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Lemborexant in Delayed Sleep Phase Syndrome

Primary Purpose

Delayed Sleep Phase Syndrome

Status
Recruiting
Phase
Phase 4
Locations
United States
Study Type
Interventional
Intervention
Lemborexant
Placebo
Sponsored by
Stanford University
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Delayed Sleep Phase Syndrome

Eligibility Criteria

18 Years - undefined (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  1. 18 years of age or older.
  2. Diagnosed with delayed sleep phase syndrome (DSPS) meaning that:

    1. Sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime for the subject (their desired bedtime).
    2. Subjects not able to fall asleep if trying to sleep before the later bedtime;
    3. This is interfering with their wishes/having social impact.
  3. Concomitant medications will be allowed, though dosages will be required to remain fixed throughout participation in the study.
  4. The participant also needs to be willing and able to comply with all aspects of the protocol.

Exclusion Criteria:

  1. Clinically significant depression (PHQ-9 score of 10 or more), anxiety disorder (GAD-7 score of 10 or more), substance use disorder, any other sleep disorder (assessed by the Alliance Sleep Questionnaire- ASQ), or any medical disorder/therapy that could interfere with the trial (this will be verified through interview and analysis of the ASQ).
  2. Use of medications with significant effects on sleep-wake function (insomnia therapies, stimulants)- unless they are discontinued at least 5 half-lives prior to study participation. Non-sedative antidepressants or SSRI will be allowed if at a stable dose in the absence of concomitant severe depression or severe anxiety.
  3. Use of CYP3A inhibitors and CYP3A inducers, at least 1 week (or five half-lives, whichever is longer) prior to the first day of the baseline phase.
  4. Pregnancy (verified by urine pregnancy test on visits 1, 2, and 3) or plan to become pregnant in the next 3 months or currently breastfeeding.
  5. Shift workers or subjects working unusual hours.
  6. Any risk of suicide within 6 months of screening period or throughout the trial (accessed by the Investigator and by the C-SSRS questionnaire).
  7. Transmeridian travel across more than 3 time zones 4 weeks prior to the screening phase.
  8. Transmeridian travel across more than 2 time zones during this trial (including the screening phase).
  9. Having a positive drug test or being unwilling to refrain from using illegal drugs or marijuana during this trial.
  10. Any clinically abnormal symptom or organ impairment found by medical history at Screening or Baseline and physical examinations, vital signs, ECG findings, or laboratory test results that require medical treatment.
  11. Impaired liver function (values for enzymes aspartate transaminase (AST) and alanine transaminase (ALT) > 1.5 times the Upper Limit of Normal).
  12. Known to be human immunodeficiency virus positive.
  13. Has a QT interval corrected using Fridericia's formula interval (QTcF interval) >450 ms demonstrated on repeated ECGs (repeated only if initial ECG showed corrected QT interval (QTc) >450 ms) at Screening or Baseline.

Sites / Locations

  • Stanford UniveristyRecruiting

Arms of the Study

Arm 1

Arm 2

Arm Type

Active Comparator

Placebo Comparator

Arm Label

Lemborexant

Placebo

Arm Description

Patients receive Lemborexant 5mg for 7 days and may be dose adjusted to 10mg. Patients continue to take Lemborexant 5mg or 10 mg for an additional 7 days.

Patients receive placebo to match Lemborexant for 14 days.

Outcomes

Primary Outcome Measures

Change in actigraphy sleep latency onset
Sleep latency is the time from laying down until falling asleep. Actigraphy data obtained using Axivity- AX6.

Secondary Outcome Measures

Change in Epworth Sleepiness Scale (ESS)
This is a scale to evaluate daytime sleepiness. Range from 0 to 24 points (higher scores mean more sleepiness).
Change in Karolinska Sleepiness Scale (KSS)
Self-report for daytime sleepiness with 1 being extremely alert and 10 being extremely sleepy, can't keep awake.
Change in sleep diary derived sleep onset latency
Sleep latency is the time from laying down until falling asleep as estimated by patient in dairy.
Sleep Regularity Index
Sleep Regularity Index is defined as the percentage probability of a person being asleep (or awake) at any two time points 24 hours apart. Actigraphy data obtained using Axivity- AX6.
Change in actigraphy derived total sleep time
Actigraphy data obtained using Axivity- AX6.
Change in sleep diary derived total sleep time.
Estimated by patient in dairy.
Change in mean actigraphy derived wake time
Wake time is total time awake over night after sleep onset. Actigraphy data obtained using Axivity- AX6.
Change in mean sleep diary derived wake time
Wake time is total time awake over night after sleep onset as estimated by patient in dairy.

