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November 18, 2022
Daridorexant (Quviviq®): A Dual Orexin Receptor Antagonist for Adults with Insomnia: Daridorexant is a dual orexin receptor antagonist recently approved for treatment of insomnia in adults based on two multicenter, randomized double-blind, placebo-controlled phase 3 trials. Improvements were seen in the 25 and 50mg groups in comparison to placebo in wake time after sleep onset, latency to persistent sleep and total self-reported sleep time. Improvements in next day sleepiness were only seen in the 50mg group. Common adverse effects included headache, nasopharyngitis and somnolence. Patients should be monitored for these as well as sleep behaviors, depression and suicidality while taking this medication.
Upon completion of the chapter, the reader will be able to:
List the sequelae of undiagnosed or untreated sleep disorders and appreciate the importance of successful treatment of sleep disorders.
Describe the pathophysiology and characteristic features of the sleep disorders covered in this chapter, including insomnia, narcolepsy, restless legs syndrome (RLS), obstructive sleep apnea (OSA), and parasomnias.
Assess patient sleep complaints, conduct sleep histories, and evaluate sleep studies to recognize daytime and nighttime symptoms and characteristics of common sleep disorders.
Recommend and optimize appropriate sleep hygiene and nonpharmacologic therapies for the management and prevention of sleep disorders.
Recommend and optimize appropriate pharmacotherapy for sleep disorders.
Describe the components of the patient care process to implement and assess safety and efficacy of pharmacotherapy for common sleep disorders.
Educate patients about preventive behavior, appropriate lifestyle modifications, and drug therapy required for effective treatment and control of sleep disorders.
Individuals with normal sleep patterns sleep up to one-third of their lives and spend more time sleeping than in any other single activity. Despite this, our understanding of the full purpose of sleep and the mechanisms regulating sleep homeostasis remain incomplete. Sleep is necessary to allow one to maintain wakefulness and good health. Disruption of normal sleep is a major cause of societal morbidity, lost productivity, reduced quality of life, and contributes to the development and progression of comorbid medical conditions.1
Sleep is governed and paced by the suprachiasmic nucleus in the brain that regulates circadian rhythm. There are two main types of sleep: rapid eye movement (REM) sleep, during which eye movements and dreaming occur, but the body is mostly paralyzed, and nonrapid eye movement (NREM) sleep, which consists of three substages (stages 1–3). Stage 1 serves as a transition between wake and sleep and is NREM sleep. This stage of sleep typically lasts several minutes. Most of the time being asleep is spent in stage 2 NREM sleep and is a period of light sleep. Stage 3 is referred to as deep sleep, or delta sleep, because prominent delta waves are seen on the electroencephalogram (EEG) ...