Efficacy and safety of single-use suvorexant for insomnia during in-laboratory polysomnography in patients with obstructive sleep apnea: A feasibility study

Background: Although most patients with obstructive sleep apnea (OSA) can undergo in-laboratory polysomnography (PSG) with substantial sleep due to the symptom of sleepiness, some experience difficulty in falling asleep. However, there are no established criteria for the use of standard sedative hypnotics to achieve natural sleep during PSG. The aim of this feasibility study was to investigate the efficacy and safety of single-use suvorexant, a dual orexin receptor antagonist, for OSA patients with insomnia during in-laboratory PSG. Methods: The cohort consisted of 156 patients with suspected OSA who underwent PSG. Patients with severe insomnia during PSG were recommended to take single-use suvorexant followed by optional zolpidem as an add-on medication. Patients were divided into two groups according to the use of add-on hypnotics during PSG: a no add-on group of 61 patients who did not use add-on hypnotics and a suvorexant group of 83 patients who used suvorexant as an add-on hypnotic. Clinical data and sleep questionnaire results were analyzed. Results: Of 144 patients with OSA, 83 (57.6%) experienced insomnia during in-laboratory PSG and required a hypnotic agent. Among these 83 patients, 46 (55.4%) achieved sufficient subjective sleep with single-use of suvorexant, while the other 37 (44.6%) required suvorexant plus zolpidem. No patient taking suvorexant had an adverse event, such as delirium or falling. Conclusions: Suvorexant might have potential as an effective and safe hypnotic agent during in-laboratory PSG for OSA patients with insomnia. Further prospective studies are required to confirm the results of this feasibility study.