Study to Evaluate the Respiratory Safety of Lemborexant in Adult and Elderly Healthy Subjects and Adult and Elderly Subjects With Mild Obstructive Sleep Apnea
Condition: Obstructive Sleep Apnea; Healthy Subjects
MeSH terms: Apnea; Sleep Apnea Syndromes; Sleep Apnea, Obstructive
Intervention: Placebo; Lemborexant 10 mg; Lemborexant 25 mg; Placebo; Lemborexant 10 mg
Intervention description: HV: Lemborexant-matched oral placebo will be administered at bedtime in the clinic (within 5 minutes of lights off).; HV: 10 mg oral lemborexant will be administered at bedtime in the clinic (within 5 minutes of lights off).; HV: 25 mg oral lemborexant will be administered at bedtime in the clinic (within 5 minutes of lights off).; OSA: Lemborexant-matched oral placebo will be administered at bedtime in the clinic (within 5 minutes of lights off) in the evening of Days 1 and 8. On Days 2 to 7, participants will take study drug at home, immediately (within 5 minutes) of the time they intend to try to sleep.; OSA: 10 mg oral lemborexant will be administered at bedtime in the clinic (within 5 minutes of lights off) in the evening of Days 1 and 8. On Days 2 to 7, participants will take study drug at home, immediately (within 5 minutes) of the time they intend to try to sleep.
Intervention MeSH terms: Lemborexant
Phase: Phase 1
Study type: Interventional
Primary purpose: Other
Allocation: Randomized
Intervention model: Crossover Assignment
Masking: Double (Participant, Investigator)
Enrollment: 146.0
Sex: All
Minimum age: 18 Years
Maximum age: 90 Years
Healthy volunteers: Accepts Healthy Volunteers
Keywords: Elderly Healthy Subjects; Adult Healthy Subjects; Lemborexant; Respiratory Safety; Peripheral Oxygen Saturation; Total Sleep Time

Summary:

      This study will be conducted to determine whether lemborexant as compared to placebo
      decreases the peripheral oxygen saturation during total sleep time in healthy adult and
      elderly participants after a single dose of treatment and to determine whether it increases
      the apnea-hypopnea index after single and multiple doses of treatment in adult and elderly
      participants with mild obstructive sleep apnea (OSA).
    

Eligibility criteria:

        Inclusion Criteria:

        Participants must meet all of the following criteria to be included in this study:

          -  Male or female, age ≥18 years and ≤90 years at the time of informed consent

          -  Voluntary agreement and ability to provide written informed consent

          -  Reports habitually sleeping for at least 5.5 hours per night

          -  Agrees to stay in bed for 7 hours per night for the duration of treatment

          -  Reports habitual bedtime between 21:00 and 01:00

          -  Peripheral capillary oxygen saturation (SpO2) ≥94% assessed as part of vital signs at
             Screening Visit 1

        Additional Inclusion Criteria (Healthy Volunteer [HV] Cohort):

          -  Body mass index (BMI) less than or equal to 32 kilograms per meters squared (kg/m^2)

          -  On screening polysomnography (PSG) (Screening Visit 2): apnea-hypopnea index (AHI) <5

        Additional Inclusion Criteria (Obstructive Sleep Apnea [OSA] Cohort):

          -  BMI ≤40 kg/m^2

          -  OSA, diagnosed according to the criteria of the International Classification of Sleep
             Disorders, version 3

          -  On Screening PSG: AHI ≥5 to <15 (mild severity)

        Exclusion Criteria:

          -  A current diagnosis of restless legs syndrome, periodic limb movement disorder,
             circadian rhythm sleep disorder, or narcolepsy

          -  Reports symptoms potentially related to narcolepsy, that in the clinical opinion of
             the investigator indicate the need for referral for a diagnostic evaluation for the
             presence of narcolepsy

          -  A history of a parasomnia or parasomnia observed on the Screening PSG that in the
             investigator's opinion makes the participant unsuitable for the study

          -  Periodic Limb Movement with Arousal Index (PLMAI) as measured on the Screening PSG:

               1. Age 18 to <65 years: PLMAI ≥10

               2. Age ≥65 years: PLMAI >15

          -  History of or suspected drug or alcohol use disorder within approximately 2 previous
             years

          -  A positive urine drug test or breath alcohol test at Screening or Baseline, or
             unwilling to refrain from use of recreational drugs during the study

