OBJECTIVE: Suvorexant is a novel hypnotic drug that does not interact with the conventional γ-aminobutyric acid (GABA)-A receptor. We investigated the method by which suvorexant was introduced in insomnia patients who were taking benzodiazepine receptor agonists (BzRA). METHODS: This was a retrospective study. We extracted clinical data for patients who were prescribed suvorexant and were already using BzRA. The patients were assigned to two groups, the switching and add-on groups. We assessed the suvorexant discontinuation rate at one month after the prescription of the drug. RESULTS: One hundred and nineteen patients were assigned to the switching group, and 109 were assigned to the add-on group. The add-on group exhibited a significantly higher all-cause discontinuation rate than the switching group (odds ratio, 2.7; 95% confidence interval, 1.5 to 5.0; adjusted p < 0.001). Intolerability was a significantly stronger risk factor for suvorexant discontinuation in the add-on group (22.0% vs. 7.6%, p < 0.002), and the most common adverse effect was oversedation. CONCLUSION: Our results show that the add-on of suvorexant increases the frequency of oversedation compared with switching in insomnia patients that are taking BzRA. However, this was only a preliminary retrospective study, and further studies will be required to confirm our findings.
Benzodiazepines* ; Humans ; Methods ; Orexin Receptor Antagonists ; Prescriptions ; Receptors, GABA-A* ; Retrospective Studies* ; Risk Factors ; Sleep Initiation and Maintenance Disorders*

To investigate the factors affecting the rate of improvement in endurance exercise performance following pre-cooling with ice slurry, we focused on individual physical characteristics and thermoregulatory capacity. Twenty-four healthy adults (12 males and 12 females) ingested 7.5g kg-1 of either ice slurry at -1°C (ICE) or control water at 20°C (CON) before cycling at 55% VO2max and continued cycling until the rectal temperature reached 38.5°C or untill exhaustion in a hot environment (controlled at 38°C, 40% relative humidity). The relationship between the rate of improvement in exercise performance and physical characteristics and thermoregulatory factors (changes in rectal temperature, the rate of rectal temperature increase, whole body sweat loss, mean metabolic heat production, and heat storage) was investigated. No correlation was noted between the rate of improvement in exercise performance and physical characteristics and heat storage. On the other hand, the rate of improvement in exercise performance showed significant correlations with changes in rectal temperature (r = -0.497), the rate of rectal temperature increases during exercise (r = -0.784), whole body sweat loss (r = 0.407), and mean metabolic heat production (r = -0.436). The rate of inhibition of sweating and the rate of increase in metabolic heat production by ice slurry ingestion during exercise have been suggested to be related to the rate of improvement in exercise performance. On the other hand, there was no relationship between body composition or VO2max and the rate of improvement in exercise performance.