18
AASM Membership Sections Newsletter
■
Issue #6
American Academy
of Sleep Medicine
Steering Committee
Profiles
Richard P Knudsen, MD
(Chair)
Dr. Richard Knudsen, MD,
Chair,
is
dually Fellowship trained in Pediatric
Neurology and Advanced Clinical
Neurophysiology. He is with the
University of California Davis in
Sacramento, CA in the Department
of Neurology. His primary interests
are in pediatric sleep medicine and
epileptology. He is especially invest-
ed in the central hypersomnias and
the nocturnally activated epilepsy
syndromes. He is published on
Hypersomnias and is invited to speak
internationally regarding Narcolepsy.
Vyes Dauvilliers, MD, PhD
(Vice Chair)
Dr. Yves Dauvilliers, MD, PhD,
Vice-
Chair,
is Professor of Neurology and
Physiology and Head of the clinical
and research activity of the sleep
laboratory at the University of Mont-
pellier-France. He is a Coordinator of
(INSERM
U1061 Neuropsychiatry: Clinical and
Epidemiological Research) and the
coordinator of the National Reference
Network for Orphan Diseases: Narco-
lepsy and Idiopathic Hypersomnia.
Dr. Dauvilliers is a world-recognized
leader in Sleep Medicine, author or
coauthor of more than 180 papers
published in international peer-re-
viewed journals and book chapters
and has edited two French books
related to sleep medicine.
Narcolepsy
2014 – 2015
CHAIR
Richard P. Knudsen, MD
VICE-CHAIR
Vyes Dauvilliers, MD, PhD
MEMBERS
Peter Bernad, MD
Rosemarie Rohatgi, DMD
Novel Sedative Agent Now Available
By Dr. Richard P Knudsen, MD
There is now a novel, ‘first-in-class’ sedative agent available. The name, generically, is
suvorexant. This schedule IV pharmaceutical was FDA approved this August 2014. It is a
DORA, or dual orexin receptor antagonist.
We have realized the profound importance of orexinergic systems in regard to
wakefulness/arousal as well as reward, coordination of emotion (limbic link) and appetite
(energy homeostasis). We know, in Narcolepsy I, there is a deficiency of expression of this
critical hypothalamic neuropeptide. Now we have the prescribing latitude of offering an
‘anti-wakefulness’ agent which inhibits the activity of this arousal system, thus promoting
natural transitioning to sleepfulness.
Insomnia is a highly prevalent disorder with significant morbidity. Insomnia is associated
with worsened physical and emotional health, including cardiovascular disease, anxiety,
substance abuse, depression with suicidality and compromised quality of life (QOL). Some
30% of adults suffer from non-restorative sleep.
To date, the most common pharmacologic interventions toward treatment of insomnia
have included the BZDs (benzodiazepines) and BZRAs (benzodiazepine receptor agonists),
which are presumed to be GABAergic in their principal mechanism of action. These
produce significant short term gain but can induce substantial side effects of cognitive
dysfunction, fatigue and daytime sedation, as well as headache, nausea and dizziness. Other
less frequently prescribed agents include sedative anti-depressants, anti-histamines and
melatonin derivatives. Ramelteon, uniquely, is a melatonin receptor agonist which selectively
binds to MT1 and MT2 receptors.
Suvorexant, the recently approved DORA, has a molecular structure of C23H23ClN6O2.
It has a t ½ life of approximately 9 hours. It reaches steady state equilibrium at day 3. It
is beneficial for both initiation onset and maintenance (WASO) insomnia. There is low
potential for both addiction and dependence.
The maximum recommended dosage is 20 mg. The FDA shared concern regarding
EDS (excessive daytime somnolence), impairment of driving and, possibly, induction of a
“narcolepsy – syndrome.”
DISCLAIMER
No part of this publication may be reproduced without the permission of the American Academy of Sleep Medicine
(AASM). The statements and opinions contained in editorials and articles in this newsletter are solely those of the authors
and not of the AASM or of its officers, members or employees. The Editor and Managing Editor of the Membership
Sections Newsletter, the AASM and its officers, members and employees disclaim all responsibility for any injury to
persons or property resulting from any ideas, products or services referred to in articles in this publication.
