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Orexin Receptor Antagonists and Insomnia

  • Sleep Disorders (P Gehrman, Section Editor)
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Abstract

Purpose of Review

We review recent evidence on the use of orexin receptor antagonists (ORAs) for treating insomnia. We evaluate studies on five dual ORAs and one selective ORA.

Recent Findings

Research on suvorexant in recent years gradually focus on comorbid insomnia, while lemborexant and daridorexant were still being validated in primary insomnia. Almorexant is now mainly used as a commercial specific inhibitor of the orexin system in animal studies due to safety issues. Although filorexant has also shown a certain sleep-promoting effect, there are few clinical or experimental studies on sleep-related aspects of filorexant in recent years. As for selective ORAs, orexin receptor 2 antagonist seltorexant still has not yet reached phase 3.

Summary

High-quality clinical trials in insomnia populations are needed which directly compare authorized ORAs and investigate non-approved ORAs, the use of ORAs in comorbid insomnia, and the orexin signaling system pathophysiology in insomnia.

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Acknowledgements

Preparation of this article was supported by the Wujiang Science, Education, and Health Project (WWK202112) to Xin Wu. Zhouqing Chen was supported by the Natural Science Foundation of Jiangsu Province (BK20200203) and the Suzhou Health Talents Training Project (GSWS2020022). Zhong Wang was supported by the Suzhou Health Talents Training Project (GSWS2019002).

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Author notes

  1. Xin Wu and Tao Xue contribute equally to this work.

Authors and Affiliations

  1. Department of Neurosurgery & Brain, Nerve Research Laboratory, The First Affiliated Hospital of Soochow University, Jiangsu Province, Suzhou, 215006, China

    Xin Wu, Zhouqing Chen, Zhong Wang & Gang Chen

  2. Department of Neurosurgery, Suzhou Ninth People’s Hospital, Suzhou, 215200, China

    Xin Wu

  3. Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China

    Tao Xue

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  1. Xin Wu
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Wu, X., Xue, T., Chen, Z. et al. Orexin Receptor Antagonists and Insomnia. Curr Psychiatry Rep 24, 509–521 (2022). https://doi.org/10.1007/s11920-022-01357-w

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