A Series of Remote Melatonin Supplement Interventions for Poor Sleep: Protocol for a Feasibility Pilot Study for a Series of Personalized (N-of-1) Trials

Abstract

Background Poor sleep, defined as short-duration or poor-quality sleep, is a frequently reported condition with many deleterious effects including poorer cognitive functioning, increased accidents, and poorer health. Melatonin has been shown to be an efficacious treatment to manage symptoms of poor sleep. However, the treatment effects of melatonin on sleep can vary greatly between participants. Personalized, or N-of-1, trial designs represent a method for identifying the best treatment for individual participants. Although using N-of-1 trials of melatonin to treat poor sleep is possible, the feasibility, acceptability, and effectiveness of N-of-1 trials using melatonin are unknown. Using the National Institutes of Health Stage Model for Behavioral Intervention Development, a stage IB (intervention refinement, modification, and adaptation and pilot testing) design appeared to be needed to address these feasibility questions. Objective This trial series evaluates the feasibility, acceptability, and effectiveness of a series of personalized interventions for remote delivery of melatonin dose (3 and 0.5 mg) versus placebo supplements for self-reported poor sleep among 60 participants. The goal of this study is to provide valuable information about implementing remote N-of-1 randomized controlled trials to improve poor sleep. Methods Participants will complete a 2-week baseline followed by six 2-week alternating intervention periods of 3 mg of melatonin, 0.5 mg of melatonin, and placebo. Participants will be randomly assigned to 2 intervention orders. The feasibility and acceptability of the personalized trial approach will be determined with participants’ ratings of usability and satisfaction with the remote, personalized intervention delivery system. The effectiveness of the intervention will be measured using participants’ self-reported sleep quality and duration and Fitbit tracker–measured sleep duration and efficiency. Additional measures will include ecological momentary assessment measures of fatigue, stress, pain, mood, concentration, and confidence as well as measures of participant adherence to the intervention, use of the Fitbit tracker, and survey data collection. Results As of the submission of this protocol, recruitment for this National Institutes of Health stage IB personalized trial series is approximately 78.3% complete (47/60). We expect recruitment and data collection to be finalized by June 2023. Conclusions Evaluating the feasibility, acceptability, and effectiveness of a series of personalized interventions of melatonin will address the longer term aim of this program of research—is integrating N-of-1 trials useful patient care? The personalized trial series results will be published in a peer-reviewed journal and will follow the CONSORT (Consolidated Standards of Reporting Trials) extension for N-of-1 trials (CENT 2015) reporting guidelines. This trial series was approved by the Northwell Health institutional review board. Trial Registration ClinicalTrials.gov NCT05349188; https://www.clinicaltrials.gov/study/NCT05349188 International Registered Report Identifier (IRRID) DERR1-10.2196/45313

Protocol for randomized personalized trial for stress management compared to standard of care

“…Participant responses to the SUS and rating of satisfaction will be reported with means, standard deviations, and frequencies for participant responses for survey items. As the SUS is a standardized measure, overall participant scores will be compared to other comparable digital interventions and to previous digital N-of-1 trials ( Butler et al, 2022a , b , 2023 ).…”

“…Results from these regressions will be presented to participants in a participant report delivered after trial completion. The methods used will be identical to previously published personalized N-of-1 trials ( Butler et al, 2022a , b , 2023 ).…”

“…The primary outcome is the between-arm change in average daily perceived stress, assessed using EMA, 2 weeks post-intervention selection compared to baseline assessment. The EMA used is a measure adapted from the Numeric Pain Rating Scale ( Jensen et al, 1999 ) and has previously been utilized as a self-reported stress measure in other personalized trials ( Butler et al, 2022a , b , 2023 ). This assessment measure is a single-item assessment administered three times daily via text message asking participants to rate their stress (as well as other states described further in “Secondary Outcomes”) in the current moment on a scale of 0–10.…”

Role of Melatonin in Ovarian Function

“…In fact, unlike unicellular organisms, which directly perceive photoperiod changes and consequently adapt their biological activities, multicellular organisms need a signaling molecule which translates light information into a circadian signal for all cells. Melatonin is widely used in adult humans for the treatment of various sleep disorders, since it displays multiple benefits without the occurrence of tolerance, dependence or side effects at low doses [25,26]. It is commonly utilized for the prevention of jet lag and for the restoration of circadian rhythms.…”