2022 Fiscal Year Final Research Report
The potential usefulness of orexin antagonists for sleep disorders and delirium in patients in the intensive care unit.
| Project/Area Number |
16K11418
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| Research Category |
Grant-in-Aid for Scientific Research (C)
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| Allocation Type | Multi-year Fund |
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| Section | 一般 |
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| Research Field |
Emergency medicine
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| Research Institution | Jichi Medical University |
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Principal Investigator |
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| Project Period (FY) |
2016-04-01 – 2023-03-31
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| Keywords | せん妄 / 睡眠 / 重症患者 / 集中治療 / オレキシン / スボレキサント |
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| Outline of Final Research Achievements |
As a first step to investigate preventive effects of orexin antagonists for delirium in critically ill patients, we measured the orexin levels in the cerebrospinal fluid and obtained results suggesting the possibility of a disappearance of diurnal variation in orexin secretion in delirious patients. We utilized existing simple sleep monitors to investigate the feasibility of simple sleep monitoring in critically ill patients and showed its characteristics and limitations. We found methodological problems in observational studies regarding potential preventive effects on delirium with orexin antagonists, and suggested the possibility of no preventive effect. We conducted a multicenter prospective pre-post intervention study to verify the usefulness of a sleep promotion and delirium prevention protocol in the ICU including orexin antagonists, but no significant results were obtained.
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| Free Research Field |
集中治療
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| Academic Significance and Societal Importance of the Research Achievements |
重症患者におけるオレキシン拮抗薬のせん妄予防効果が、観察研究や一部のランダム化比較試験で示されているが、その生理学的論拠や研究方法論には検討の余地が大きい。本研究は、生理学的に拮抗薬使用の論拠となる、“重症患者におけるオレキシンの動態”に迫る初の研究であり、今後も研究を継続する意義が大きい。また研究方法論として、重症患者の睡眠に対する有用・簡便なモニタリング法が確立されていない現状から、各種のモニタリングを検討し、その限界を示した。また、既存の観察研究の重大な問題点を指摘した。総じて、重症患者におけるせん妄の減少という重大な課題を解決する道程の中で、一定の足跡を残したと考える。
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