Full Information

First Posted
September 20, 2021
Last Updated
May 23, 2023
Sponsor
Stanford University
Collaborators
University of California, San Francisco
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1. Study Identification

Unique Protocol Identification Number
NCT05463861
Brief Title
Lemborexant in Delayed Sleep Phase Syndrome
Official Title
Lemborexant in Delayed Sleep Phase Syndrome
Study Type
Interventional

2. Study Status

Record Verification Date
May 2023
Overall Recruitment Status
Recruiting
Study Start Date
February 1, 2022 (Actual)
Primary Completion Date
May 13, 2025 (Anticipated)
Study Completion Date
May 30, 2025 (Anticipated)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Principal Investigator
Name of the Sponsor
Stanford University
Collaborators
University of California, San Francisco

4. Oversight

Studies a U.S. FDA-regulated Drug Product
Yes
Studies a U.S. FDA-regulated Device Product
No
Product Manufactured in and Exported from the U.S.
Yes
Data Monitoring Committee
No

5. Study Description

Brief Summary
The purpose of the study is to evaluate whether Lemborexant is more effective than placebo in shortening sleep onset latency in patients with delayed sleep phase syndrome (both type 1 and type 2). This will be tracked using sleep logs as well as actigraphy. In this 2-year study, we will examine if Lemborexant administered 5-10 mg nightly taken at desired bedtime (at least 2 hours prior to self-reported sleep onset habitual time) can improve the symptoms of Delayed Sleep Phase Syndrome.
Detailed Description
Delayed sleep phase syndrome (DSPS) is a disorder in which a person's sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime. The delayed sleep then causes difficulty in being able to wake up at the desired time. In DSPS, bedtime is shifted later than the general population such that individuals have difficulty getting enough sleep to meet their sleep needs before they have to get up for their daytime obligations (work, school, childcare, etc.). As a result, patients experience daytime impairment, including daytime sleepiness and cognitive impairment. DSPS, if maintained in adulthood, is associated with numerous deleterious health effects, although causality is not well established. Two phenotypes of DSPS are recognized depending on the phase of entrainment: one with a late phase and normal phase angle (non-circadian) and other with a late phase and abnormal phase angle (circadian). The differentiation of these two phenotypes is theoretical: a mixed situation may be involved in some cases and the exact pathophysiology of each subtype is still controversial. In theory, however, separating the sample into these two subtypes is likely important to predict short- and long-term responses to orexin antagonists in DSPS. Lemborexant is one of the dual orexin receptor antagonists on the US market. The purpose of this study is to examine if lemborexant administered 5 to 10 mg nightly, taken at desired bedtime (at least 2 hours prior to self-reported sleep onset time), can improve the symptoms of Delayed Sleep Phase Syndrome both in the circadian and non-circadian phenotypes. The phenotypes will be recruited in 1:1 proportion.The effect of lemborexant will be analyzed based on the collection of information from actigraphy watches, sleep diaries, and sleep scales. The total participation time involved in this study will be approximately 6 weeks (2 weeks of baseline assessment followed by 2-weeks of treatment/placebo, and 2 weeks post-treatment).

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Delayed Sleep Phase Syndrome

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 4
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Masking Description
Double blind
Allocation
Randomized
Enrollment
60 (Anticipated)

