Summary

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• This summary is based on the review of 11 systematic review(s)/meta-analysis(es). ^[1-11]
• Latency to Persistent Sleep (LPS) Reduction: Suvorexant (20 and 40 mg) and daridorexant (10 and 50 mg) were among the most effective treatments for reducing LPS, with both suvorexant and lemborexant showing significant reductions in LPS compared to placebo.
• Subjective Sleep Onset Time (sTSO) Reduction: Lemborexant (5 and 10 mg) demonstrated the highest effectiveness in reducing sTSO, performing better than suvorexant in certain studies.
• Wake Time After Sleep Onset (WASO): Reductions in WASO were observed for all drugs except daridorexant 5 mg, with lemborexant 10 mg and suvorexant 20/15 mg showing the largest impacts in both short-term and long-term WASO.
• Total Sleep Time (TST) and Subjective Total Sleep Time (sTST): Suvorexant 40 mg and lemborexant 10 mg showed the highest effectiveness in increasing TST and sTST, with lemborexant having a high probability of being the best treatment for improving TST across studies.
• Common Adverse Events: Suvorexant was associated with somnolence, excessive daytime sleepiness, sedation, dry mouth, back pain, fatigue, and abnormal dreams, while lemborexant commonly reported somnolence and nightmares, with both drugs showing no significant differences from placebo in hallucinations, suicidal ideation/behavior, or motor vehicle accidents.
• Serious Adverse Events (SAEs): Neither suvorexant nor lemborexant demonstrated a significant increase in serious adverse events compared to placebo.
• Discontinuation Due to Adverse Events and Driving Performance: Discontinuation rates due to adverse events were comparable between lemborexant, suvorexant, and placebo. Lemborexant had no clinically significant effect on driving performance, while suvorexant was linked to some premature terminations in driving studies.
• Studies included older adults and individuals with psychiatric comorbidities such as depression and bipolar disorder, with both suvorexant and lemborexant demonstrating effectiveness in treating insomnia across these groups, showing similar efficacy and safety profiles in older adults as in general adult populations.