          -  Known to be human immunodeficiency virus positive

          -  Active viral hepatitis (B or C) as demonstrated by positive viral serology at
             Screening

          -  A prolonged QT/corrected QT (QTc) interval (QT interval corrected for heart rate using
             Fridericia's formula [QTcF] >450 milliseconds [ms]) as demonstrated by a repeated
             electrocardiogram (ECG) at Screening (repeated if initial ECG indicates a QTcF
             interval >450 ms)

          -  Comorbid nocturia resulting in the need to get out of bed to use the bathroom more
             than 3 times during the night

          -  Any history of medical or psychiatric condition that in the opinion of the
             investigator could affect the participant's safety or interfere with the study
             assessments

          -  Any suicidal ideation with intent to act with or without a plan, current or within 6
             months before the Columbia - Suicide Severity Rating Scale (C-SSRS) administration
             during the Screening (e.g., answering "Yes" to questions 4 or 5 on the Suicidal
             Ideation section of the C-SSRS

          -  Any suicidal behavior (per the Suicidal Behavior section of the C-SSRS) within 10
             years of Screening

          -  Scheduled for surgery during the study that requires general anesthesia or
             administration of prohibited medications

          -  Used any prohibited prescription or over-the-counter medications within 1 week or 5
             half-lives, whichever is longer, before the Screening PSG

          -  Hypersensitivity to lemborexant or excipients

          -  Currently enrolled in another interventional clinical trial or used any
             investigational drug or device within 30 days or 5 times the half-life, whichever is
             longer preceding informed consent

          -  Previously participated in other clinical trial of lemborexant

          -  Is unable to avoid working a night shift within 2 weeks before the Screening PSG, or
             between the Screening PSG and End-of-Study

          -  Has travelled across 3 or more time zones in the week prior to Screening, or plans to
             travel across more than 3 time zones during the study

          -  Clinically significant findings based on vital signs, physical examination, ECG, or
             clinical laboratory tests

        Additional Exclusion Criteria (HV Cohort):

          -  Any valid event of SpO2 <90% during the Screening PSG

          -  Current evidence of a clinically significant, active respiratory disorder. This
             includes bronchiectasis, emphysema, asthma, chronic obstructive pulmonary disease, or
             any other pulmonary disorder identified by review of medical history, physical
             examination, and which in the opinion of the investigator, could compromise the
             participant's safety or interfere with study assessments

          -  Presence of significant illness (including insomnia) that requires treatment or may
             influence the study assessments (e.g., psychiatric disorders, disorders of the
             gastrointestinal tract, liver, kidney, respiratory system, endocrine system,
             hematological system, neurological system, cardiovascular system, or a congenital
             abnormality), malignancy within the past 5 years (other than adequately treated basal
             cell carcinoma or in situ carcinoma of the cervix), or chronic pain that in the
             opinion of the investigator could interfere with the study assessments. Participants
             for whom a sedating drug would be contraindicated for safety reasons because of the
             participant's occupation or activities are also excluded

        Additional Exclusion Criteria (OSA Cohort):

          -  SpO2 less than 80% for ≥ 5% of total sleep time during the Screening PSG

          -  Uses or plans to use of continuous positive airway pressure device or dental appliance
             within 2 weeks of the Screening PSG (Screening Visit 2) or during the study

          -  Current evidence of a clinically significant, active respiratory disorder other than
             OSA. This includes bronchiectasis, emphysema, asthma, chronic obstructive pulmonary
             disease or any other pulmonary disorder identified by review of medical history,
             physical examination, and which in the opinion of the investigator, could compromise
             the participant's safety or interfere with study assessments

          -  Current evidence of other clinically significant disease (e.g., psychiatric disorders,
             disorders of the gastrointestinal tract, liver, kidney, respiratory system, endocrine
             system, hematological system, neurological system, cardiovascular system, or a
             congenital abnormality), malignancy within the past 5 years (other than adequately
             treated basal cell carcinoma or in situ carcinoma of the cervix), or chronic pain that
             in the opinion of the investigator could affect the participant's safety or interfere
             with the study assessments. Participants for whom a sedating drug would be
             contraindicated for safety reasons because of the participant's occupation or
             activities are also excluded. Participants with insomnia disorder, who complain of
             difficulties with sleep onset and/or sleep maintenance, are eligible provided that
             they meet this criterion. Note that medications to treat insomnia are prohibited.