Effect of Suvorexant vs Placebo on Total Daytime Sleep Hours in Shift Workers: A Randomized Clinical Trial

Article


Zeitzer, Jamie M., Joyce, Daniel, Mcbean, Amanda, Quevedo, Yvonne L., Hernandez, Beatriz and Holty, Jon-Erik. 2020. "Effect of Suvorexant vs Placebo on Total Daytime Sleep Hours in Shift Workers: A Randomized Clinical Trial." JAMA Network Open. 3 (6), pp. 1-10. https://doi.org/10.1001/jamanetworkopen.2020.6614
Article Title

Effect of Suvorexant vs Placebo on Total Daytime Sleep Hours in Shift Workers: A Randomized Clinical Trial

ERA Journal ID213045
Article CategoryArticle
AuthorsZeitzer, Jamie M., Joyce, Daniel, Mcbean, Amanda, Quevedo, Yvonne L., Hernandez, Beatriz and Holty, Jon-Erik
Journal TitleJAMA Network Open
Journal Citation3 (6), pp. 1-10
Number of Pages10
Year02 Jun 2020
PublisherAmerican Medical Association (AMA)
Place of PublicationUnited States
ISSN2574-3805
Digital Object Identifier (DOI)https://doi.org/10.1001/jamanetworkopen.2020.6614
Web Address (URL)https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2766606
Abstract

Importance: Many shift workers have difficulty sleeping during the daytime owing to an inappropriately timed circadian drive for wakefulness. Objective: To determine whether a dual hypocretin receptor antagonist would enable shift workers to have more daytime sleep. Design, Setting, and Participants: This double-blind, placebo-controlled randomized clinical trial included 2 weeks of baseline data and 3 weeks of intervention data, from March 2016 to December 2018. Individuals were recruited through poster advertisements in the broader San Francisco Bay area in California. From an initial voluntary recruitment cohort of 38 shift workers, 19 individuals with self-reported difficulty sleeping during the daytime following night work shift were included. Data were analyzed from Janaury to March 2019. Interventions: 1 week of 10 mg suvorexant or placebo, titrated upward to 20 mg suvorexant or placebo for 2 additional weeks. Main Outcomes and Measures: Objective (ie, actigraphy) and subjective (ie, sleep logs) measures of sleep. Results: Among 19 participants who completed the study (mean [SD] age, 37.7 [11.1] years; 13 [68%] men), 8 participants (42%) were assigned to the suvorexant group and 11 participants (58%) were assigned to the placebo group. Compared with individuals in the placebo group, individuals in the suvorexant group increased their objective total sleep time by a mean (SE) of 1.04 (0.53) hours (P = .05) at the end of 1 week of 10-mg doses and by 2.16 (0.75) hours (P = .004) by the end of the 2 weeks of 20-mg doses. Subjective sleep was similarly improved as, compared with the placebo group, individuals in the suvorexant group increased their subjective total sleep time by a mean (SE) of 2.08 (0.47) hours (P < .001) at the end of 1 week of 10-mg doses and by 2.97 (0.56) hours (P < .001) by the end of the 2 weeks of 20-mg doses. Physician ratings of daytime sleep aligned with these measures, as there was no change in the placebo group and a much improved change in the suvorexant group. No adverse events were reported in the suvorexant group. Conclusions and Relevance: This pilot study found that the use of a dual hypocretin receptor antagonist in shift workers under real-world conditions resulted in more than 2 extra hours of daytime sleep per episode. Future research should confirm this pilot finding in a larger sample size and examine whether, over the long term, use of this medication has a concomitant improvement in medical and psychiatric health as well as workplace performance and safety.

KeywordsTotal Daytime Sleep Hours; shift workers
ANZSRC Field of Research 2020520301. Clinical neuropsychology
321402. Clinical pharmacology and therapeutics
Byline AffiliationsStanford University, United States
VA Palo Alto Health Care System, United States
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