Suvorexant is associated with a low incidence of delirium in critically ill patients: a retrospective cohort study.

Abstract

BACKGROUND:

Benzodiazepine use is a risk factor for the development of delirium in adult intensive care unit (ICU) patients. Suvorexant is an alternative to benzodiazepines to induce sleep, but the incidence of delirium in critically ill patients is unknown. We undertook this retrospective study to investigate the incidence of delirium in patients who receive suvorexant in the ICU.

METHODS:

This retrospective cohort study was conducted in a closed 12-bed ICU at a tertiary teaching hospital. Patients admitted to the ICU for 72 h or longer between January and June 2015 were evaluated for delirium using the Confusion Assessment Method for the Intensive Care Unit tool. We evaluated the incidence of delirium in patients who received suvorexant and those who did not. To adjust for confounding factors, multivariable logistic regression analysis was conducted.

RESULTS:

Study subjects included 118 patients, with a median age of 72 years and a median Acute Physiology and Chronic Health Evaluation II score of 18 points. Eighty-two patients (69.5%) were admitted after cardiovascular surgery. In the suvorexant group, there were fewer post-cardiovascular surgical patients and more medical patients. The duration of mechanical ventilation during ICU stay was longer in the suvorexant group, and sedatives and sleep inducers other than suvorexant were used more frequently in the suvorexant group. The incidence of delirium was 43.8% in the suvorexant group and 58.8% in the non-suvorexant group (P = 0.149). After adjustment for risk factors using multivariable logistic regression analysis, suvorexant was associated with a lower incidence of delirium (odds ratio = 0.23, 95% confidence interval: 0.07-0.73; P = 0.012).

CONCLUSIONS:

Suvorexant was associated with decreased odds of transitioning to delirium in critically ill patients. The use of suvorexant may lower the incidence of delirium in ICU patients. Future prospective studies are warranted.

• Authors: Tomoyuki Masuyama, Masamitsu Sanui, Naoto Yoshida, Yusuke Iizuka, Kunio Ogi, Satoko Yagihashi, Kanae Nagatomo, Yusuke Sasabuchi, Alan K Lefor
• Journal: Psychogeriatrics : the official journal of the Japanese Psychogeriatric Society (Psychogeriatrics) Vol. 18 Issue 3 Pg. 209-215 (May 2018) ISSN: 1479-8301 [Electronic] England
• PMID: 29423967 (Publication Type: Journal Article)
• Copyright: © 2018 Japanese Psychogeriatric Society.

Chemical References

• Azepines
• Orexin Receptor Antagonists
• Sleep Aids, Pharmaceutical
• Triazoles
• suvorexant

Topics

• Aged
• Azepines (administration & dosage, adverse effects)
• Bed Occupancy
• Critical Care
• Delirium (chemically induced, epidemiology)
• Female
• Humans
• Incidence
• Intensive Care Units (statistics & numerical data)
• Japan (epidemiology)
• Length of Stay
• Male
• Orexin Receptor Antagonists (administration & dosage, adverse effects)
• Retrospective Studies
• Sleep Aids, Pharmaceutical (administration & dosage, adverse effects)
• Treatment Outcome
• Triazoles (administration & dosage, adverse effects)