Burden and determinants of self-reported non-communicable disease comorbidities among HIV positive adults in Tanzania: insights from the Tanzania HIV Impact Survey 2022-2023.

Insomnia is prevalent in patients with schizophrenia and represents a clinically important issue associated with symptom exacerbation. Approximately half of the patients with schizophrenia in Japan are prescribed hypnotic medications. Benzodiazepine receptor agonists (BZRAs) are widely used for insomnia; however, their use is associated with adverse effects, such as dependence and cognitive impairment. Dual orexin receptor antagonists (DORAs) have emerged as a novel therapeutic option. Evidence from randomized controlled trials and network meta‐analyses has demonstrated the efficacy and safety of DORAs for insomnia. However, evidence regarding insomnia comorbid with psychiatric disorders remains limited, and data focusing on patients with schizophrenia are scarce. In this study, we aimed to compare objective sleep parameters between patients with schizophrenia and comorbid insomnia receiving DORAs and those receiving BZRAs. This was a single‐center observational study. We included patients aged 18–65 years who met the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM‐5) criteria for schizophrenia and had been hospitalized for at least 1 year in a chronic psychiatric ward at Kurita Hospital from 2024 to 2025. Eligible participants met the criteria for chronic insomnia according to the International Classification of Sleep Disorders, Third Edition (ICSD‐3) and had been receiving either a DORA (suvorexant or lemborexant) or a BZRA (including Z‐drugs) at bedtime for at least 4 consecutive weeks. Forty‐five patients were included (DORA group:  = 22; BZRA group:  = 23). Objective sleep parameters were assessed using actigraphy over 7 consecutive days, and mean values were calculated. During the actigraphy period, as‐needed medications were prohibited. Days with <80% wear time were excluded. Sleep–wake states were analyzed using the Cole–Kripke algorithm in ActiLife 6 (ActiGraph). The primary outcomes were sleep latency (SL), total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE). Demographic and pharmacological data were extracted from electronic medical records. During the actigraphy assessment period, clinical evaluations were conducted using the Brief Psychiatric Rating Scale (BPRS), Drug‐Induced Extrapyramidal Symptoms Scale, Montreal Cognitive Assessment, and Epworth Sleepiness Scale. Group comparisons were performed using ‐tests. Multivariate linear regression analyses were conducted for variables identified as significant in the group comparisons, adjusting for age, sex, and psychiatric symptom severity (BPRS). As this was a preliminary study, no correction for multiple comparisons was applied.