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Risk Factors for Delirium in Hospitalized Patients With Medical Conditions Receiving Dual Orexin Receptor
Ryuji Henmi1, Tomoyuki Nakamura, Motohiro Ozone
1Department of Neuropsychiatry, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
Journal of Clinical Psychopharmacology
|June 11, 2026
Summary
Dual orexin receptor antagonists (DORAs) can help prevent delirium in older adults with insomnia. However, advanced age, certain medications like benzodiazepines, and ramelteon increase delirium risk when used with DORAs.
Area of Science:
- Geriatric Medicine
- Psychiatry
- Pharmacology
Background:
- Dual orexin receptor antagonists (DORAs) show promise in preventing delirium in high-risk patients.
- Delirium incidence during DORA treatment varies significantly (0%–43.8%).
- This study focuses on identifying factors contributing to delirium in older inpatients with insomnia disorder undergoing DORA therapy.
Purpose of the Study:
- To investigate the factors associated with delirium development in older inpatients with insomnia disorder receiving DORAs.
- To identify specific risk factors that predict delirium incidence in this patient cohort.
Main Methods:
- Retrospective study of patients aged 65+ admitted between April 2019 and March 2023.
- Data collected included patient demographics, clinical conditions, and known delirium risk factors.
- Multivariable logistic regression analysis was employed to identify independent risk factors.
Main Results:
- Out of 406 patients, 116 (28.6%) developed delirium.
- Independent risk factors for delirium included advanced age (per year), potentially deliriogenic medications, benzodiazepine use, and ramelteon co-administration.
- Specific adjusted odds ratios (aORs) were reported for each identified risk factor.
Conclusions:
- Concomitant medications are significant, modifiable risk factors for delirium in patients on DORAs.
- DORA monotherapy may be a preferred strategy for managing insomnia in older hospitalized patients to minimize delirium risk.
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