Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes

Wade, Alan G; Ford, Ian; Crawford, G.; McMahon, Alex D.; Nir, Tali; Laudon, Moshe; Zisapel, Nava

doi:10.1185/030079907x233098

Cited by 218 publications

(177 citation statements)

References 24 publications

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“…Et depotpreparat av melatonin (Circadin®) ble i 2008 godkjent i Norge med indikasjonen insomni hos pasienter som er 55 år eller eldre. Preparatet er vist å gi kortere innsovningstid og bedre subjektiv søvn-kvalitet (22). Men det finnes ikke sammenliknende studier mellom depotmelatonin og andre hypnotika eller CBTi.…”

Section: Medikamentell Behandlingunclassified

Søvnproblemer blant eldre

Bjorvatn¹,

Fetveit²

2012

Nor J Epidemiol

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1) Nasjonalt kompetansetjeneste for søvnsykdommer, Haukeland universitetssykehus 2) Institutt for samfunnsmedisinske fag, Universitetet i Bergen 3) Institutt for allmenn-og samfunnsmedisin, Universitetet i Oslo SAMMENDRAGMange eldre sover dårlig, og dårlig søvn påvirker helse og livskvalitet. Vi vil i denne artikkelen ta for oss typiske trekk ved søvnen hos eldre mennesker. Søvnsykdommer deles inn i seks ulike undergrupper: insomnier, døgnrytmeforstyrrelser, søvnrelaterte respirasjonsforstyrrelser, søvnrelaterte bevegelsesforstyrrelser, hypersomnier og parasomnier. Hovedfokuset i artikkelen vil vaere på insomni, men også de andre søvnsyk-dommene blir beskrevet. Flere av søvnsykdommene er hyppigere hos eldre enn hos yngre mennesker. I tillegg er mange somatiske og psykiske lidelser assosiert til søvnproblemer, hvorav depresjon regnes som den hyppigste komorbide lidelsen. Grundig anamnese vil avdekke de fleste av søvnsykdommene, og bruk av søvndagbøker gir viktig tilleggsinformasjon. Behandlingsalternativene varierer fra ikke-medikamentelle til medikamentelle tiltak, avhengig av hvilken diagnose som stilles. Langvarig bruk av hypnotika frarådes på grunn av toleranseutvikling og uheldige bivirkninger. Det er viktig at utredning gjøres før behandlingen starter, og korrekt behandling kan ha stor effekt -også hos eldre. ENGLISH SUMMARYSleep problems are common among the elderly, and poor sleep affects health and quality of life. In this paper we will cover the characteristics of sleep in elderly patients. Sleep disorders are divided into six subgroups: insomnia, circadian rhythm sleep disorders, sleep related breathing disorders, sleep related movement disorders, hypersomnias, and parasomnias. The main focus of this paper will be on insomnia, but also the other sleep disorders will be described. Several of the sleep disorders are more common among older than younger people. Furthermore, many somatic and psychiatric disorders are associated with sleep problems, with depression being the most common comorbid disorder. A thorough patient history will uncover most of the sleep disorders, and the use of sleep diaries gives important additional information. The treatments of choice vary from non-pharmacological to pharmacological approaches, depending on the diagnosis. Chronic use of hypnotics is discouraged due to risk of tolerance and unfavourable side effects. It is vital to do a proper assessment before treatment is commenced, and appropriate treatment may have large effects -also among elderly patients. INTRODUKSJONHelse og velvaere er avhengig av god søvn. De fleste av oss har opplevd en natt med dårlig søvn, og vet hvordan det påvirker humøret, konsentrasjonen og yteevnen. Søvnproblemer og søvnighet er vanlige årsaker til ulykker, for eksempel i trafikken. Norske studier har dokumentert at dårlig søvn gir økt sykefravaer og uføretrygd. Behovet for søvn er imidlertid veldig varierende fra person til person. Enkelte mennesker klarer seg med få timer, kanskje faerre enn 6 timer, mens andre trenger over 9 timer søvn fo...

