Single-use suvorexant for treating insomnia during overnight polysomnography in patients with suspected obstructive sleep apnea: a single-center experience

Abstract

Purpose

Although patients with suspected obstructive sleep apnea (OSA) might suffer difficulty in falling asleep during overnight polysomnography (PSG), standard hypnotics to obtain sleep during PSG have not been established. The aim of this study was to investigate the safety and efficacy of a new hypnotic agent, suvorexant, a dual orexin receptor antagonist, for insomnia in suspected OSA patients during in-laboratory PSG.

Patients and methods

An observational study was conducted during PSG for 149 patients with suspected OSA who had no insomnia at home. Patients with difficulty in falling asleep during PSG were optionally permitted to take single-use suvorexant. Patients with residual severe insomnia (>1 hour) after taking suvorexant were permitted to take an add-on use zolpidem. Clinical data and sleep questionnaire results were analyzed between a no insomnia group (without hypnotics) and an insomnia group (treated with suvorexant).

Results

Among 84 patients who experienced insomnia during PSG and required hypnotics (the insomnia group; treated with suvorexant), 44 (52.4%) achieved sufficient subjective sleep with single-use of suvorexant, while the other 40 (47.6%) required suvorexant plus zolpidem. An apnea hypopnea index (AHI) of ≥5 was observed in 144 out of 149 patients with predominantly obstructive respiratory events. Among those patients, 70.8% in the no insomnia group and 63.1% in the insomnia group had severe OSA. Regarding both subjective sleep time and morning mood, significant differences between the no insomnia group and the insomnia group were not observed. No patient taking suvorexant had an adverse event, such as delirium or falling.

Conclusion

Single-use suvorexant seems to be a safe and effective (but mild) hypnotic agent for suspected OSA patients with insomnia during in-laboratory PSG.

Keywords:

• insomnia
• suvorexant
• polysomnography
• obstructive sleep apnea
• zolpidem
• natural sleep

Acknowledgments

The authors sincerely thank Reiko Kunii and Shinobu Ikeda (Department of Laboratory Medicine, Chiba University Hospital) for the technical support of this research, and thank ENAGO (www.enago.jp) for the English language editing. This work was supported, in part, by a research grant to the Intractable Respiratory Diseases and Pulmonary Hypertension Research Group, the Ministry of Health, Labor and Welfare, the Japan Agency for the Medical Research and Development (AMED), and JSPS KAKENHI (Grant number 16K09528).

Author contributions

T Matsumura and J Terada performed the statistical analysis. All authors contributed to data analysis, conceptual design of the survey, drafting and revising the article, gave final approval of the version to be published, and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Supplementary material

Figure S1 Summary in the questionnaire of subjective sleep latency.

Notes: The subjective sleep latency was significantly longer in the insomnia group compared to the no insomnia group. Among the insomnia group, the subjective sleep latency in the no insomnia group was significant shorter compared to the insomnia group. Furthermore, subjective sleep latency was significantly shorter in the suvorexant only group than in the suvorexant+zolpidem group.