8. Arms, Groups, and Interventions

Arm Title
Lemborexant
Arm Type
Active Comparator
Arm Description
Patients receive Lemborexant 5mg for 7 days and may be dose adjusted to 10mg. Patients continue to take Lemborexant 5mg or 10 mg for an additional 7 days.
Arm Title
Placebo
Arm Type
Placebo Comparator
Arm Description
Patients receive placebo to match Lemborexant for 14 days.
Intervention Type
Drug
Intervention Name(s)
Lemborexant
Other Intervention Name(s)
dayvigo®
Intervention Description
Lemborexant tablet administered orally once daily.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Placebo to match Lemborexant tablet administered orally once daily.
Primary Outcome Measure Information:
Title
Change in actigraphy sleep latency onset
Description
Sleep latency is the time from laying down until falling asleep. Actigraphy data obtained using Axivity- AX6.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Secondary Outcome Measure Information:
Title
Change in Epworth Sleepiness Scale (ESS)
Description
This is a scale to evaluate daytime sleepiness. Range from 0 to 24 points (higher scores mean more sleepiness).
Time Frame
From randomization to 4 weeks post randomization
Title
Change in Karolinska Sleepiness Scale (KSS)
Description
Self-report for daytime sleepiness with 1 being extremely alert and 10 being extremely sleepy, can't keep awake.
Time Frame
From randomization to 4 weeks post randomization
Title
Change in sleep diary derived sleep onset latency
Description
Sleep latency is the time from laying down until falling asleep as estimated by patient in dairy.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Title
Sleep Regularity Index
Description
Sleep Regularity Index is defined as the percentage probability of a person being asleep (or awake) at any two time points 24 hours apart. Actigraphy data obtained using Axivity- AX6.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Title
Change in actigraphy derived total sleep time
Description
Actigraphy data obtained using Axivity- AX6.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Title
Change in sleep diary derived total sleep time.
Description
Estimated by patient in dairy.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Title
Change in mean actigraphy derived wake time
Description
Wake time is total time awake over night after sleep onset. Actigraphy data obtained using Axivity- AX6.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization
Title
Change in mean sleep diary derived wake time
Description
Wake time is total time awake over night after sleep onset as estimated by patient in dairy.
Time Frame
From 2 weeks prior to randomization to 4 weeks post randomization

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: 18 years of age or older. Diagnosed with delayed sleep phase syndrome (DSPS) meaning that: Sleep is delayed by two hours or more beyond what is considered an acceptable or conventional bedtime for the subject (their desired bedtime). Subjects not able to fall asleep if trying to sleep before the later bedtime; This is interfering with their wishes/having social impact. Concomitant medications will be allowed, though dosages will be required to remain fixed throughout participation in the study. The participant also needs to be willing and able to comply with all aspects of the protocol. Exclusion Criteria: Clinically significant depression (PHQ-9 score of 10 or more), anxiety disorder (GAD-7 score of 10 or more), substance use disorder, any other sleep disorder (assessed by the Alliance Sleep Questionnaire- ASQ), or any medical disorder/therapy that could interfere with the trial (this will be verified through interview and analysis of the ASQ). Use of medications with significant effects on sleep-wake function (insomnia therapies, stimulants)- unless they are discontinued at least 5 half-lives prior to study participation. Non-sedative antidepressants or SSRI will be allowed if at a stable dose in the absence of concomitant severe depression or severe anxiety. Use of CYP3A inhibitors and CYP3A inducers, at least 1 week (or five half-lives, whichever is longer) prior to the first day of the baseline phase. Pregnancy (verified by urine pregnancy test on visits 1, 2, and 3) or plan to become pregnant in the next 3 months or currently breastfeeding. Shift workers or subjects working unusual hours. Any risk of suicide within 6 months of screening period or throughout the trial (accessed by the Investigator and by the C-SSRS questionnaire). Transmeridian travel across more than 3 time zones 4 weeks prior to the screening phase. Transmeridian travel across more than 2 time zones during this trial (including the screening phase). Having a positive drug test or being unwilling to refrain from using illegal drugs or marijuana during this trial. Any clinically abnormal symptom or organ impairment found by medical history at Screening or Baseline and physical examinations, vital signs, ECG findings, or laboratory test results that require medical treatment. Impaired liver function (values for enzymes aspartate transaminase (AST) and alanine transaminase (ALT) > 1.5 times the Upper Limit of Normal). Known to be human immunodeficiency virus positive. Has a QT interval corrected using Fridericia's formula interval (QTcF interval) >450 ms demonstrated on repeated ECGs (repeated only if initial ECG showed corrected QT interval (QTc) >450 ms) at Screening or Baseline.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Emmanuel Mignot, MD, PhD
Organizational Affiliation
Stanford University
Official's Role
Principal Investigator
Facility Information:
Facility Name
Stanford Univeristy
City
Redwood City
State/Province
California
ZIP/Postal Code
94063
Country
United States
Individual Site Status
Recruiting
Facility Contact:
First Name & Middle Initial & Last Name & Degree
Study Team
Phone
650-497-8690
Email
ffbueno@stanford.edu

12. IPD Sharing Statement

Plan to Share IPD
No

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Lemborexant in Delayed Sleep Phase Syndrome

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