Effects of benzodiazepine and orexin receptor antagonist on cognitive function revealed by auditory event-related potentials

Abstract

Background: Cognitive decline after oral administration of sedatives, such as benzodiazepines, is a serious side effect. Suvorexant, an orexin receptor antagonist, has a favorable tolerability and a limited side-effect profile. Aim: The purpose of this study was to estimate the cognitive decline 1 day after oral medication with lormetazepam, a benzodiazepine, and suvorexant by comparing mismatch negativity (MMN) and P300 reflecting auditory discrimination function. Methods: Sixty healthy subjects (42 males) were randomly assigned to three groups receiving suvorexant 20 mg, lormetazepam 2 mg, or placebo in this double-blind, randomized control study. Event-related potential recordings during an auditory oddball task and a digit symbol substitution test (DSST) were performed 1 day after oral administration. Results: MMN, on the day after oral administration, was significantly attenuated in the lormetazepam group compared with the other two groups, but there was no difference between the suvorexant and placebo groups. No significant difference was found in P300 amplitudes and DSST scores among the three groups. Conclusion: These findings suggest that suvorexant, unlike benzodiazepine, is not associated with cognitive deficits, as revealed by MMN but not P300. This study shows a neurophysiological difference in the effects of suvorexant and benzodiazepine on cognitive function.

Treatment of sleep‐related eating disorder with suvorexant: A case report on the potential benefits of replacing benzodiazepines with orexin receptor antagonists

“…The possible benefit of benzodiazepine discontinuation on reduced nocturnal eating is consistent with our previous report. 10 Although the reason why suvorexant does not worsen nocturnal eating behavior or sleepwalking is unclear, it may be because suvorexant does not cause memory impairment, 13 unlike GABA A receptor agonists. 7 Additionally, suvorexant does not affect the arousal threshold, 14 thus being less likely to cause sleep inertia after nocturnal awakening.…”

Electrophysiological and Neuropsychological Indices of Cognitive Dysfunction in Patients with Chronic Insomnia and Severe Benzodiazepine Use Disorder

“…BDZ reduces P300 amplitude to induce a more inconstant—and possibly BDZ-type dependent—prolongation in P300 latency [ 10 , 11 , 12 , 13 ]. A modulating influence of the GABA receptor activity on MMN generation has also been reported, with BDZ decreasing MMN amplitude [ 14 , 15 ]. In addition, insomnia per se may impact on subjective and objective measures of cognitive functions [ 16 ].…”

A pilot study on improvements in attention function in major depressive disorder after 12 weeks of escitalopram monotherapy or combined treatment with agomelatine

“…In addition, more than 90% of patients with MDD simultaneously have varying degrees of sleep problems ( 27 ), and cognitive functions in these patients are severely negatively affected by poor sleep quality ( 28 ). Sedative and hypnotic drugs can interfere with cognitive functions such as attention and memory ( 29 ). Agomelatine, an agonist of melatonin receptors (MT1 and MT2) and an antagonist of the serotonin 2C receptor (5-HT 2C ), can exert different effects at different stages of the diurnal cycle ( 30 ).…”