Prospective Observational Study on the Effectiveness of Daridorexant in Chronic Insomnia in a Real-World Setting

N/ACompletedNCT07132086

Azienda Ospedaliero, Universitaria Pisana31 enrolled

Overview

The primary objectives of this study is to evaluate the real-world effectiveness of daridorexant 50 mg in improving both subjective (self-report) and objective (actigraphic) sleep parameters in patients with chronic insomnia. The secondary aims of this study are: * To compare the effectiveness of daridorexant 50 mg with other guideline-recommended therapies for chronic insomnia in improving sleep parameters and sleep health. * To identify clinical and demographic predictors of response to daridorexant 50 mg, such as age, sex, BMI, duration of insomnia, and treatment regimen (monotherapy vs. add-on). * To monitor changes over time in the symptoms related to comorbid sleep disorders (e.g., OSA, RLS, circadian rhythm disorders) in patients treated with daridorexant 50 mg.

Insomnia affects approximately 10% of the European population and represents a significant risk factor for multiple chronic conditions, including cardiovascular diseases, depression, and type II diabetes. The latest European Guidelines for the Management of Insomnia have included daridorexant among the first-line pharmacological options for chronic insomnia. Daridorexant is a dual orexin receptor antagonist (DORA) that offers advantages over traditional hypnotics by avoiding common adverse effects such as residual daytime sedation, impaired motor coordination, and the risk of dependence. Clinical trials have demonstrated that DORAs, including daridorexant, are effective in improving several subjective and objective sleep parameters. However, no studies to date have investigated predictors of treatment response in patients with insomnia receiving daridorexant, despite increasing awareness of the need for personalized pharmacological strategies. In pivotal trials, daridorexant efficacy was evaluated using both subjective (patient-reported) and objective (polysomnographic) sleep outcomes. While polysomnography (PSG) is the gold standard for objective sleep evaluation, it is poorly suited for long-term, real-world monitoring due to cost, complexity, and reduced ecological validity. In contrast, actigraphy allows for non-invasive, home-based sleep-wake monitoring through wrist movement detection over multiple nights and is widely used in sleep research and clinical settings. However, no studies have employed actigraphy to assess daridorexant's real-world effectiveness, leaving a significant knowledge gap. Another relevant aspect is the frequent co-occurrence of insomnia with other sleep disorders such as restless legs syndrome (RLS), circadian rhythm sleep-wake disorders, and obstructive sleep apnea (OSA). Evaluating the evolution of symptoms related to these comorbid sleep conditions in patients treated with daridorexant could help clarify whether its use should be expanded or restricted in certain clinical populations. Study Objectives and Outcome Measures Primary Objectives: To evaluate the real-world effectiveness of daridorexant 50 mg in improving both subjective (questionnaire-based) and objective (actigraphy-based) sleep parameters in patients with chronic insomnia. Secondary Objectives: To compare the effectiveness of daridorexant 50 mg with other guideline-recommended therapies for chronic insomnia in improving sleep parameters and sleep health. To identify clinical and demographic predictors of response to daridorexant 50 mg, such as age, sex, BMI, duration of insomnia, and treatment regimen (monotherapy vs. add-on). To monitor changes over time in the symptoms related to comorbid sleep disorders (e.g., OSA, RLS, circadian rhythm disorders) in patients treated with daridorexant 50 mg. Primary Endpoint: This is the first prospective observational study aiming to assess the real-world effectiveness of daridorexant 50 mg in improving both subjective and actigraphic sleep parameters in patients with chronic insomnia. In addition, the study will evaluate possible changes in circadian metrics over time, with the goal of better understanding the impact of daridorexant on patients' sleep-wake rhythm under real-life conditions.

Interventions

Daridorexant 50 mg orally, once daily at bedtime, administered as monotherapy or add-on therapy for chronic insomnia, in a real-world, observational, prospective clinical settingDRUG

Daridorexant 50 mg is administered once daily at bedtime, either as monotherapy or as add-on therapy in patients with chronic insomnia. The intervention is evaluated in a naturalistic, real-world setting over a 3-month observational period. Both subjective (questionnaires, sleep diary) and objective (actigraphy) sleep parameters are collected at baseline, 1 month, and 3 months. Actigraphy is used to assess total sleep time, sleep efficiency, wake after sleep onset, and circadian rhythm parameters. Sleep misperception is calculated as the discrepancy between subjective and objective sleep metrics. The study also explores potential predictors of treatment response such as age, sex, BMI, insomnia duration, and comorbid sleep disorders.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Age ≥ 18 years * Signed informed consent form * Diagnosis of chronic insomnia according to DSM-5 criteria, defined as: Dissatisfaction with sleep quantity or quality, associated with one or more of the following: Difficulty initiating sleep Difficulty maintaining sleep (frequent awakenings or trouble returning to sleep) Early morning awakenings with inability to return to sleep The sleep disturbance causes clinically significant distress or impairment in social, occupational, educational, academic, or other important areas of functioning Sleep difficulties occur despite adequate opportunity and circumstances for sleep The insomnia is not better explained by or occurring exclusively during other sleep-wake disorders (e.g., narcolepsy, parasomnias, circadian rhythm sleep-wake disorders, breathing-related sleep disorders) The insomnia is not attributable to the physiological effects of a substance (e.g., drug abuse or medication) \- No contraindications to daridorexant use according to the European Medicines Agency (EMA) Exclusion Criteria: * Pregnancy * Breastfeeding * Withdrawal of informed consent at any time

Outcomes

Primary Outcomes

Change in total sleep time after 3 months of daridorexant treatment

This outcome assesses the change in both subjective (patient-reported) and objective (actigraphic) total sleep time (TST) from baseline to 3 months after initiating daridorexant 50 mg. Primary Outcome Measures: * Change in subjective TST \[minutes/night\] * Change in actigraphic TST \[minutes/night\]