receptor antagonists (DORAs) have been investigated as a treatment for chronic insomnia. The objective of this systematic review was to examine evidence for two DORAs, lemborexant and suvorexant, as treatments for insomnia comorbid with a psychiatric disorder. We searched PubMed, Cochrane, and Embase from their inception until January and April 2023, and included studies examining suvorexant and lemborexant for treating insomnia comorbid with psychiatric disorders. We also manually searched clinical trial registries ( https://clinicaltrials.gov and https://www.umin.ac.jp/ctr ). Randomized clinical trials and observational/cohort studies were included. We identified 18 studies from PubMed, Cochrane, and Embase and three studies from clinicaltrials.gov and UMIN. Of the 21 reports, four were completed/terminated randomized clinical trials, eight were ongoing clinical trials, and nine were observational studies. We identified evidence for switching from benzodiazepine receptor agonists to a DORA, or using a DORA as add-on therapy and, therefore, discuss this topic as well. Two studies examined switching to or adding on a DORA in patients being treated with a benzodiazepine receptor agonist. DORAs may be as effective and safe for treating psychiatric comorbid insomnia (for most psychiatric conditions) as they are for treating primary insomnia. However, the evidence is limited to a few small studies. Further investigation of DORAs for the treatment of comorbid insomnia in those with coexisting psychiatric conditions is warranted.
失眠症在精神障碍患者中高度共病，包括抑郁症、双相情感障碍和物质使用障碍，应作为一种独立的病症进行治疗。双重食欲素受体拮抗剂（DORAs）已被研究作为慢性失眠症的治疗方法。本系统评价的目的是研究两种 DORA，lemborexant 和 suvorexant，作为治疗与精神障碍共病的失眠症的证据。我们检索了 PubMed、Cochrane 和 Embase 从成立到 2023 年 1 月和 4 月的文献，并纳入了研究 suvorexant 和 lemborexant 治疗与精神障碍共病的失眠症的研究。我们还手动检索了临床试验注册处（https://clinicaltrials.gov 和 https://www.umin.ac.jp/ctr）。纳入了随机临床试验和观察性/队列研究。我们从 PubMed、Cochrane 和 Embase 中确定了 18 项研究，从 clinicaltrials.gov 和 UMIN 中确定了 3 项研究。在 21 份报告中，有 4 项是完成/终止的随机临床试验，8 项是正在进行的临床试验，9 项是观察性研究。我们确定了从苯二氮䓬受体激动剂转换为 DORA 或作为附加治疗使用 DORA 的证据，因此也讨论了这个话题。两项研究考察了在接受苯二氮䓬受体激动剂治疗的患者中转换或添加 DORA 的情况。对于大多数精神疾病，DORAs 治疗精神共病性失眠症的有效性和安全性可能与治疗原发性失眠症相当。然而，证据仅限于少数小型研究。进一步研究 DORA 在治疗伴有共存精神疾病的患者的共病性失眠症是有必要的。
