Efficacy and moderators of prevention and treatment of delirium with melatonin receptor agonists: A systematic review and meta-analysis of randomized controlled trials

Wada, Masataka; Yasuda, Hideaki; Nakajima, Shinichiro; Etani, Takahide; Miura, Akihiko; Asada, Shintaro; Yoshida, Kazunari; Noda, Yoshihiro; Takeuchi, Hiroyoshi

doi:10.1016/j.genhosppsych.2023.08.011

Cited by 1 publication

(2 citation statements)

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“…155 However, a systematic review and meta-analysis indicated that melatonin receptor agonists have significant preventive effects on delirium but did not demonstrate therapeutic effects. 156 Given the variability in study populations, assessment methodologies, drug regimens, and the resulting diverse study outcomes, further investigation is required to clarify the impact of melatonin receptor agonists on PND. The research is crucial to understand better the role of melatonin in perioperative care, particularly regarding cognitive function and delirium prevention in elderly patients undergoing surgery.…”

Section: Melatonin Receptor Agonistsmentioning

confidence: 99%

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The influence of sleep disorders on perioperative neurocognitive disorders among the elderly: A narrative review

Chen,

Zhai,

Lan

et al. 2024

Ibrain

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This review comprehensively assesses the epidemiology, interaction, and impact on patient outcomes of perioperative sleep disorders (SD) and perioperative neurocognitive disorders (PND) in the elderly. The incidence of SD and PND during the perioperative period in older adults is alarmingly high, with SD significantly contributing to the occurrence of postoperative delirium. However, the clinical evidence linking SD to PND remains insufficient, despite substantial preclinical data. Therefore, this study focuses on the underlying mechanisms between SD and PND, underscoring that potential mechanisms driving SD‐induced PND include uncontrolled central nervous inflammation, blood–brain barrier disruption, circadian rhythm disturbances, glial cell dysfunction, neuronal and synaptic abnormalities, impaired central metabolic waste clearance, gut microbiome dysbiosis, hippocampal oxidative stress, and altered brain network connectivity. Additionally, the review also evaluates the effectiveness of various sleep interventions, both pharmacological and nonpharmacological, in mitigating PND. Strategies such as earplugs, eye masks, restoring circadian rhythms, physical exercise, noninvasive brain stimulation, dexmedetomidine, and melatonin receptor agonists have shown efficacy in reducing PND incidence. The impact of other sleep‐improvement drugs (e.g., orexin receptor antagonists) and methods (e.g., cognitive‐behavioral therapy for insomnia) on PND is still unclear. However, certain drugs used for treating SD (e.g., antidepressants and first‐generation antihistamines) may potentially aggravate PND. By providing valuable insights and references, this review aimed to enhance the understanding and management of PND in older adults based on SD.

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Section: Melatonin Receptor Agonistsmentioning

confidence: 99%

“… 155 However, a systematic review and meta‐analysis indicated that melatonin receptor agonists have significant preventive effects on delirium but did not demonstrate therapeutic effects. 156 …”

Section: Interventions Targeting Sd and Their Impact On Pndmentioning

confidence: 99%