Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study
Abstract Background Post-stroke delirium affects between 24% and 43% of patients, and negatively impacts patient outcomes. Recently, research attention has been on preventive interventions for delirium, with melatonin receptor agonists and orexin receptor antagonists reported to be effective in prev...
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BMC
2024-11-01
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| Series: | Journal of Pharmaceutical Health Care and Sciences |
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| Online Access: | https://doi.org/10.1186/s40780-024-00397-z |
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| author | Yukiko Miyoshi Yuki Shigetsura Daiki Hira Takakuni Maki Hirotsugu Kawashima Naoko Sugita Noriko Sugawara Noriaki Kitada Machiko Hirai Masayoshi Kawata Hiroki Endo Yusuke Kojima Keiko Ikuta Yurie Katsube Natsuki Imayoshi Shunsaku Nakagawa Masahiro Tsuda Tomohiro Terada |
| author_facet | Yukiko Miyoshi Yuki Shigetsura Daiki Hira Takakuni Maki Hirotsugu Kawashima Naoko Sugita Noriko Sugawara Noriaki Kitada Machiko Hirai Masayoshi Kawata Hiroki Endo Yusuke Kojima Keiko Ikuta Yurie Katsube Natsuki Imayoshi Shunsaku Nakagawa Masahiro Tsuda Tomohiro Terada |
| author_sort | Yukiko Miyoshi |
| collection | DOAJ |
| description | Abstract Background Post-stroke delirium affects between 24% and 43% of patients, and negatively impacts patient outcomes. Recently, research attention has been on preventive interventions for delirium, with melatonin receptor agonists and orexin receptor antagonists reported to be effective in preventing delirium in intensive care unit patients. However, the efficacy of these agents in preventing post-stroke delirium remain unclear. This study examined the efficacy of ramelteon, suvorexant, and lemborexant in preventing post-stroke delirium symptoms in patients with stroke. Methods A retrospective survey of medical records was conducted for patients with stroke aged > 75 years at Kyoto University Hospital from October 2021 to March 2023. Patients who received ramelteon, suvorexant, or lemborexant on admission and the following day were classified into the consecutive administration group, whereas those who did not were classified into the non-consecutive administration group. The primary outcome was an increase in the number of positive items in the delirium screening tool over 7 days. Results Of the 104 patients, 33 and 71 were in the consecutive and non-consecutive administration groups, respectively. Fewer patients in the consecutive administration group had an increase in the number of positive items than in the other group (6% vs. 21%). Patients in the consecutive administration group significantly less often had an increase in the number of positive items in the delirium screening tool (P = 0.05; hazard ratio, 0.27; 95% confidence interval, 0.10–0.75). Conclusions This study revealed that early administration of a melatonin receptor agonist or orexin receptor antagonists may effectively prevent post-stroke delirium in older patients. |
| format | Article |
| id | doaj-art-436dc2aef9ff4307aca066a89b91b30b |
| institution | OA Journals |
| issn | 2055-0294 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
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| series | Journal of Pharmaceutical Health Care and Sciences |
| spelling | doaj-art-436dc2aef9ff4307aca066a89b91b30b2025-08-20T02:33:00ZengBMCJournal of Pharmaceutical Health Care and Sciences2055-02942024-11-011011710.1186/s40780-024-00397-zEfficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective studyYukiko Miyoshi0Yuki Shigetsura1Daiki Hira2Takakuni Maki3Hirotsugu Kawashima4Naoko Sugita5Noriko Sugawara6Noriaki Kitada7Machiko Hirai8Masayoshi Kawata9Hiroki Endo10Yusuke Kojima11Keiko Ikuta12Yurie Katsube13Natsuki Imayoshi14Shunsaku Nakagawa15Masahiro Tsuda16Tomohiro Terada17Department of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Neurology, Graduate School of Medicine, Kyoto UniversityDepartment of Psychiatry, Graduate School of Medicine, Kyoto UniversityDepartment of Psychiatry, Graduate School of Medicine, Kyoto UniversityDepartment of Nursing, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalDepartment of Clinical Pharmacology and Therapeutics, Kyoto University HospitalAbstract Background Post-stroke delirium affects between 24% and 43% of patients, and negatively impacts patient outcomes. Recently, research attention has been on preventive interventions for delirium, with melatonin receptor agonists and orexin receptor antagonists reported to be effective in preventing delirium in intensive care unit patients. However, the efficacy of these agents in preventing post-stroke delirium remain unclear. This study examined the efficacy of ramelteon, suvorexant, and lemborexant in preventing post-stroke delirium symptoms in patients with stroke. Methods A retrospective survey of medical records was conducted for patients with stroke aged > 75 years at Kyoto University Hospital from October 2021 to March 2023. Patients who received ramelteon, suvorexant, or lemborexant on admission and the following day were classified into the consecutive administration group, whereas those who did not were classified into the non-consecutive administration group. The primary outcome was an increase in the number of positive items in the delirium screening tool over 7 days. Results Of the 104 patients, 33 and 71 were in the consecutive and non-consecutive administration groups, respectively. Fewer patients in the consecutive administration group had an increase in the number of positive items than in the other group (6% vs. 21%). Patients in the consecutive administration group significantly less often had an increase in the number of positive items in the delirium screening tool (P = 0.05; hazard ratio, 0.27; 95% confidence interval, 0.10–0.75). Conclusions This study revealed that early administration of a melatonin receptor agonist or orexin receptor antagonists may effectively prevent post-stroke delirium in older patients.https://doi.org/10.1186/s40780-024-00397-zStrokeDeliriumMelatonin receptor agonistOrexin receptor antagonist |
| spellingShingle | Yukiko Miyoshi Yuki Shigetsura Daiki Hira Takakuni Maki Hirotsugu Kawashima Naoko Sugita Noriko Sugawara Noriaki Kitada Machiko Hirai Masayoshi Kawata Hiroki Endo Yusuke Kojima Keiko Ikuta Yurie Katsube Natsuki Imayoshi Shunsaku Nakagawa Masahiro Tsuda Tomohiro Terada Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study Journal of Pharmaceutical Health Care and Sciences Stroke Delirium Melatonin receptor agonist Orexin receptor antagonist |
| title | Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study |
| title_full | Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study |
| title_fullStr | Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study |
| title_full_unstemmed | Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study |
| title_short | Efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke: a retrospective study |
| title_sort | efficacy of a melatonin receptor agonist and orexin receptor antagonists in preventing delirium symptoms in the olderly patients with stroke a retrospective study |
| topic | Stroke Delirium Melatonin receptor agonist Orexin receptor antagonist |
| url | https://doi.org/10.1186/s40780-024-00397-z |
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