Non‐24‐hour sleep‐wake disorder successfully treated with the combination of ramelteon and suvorexant in a case of autism spectrum disorder

Iwata, Masaaki; Kaneko, Koichi

doi:10.1002/npr2.12142

Cited by 3 publications

(3 citation statements)

References 26 publications

(59 reference statements)

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“…As previously reported, our case confirms that they might be affected by non‐24‐h sleep–wake disorder. Melatonin (or agonist) is efficacious and safe for long‐term treatment in ASD and CRSWD, including in children, with light therapy and wakefulness promoting medication (Auger et al, 2015; Iwata & Kaneko, 2020; Maras et al, 2018).…”

Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure as an accurate marker for non‐24‐hour sleep–wake rhythm disorder

Bazin

Geoffroy

Benzaquen

et al. 2023

Journal of Sleep Research

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Summary Non‐24‐h sleep–wake rhythm disorder is quite rare in sighted patients and frequently associated with psychiatric disorders. We report the case of a 46‐year‐old man with autism spectrum disorder (ASD) and agoraphobia who had been referred for a suspicion of obstructive sleep apnea syndrome (OSAS). Polysomnography and arterial blood gas confirmed moderate OSAS associated with hypoventilation. Continuous positive airway pressure (CPAP) was started on fixed mode with excellent results. At follow‐up, his CPAP report data revealed an irregular sleep–wake rhythm with a progressive offset of sleep schedule and wake time delayed from 1 h from day to day. Melatonin (or agonist) is efficacious and safe for long‐term treatment in ASD and circadian rhythm sleep–wake disorder (CRSWD) with light therapy and wakefulness promoting medication. This case underlines the importance to sensitise psychiatrists to sleep and CRSWD, and also that CPAP data offer a possible objective alternative to sleep diary.

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Section: Discussionmentioning

confidence: 99%

Continuous positive airway pressure as an accurate marker for non‐24‐hour sleep–wake rhythm disorder

Bazin

Geoffroy

Benzaquen

et al. 2023

Journal of Sleep Research

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“…Excess orexin signaling with decreased REM sleep has been observed in an animal model of one NDD, Tuberous Sclerosis Complex, which was rescued by DORA treatment [ 9 ]. However, there is little clinical safety and efficacy data on the use of DORAs in the pediatric population [ 10 ] or in NDDs specifically [ 11 , 12 ] (Table 1 ).…”

Section: Introductionmentioning

confidence: 99%

“…[ 10 ] 30 (10–20) 20 mg Insomnia Mix of comorbid psychiatric disorders; seven patients with ASD No significant difference in sleep between those who stayed on suvorexant and those who discontinued it Two patients with nightmares Oka et al . [ 11 ] 3 (13–19) 15-20 mg Circadian rhythm sleep–wake disorders Two patients with ASD One fell asleep two hours earlier, one had sleep phase advance two hours, one had a fixed nocturnal sleep schedule None reported Iwata et al [ 12 ] 1 (23) 15 mg Non-24-h sleep–wake disorder ASD Sleep rhythm restoration* None reported Prieto et al . [ 14 ] 1 (16) 10 mg Insomnia Bipolar disorder Sleep duration improved from 3–4 to 6–7 h per night, sleep quality improved, and the patient reported more refreshing sleep None reported *Treatment in combination with ramelteon, ASD Autism spectrum disorder, mg milligrams, N number of patients …”

Section: Introductionmentioning

confidence: 99%

Dual orexin receptor antagonists for insomnia in youth with neurodevelopmental disorders: a case series and review

Besterman

Jeste

2021

Eur Child Adolesc Psychiatry

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Insomnia is a common, impairing, and difficult-to-treat comorbidity in children with neurodevelopmental disorders (NDDs). Behavioral interventions can be challenging because of developmental and behavioral features that interfere with treatment. Medication management also can be difficult due to a high burden of side effects, a high rate of paradoxical responses, and frequent treatment resistance. Therefore, new treatment options for insomnia in children with NDDs are needed. Dual orexin receptor antagonists (DORAs) are a relatively new class of pharmacotherapeutics that induce sleep by inhibiting the orexin signaling pathway. To date, there is little safety or efficacy data on the use of DORAs in children with NDDs. We present four patients with NDDs and insomnia that we treated with the DORA, suvorexant. We found that patients had a wide range of responses, with one patient displaying a robust improvement in sleep onset and maintenance, while another had significant improvement in insomnia symptoms on combination therapy with trazodone. Our final two patients had mild or no benefit from suvorexant therapy. Further research is necessary to establish the safety and efficacy of DORAs in this population and to identify predictive factors, such as specific neurogenetic diagnoses or clinical features, of a positive treatment response.

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Sleep and Circadian Disturbances in Children With Neurodevelopmental Disorders

Tamir,

Dye,

Witt

2023

Seminars in Pediatric Neurology

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Non‐24‐hour sleep‐wake disorder successfully treated with the combination of ramelteon and suvorexant in a case of autism spectrum disorder

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 3 publications

References 26 publications

Continuous positive airway pressure as an accurate marker for non‐24‐hour sleep–wake rhythm disorder

Continuous positive airway pressure as an accurate marker for non‐24‐hour sleep–wake rhythm disorder

Dual orexin receptor antagonists for insomnia in youth with neurodevelopmental disorders: a case series and review

Sleep and Circadian Disturbances in Children With Neurodevelopmental Disorders

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