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Introduction
Delirium is a clinical syndrome marked by acute cerebral dysfunction, which is de- fined by three key features: fluctuating mental status, inattention, and an altered level of consciousness or disorganized thinking. It arises in response to changes in environmental and physical conditions, and its prevalence among hospitalized patients ranges from 3% to 56%.1,2 Delirium is associated with increased length of hospital stay, higher healthcare costs, and increased risk of long-term cognitive impairment and mortality.3,4 Despite its significant impact on patient outcomes, the prevention of delirium re- mains a challenging task. Current prevention strategies, such as non-pharmacological interventions and early mobilization, have shown promise but have limitations in their effectiveness.5 As a result, there is a growing interest in the use of pharmacological agents to prevent delirium. Two such agents, suvorexant and Lemborexant, have recently gained attention for their potential role in delirium prevention.Suvorexant, a dual orexin receptor antagonist, has been shown to reduce the incidence of delirium in critically ill patients. Tamura et al. found that the incidence of delirium in patients undergoing elective coronary artery bypass grafting was significantly lower in the suvorexant treatment group compared to the control group (2.8% vs. 21.2%; P = .008).6Similarly, Hatta et al. reported that delirium was less common among acute care patients receiving suvorexant than in those who did not receive it (0% vs. 17%; P = .025).7 Similarly, Lemborexant, another orexin receptor antagonist, Terada et al. reported that it is effective in addressing sleep disturbances in cancer patients experiencing delirium.8 This meta-analysis and systematic review aim to critically evaluate the current evi- dence on the use of suvorexant and Lemborexant in the prevention of delirium, with a focus on their efficacy, safety, and potential clinical applications

Materials and method This meta-analysis followed the PRISMA guidelines. there was no need for either ethical approval or patient consent because this study used secondary data obtained from already published articles. Data Sources and searches The databases of PUBMED, EMBASE and the Cochrane library were all searched up to 01 September 2024, with the use of search strategy: Dual orexin receptor antagonist (“Suvorexant”) (“Lemborexant”) AND (“delirium”). These were additional studies that52 were sought from the reference list of the studies already included

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