Sleep Journal RLS focused in April'24

[RLSLearner]

0390 Efficacy of Suvorexant for Insomnia Disorder in Well-controlled Restless Legs Syndrome

April 2024Sleep 47(Supplement_1):A167-A168

Introduction

Sleep disturbance remains common in patients with a history of Restless Legs Syndrome (RLS), even after RLS symptoms are sufficiently controlled with medication. Multiple potential causes for treatment-refractory sleep disturbance exist, including conditioned insomnia and poor sleep habits due to chronic RLS-related sleep disturbance, and comorbid medical and psychiatric illness. We conducted a placebo-controlled crossover trial to examine the efficacy of suvorexant in improving sleep quality and quantity in patients with well-controlled RLS and persistent insomnia.

Methods

In this double-blind, randomized, placebo-controlled crossover trial, 34 patients with well-controlled RLS were randomized to placebo or suvorexant (10-20 mg) for 6 weeks, followed by a 2-week washout and then the opposite treatment. Well-controlled RLS was defined as a score of less than 15 on the International Restless Legs Syndrome Study Group Rating Scale (IRLS) and Insomnia Disorder was defined by a self-reported combined Sleep Onset Latency (SOL) and Wake After Sleep Onset (WASO) of greater than 45 minutes and a Total Sleep Time (TST) of less than 7 hours. The primary outcome was actigraphically-derived TST, and secondary outcomes were Insomnia Severity Index (ISI) score and actigraphically-derived WASO. Data for all sleep metrics were collected at baseline and for the last two weeks of each treatment period.

Results

There were no significant improvements in actigraphically-derived TST (p = 0.58) or WASO (p = 0.99) while taking suvorexant compared to placebo. However, there was a significant reduction in insomnia symptoms, measured by the ISI, while taking suvorexant (p = 0.03). Moreover, exploratory analyses revealed a significant increase in self-reported TST (p = 0.01) and a significant reduction in nightly variability in TST (p = 0.03) while taking suvorexant. The most commonly reported side effect of suvorexant was fatigue (29.4%).

Conclusion

Though we did not observe a significant change between treatments in our primary endpoint of actigraphically-derived TST, our secondary and exploratory findings revealed promising support for suvorexant’s positive impact on self-reported quantity and quality of sleep in people with well-controlled RLS who continue to suffer from insomnia.

Support (if any) Funded by an investigator-initiated grant from Merck Pharmaceuticals.

[RLSLearner]

Suvorexant alters dynamics of the sleep-electroencephalography-power spectrum and depressive-symptom trajectories during inpatient opioid withdrawal - same journal/month.

Opiod withdrawal is often made worse with restless legs. Be interested to hear if anyone has used it for sleep.

[ChrisColumbus]

Joolsg previously posted about Diego Garcia-Borreguero's suvorexant trial and attracted a chain of replies:

healthunlocked.com/rlsuk/po...

[RLSLearner in reply to ChrisColumbus]

Ta Chris,

Was at the start but not end of that thread. Just useful there is more coming out about it. people were a bit scared off by the list of side effects. Every medication has a terrifying list of SE - especially DA's!! But if people are starting to use it then good to hear.