Daridorexant to Prevent Post-cardiotomy Delirium

Inclusion criteria

• ≥ 60 yrs;
• having surgical aortic valve surgery or coronary artery bypass graft surgery at Strong Memorial Hospital;
• can provide consent;
• able to speak, read,and write English (as the instruments, including semi-structured interviews, used in this protocol have been validated in English);
• family member or close friend for collateral.

Exclusion criteria

• Prior cardiotomy
• Infectious endocarditis
• Emergency surgery
• Delirium at baseline (positive 3D-CAM)
• Auditory or visual impairment that prevents study procedures
• Alcohol or substance misuse (CAGE-AID score ≥ 2)
• Psychotic disorder
• Dementia-level deficits (TICS < 27)
• Use of a prescription sleep aid at least every other night
• Use of a strong CYP3A4 inhibitor (e.g., ceritinib, clarithromycin, cobicistat, idelalisib, itraconazole, ketoconazole, nefazodone, nelfinavir, posaconazole, ritonavir, telithromycin, voriconazole)
• Daridorexant intolerance
• Severe kidney or liver impairment (Child-Pugh ≥7, Cockcroft-Gault <30 mL/min, or on dialysis)
• Narcolepsy
• Suicidal ideation at baseline
• Any condition that, in the PI's opinion, compromises patient safety or data quality
• Additional exclusions for the NLP exploratory aim: history of traumatic brain injury or head concussions with loss of consciousness, use of corticosteroids, or history of major neurological disease or brain surgery