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Section: Medikamentell Behandlingunclassified

Søvnproblemer blant eldre

Bjorvatn¹,

Fetveit²

2012

Nor J Epidemiol

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“…Zudem liegt für die Indikation Altersinsomnie (>55 Jahre) das retardierte Melatonin-Präparat (Circadin) vor [75]. Es ist jedoch auch bei diesen Substanzen auf Nebenwirkungen zu achten.…”

Section: Melatonin Und Melatonin-agonistenunclassified

Schlafstörungen im Alter

Thum¹,

Hemmeter-Spernal²,

Hemmeter³

2011

Swiss Arch Neurol Psychiatr

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“…In all five studies for primary insomnia [44][45][46][47][48][49] there were large sample sizes, which increased reliability of results (n=40-791). The studies used a thorough prescreening assessment which was deployed to reduce confounding factors and use of medications such as benzodiazepines were stopped beforehand.…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“…Quantitative analysis of the five eligible RCTs [44,[46][47][48][49] showed an overall significant reduction in the time to fall asleep between the effect on sleep onset latency for melatonin in patients with primary insomnia compared with placebo (Total mean difference = -5.05 minutes, 95% CI: -8.51, -1.59). The overall estimated score of melatonin treatment was significant (Z=2.86, P=0.004) (Fig.2).…”

Section: A C C E P T E D Accepted Manuscriptmentioning

confidence: 99%

“…Participants unsuitable (n= 5) [26][27][28][29][30] Insufficient data for analysis (n= 2) [31,32] Inappropriate method and data collection (n= 4) [33][34][35][36] No clear comparison group (n= 4) [37][38][39][40] Number of studies included in review (n=13) [41][42][43][44][45][46][47][48][49][50][51][52] Publications handpicked (screening reference list) (n= 2) …”

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confidence: 99%

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Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders

Auld

Maschauer

Morrison

et al. 2017

Sleep Medicine Reviews

326

142

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Melatonin is a physiological hormone involved in sleep timing and is currently used exogenously in the treatment of primary and secondary sleep disorders with empirical evidence of efficacy, but very little evidence from randomised, controlled studies. The aim of this meta-analysis was to assess the evidence base for the therapeutic effects of exogenous melatonin in treating primary sleep disorders. An electronic literature review search of MEDLINE (1950-present) EMBASE (1980- present), PsycINFO (1987- present), and SCOPUS (1990- present), along with a hand-searching of key journals was performed in July 2013 and then again in May 2015. This identified all studies that compared the effect of exogenous melatonin and placebo in patients with primary insomnia, delayed sleep phase syndrome, Non 24- hour sleep wake syndrome in people who are blind, and REM-Behaviour Disorder. Meta-analyses were performed to determine the effect of magnitude in studies of melatonin in improving sleep. A total of 5030 studies were identified; of these citations, 13 were included for review based on the inclusion criteria of being: double or single-blind, randomised and controlled. Results from the meta-analyses showed the most convincing evidence for exogenous melatonin use was in reducing sleep onset latency in primary insomnia (p=0.002), delayed sleep phase syndrome (p<0.0001), and regulating the sleepwake patterns in blind patients compared with placebo. These findings highlight the potential importance of melatonin in treating certain first degree sleep disorders. The development of large-scale, randomised, controlled trials is recommended to provide further evidence for therapeutic use of melatonin in a variety of sleep difficulties

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Efficacy of prolonged release melatonin in insomnia patients aged 55–80 years: quality of sleep and next-day alertness outcomes

Abstract: The trial was conducted prior to registration being introduced.

Cited by 218 publications

References 24 publications

Søvnproblemer blant eldre

Søvnproblemer blant eldre

Schlafstörungen im Alter

Evidence for the efficacy of melatonin in the treatment of primary adult sleep disorders

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