Di Nicola Marco, Pepe Maria, Bonomo Lorenzo, Milintenda Miriam, Panaccione Isabella, Brugnoli Roberto, Sani Gabriele
Department of Neuroscience, Section of Psychiatry, Università Cattolica del Sacro Cuore, L.go Francesco Vito 1, 00168 Rome, Italy.
Department of Psychiatry, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, L.go Agostino Gemelli 8, 00168 Rome, Italy.
Pharmaceuticals (Basel). 2025 Mar 6;18(3):378. doi: 10.3390/ph18030378.
. Sleep disturbances are frequent in patients with substance use disorders (SUDs) and are associated with craving and addiction relapses, leading to increased clinical severity and detrimental outcomes. Daridorexant, a selective dual orexin receptor antagonist, has been approved for persistent insomnia disorder (ID), but specific insights on patients with SUDs are lacking. . This observational, retrospective study investigated the effects of a three-month treatment with daridorexant (50 mg/day) in 41 outpatients with comorbid IDs and SUDs. Improvement in subjective sleep measures, assessed with the Insomnia Severity Index (ISI) and subjective total sleep time, was the primary outcome measure. Changes in anxiety and depression symptoms, quality of life, clinical global severity, and craving were also investigated through the following: Hamilton Anxiety and Depression Rating Scale; Five-item World Health Organization Well-Being Index; Clinical Global Impression Severity Scale; Visual Analog Scale for Craving. . All sleep outcomes significantly improved throughout treatment, which was generally safe and well tolerated, with mild and transient drowsiness and sluggishness reported in 21.1% of patients. Similar improvements were observed in psychopathology, quality of life, and craving, and positive correlations were found among ISI scores and anxiety/depression symptoms and craving. An abstinence rate (i.e., absence of any substance use, regardless of the amount, throughout treatment) of 65.8% was also detected at the endpoint. . These preliminary findings suggest that daridorexant might represent a promising tool for treating insomnia in patients with SUDs. Identifying interventions effectively targeting insomnia with a good safety/tolerability profile in SUDs is crucial to achieve remission and full functional recovery.
物质使用障碍（SUDs）患者经常出现睡眠障碍，且与渴望和成瘾复发相关，导致临床严重程度增加和不良后果。达立多雷生是一种选择性双重食欲素受体拮抗剂，已被批准用于治疗持续性失眠障碍（ID），但缺乏关于SUDs患者的具体见解。 这项观察性、回顾性研究调查了41名合并ID和SUDs的门诊患者接受为期三个月的达立多雷生（50毫克/天）治疗的效果。以失眠严重程度指数（ISI）和主观总睡眠时间评估的主观睡眠指标改善是主要结局指标。还通过以下方式调查了焦虑和抑郁症状、生活质量、临床总体严重程度和渴望的变化：汉密尔顿焦虑和抑郁评定量表；世界卫生组织五项幸福指数；临床总体印象严重程度量表；渴望视觉模拟量表。 在整个治疗过程中，所有睡眠结局均显著改善，治疗总体安全且耐受性良好，21.1%的患者报告有轻度和短暂的嗜睡和慵懒。在精神病理学、生活质量和渴望方面也观察到类似的改善，并且在ISI评分与焦虑/抑郁症状和渴望之间发现了正相关。在终点时还检测到65.8%的戒断率（即整个治疗过程中没有任何物质使用，无论使用量多少）。 这些初步研究结果表明，达立多雷生可能是治疗SUDs患者失眠的一种有前景的工具。确定在SUDs中有效针对失眠且具有良好安全性/耐受性的干预措施对于实现缓解和完全功能恢复至关重要。
