Melatonin therapy for REM sleep behavior disorder: a critical review of evidence

McGrane, Ian R.; Leung, Jonathan G.; Louis, Erik K. St.; Boeve, Bradley F.

doi:10.1016/j.sleep.2014.09.011

Cited by 160 publications

(93 citation statements)

References 60 publications

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“…Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioural outcomes and a decrease in muscle tonicity during REM sleep. Melatonin also has a favourable safety and tolerability profile compared to clonazepam with limited potential for drug-drug interactions, which is an important consideration, especially in elderly individuals with RBD receiving polypharmacy, as adverse events were minimal [58].…”

Section: Effect Of Melatonin On Parasomniasmentioning

confidence: 99%

A review of sleep disorders and melatonin

Xie

Chen

et al. 2017

Neurological Research

315

181

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Sleep disorders are a group of conditions that affect the ability to sleep well on a regular basis and cause significant impairments in social and occupational functions. Although currently approved medications are efficacious, they are far from satisfactory. Benzodiazepines, antidepressants, antihistamines and anxiolytics have the potential for dependence and addiction. Moreover, some of these medications can gradually impair cognition. Melatonin (N-acetyl-5-methoxytryptamine) is an endogenous hormone produced by the pineal gland and released exclusively at night. Exogenous melatonin supplementation is well tolerated and has no obvious short-or long-term adverse effects. Melatonin has been shown to synchronize the circadian rhythms, and improve the onset, duration and quality of sleep. It is centrally involved in anti-oxidation, circadian rhythmicity maintenance, sleep regulation and neuronal survival. This narrative review aims to provide a comprehensive overview of various therapeutic functions of melatonin in insomnia, sleep-related breathing disorders, hypersomnolence, circadian rhythm sleep-wake disorders and parasomnias. Melatonin offers an alternative treatment to the currently available pharmaceutical therapies for sleep disorders with significantly less side effects.

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Section: Effect Of Melatonin On Parasomniasmentioning

confidence: 99%

A review of sleep disorders and melatonin

Xie

Chen

et al. 2017

Neurological Research

315

181

View full text Add to dashboard Cite

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“…However, the mechanisms that underlie the beneficial effects of melatonin and ramelteon on RBD remain unclear. Some reports have suggested that melatonin might improve RBD due to direct inhibition of REM with atonia (RWA), inhibition of gamma-aminobutyric acid, stabilization of the circadian rhythm, improvement of sleep efficiency and/or modulation of skeletal muscles that have been inhibited by calmodulin (28). Moreover, it has been reported that melatonin protects exogenous L-dopa from autoxidation in the striatum of rats (29).…”

Section: Discussionmentioning

confidence: 99%

Beneficial Effects of Ramelteon on Rapid Eye Movement Sleep Behavior Disorder Associated with Parkinson's Disease - Results of a Multicenter Open Trial

et al. 2016

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Objective Melatonin is effective for treating patients with rapid eye movement sleep behavior disorder (RBD). Ramelteon, a novel hypnotic, acts as a melatonin receptor agonist. In the current study, we investigated the effects of ramelteon on sleep disorders, including RBD, in patients with Parkinson's disease (PD). Methods We evaluated 35 patients from multiple centers with idiopathic PD accompanied by sleep disturbances (age: 69.1±11.1 years; 17 men, 18 women; PD morbidity: 6.9±5.7 years; Hoehn & Yahr stage: 2.5± 0.8; levodopa dose equivalent: 561±401 mg/day). The patients received 8 mg of ramelteon before sleep once daily for 12 weeks. Motor and sleep symptoms were evaluated both before and after ramelteon administration. Results Of the 35 patients enrolled in this study, 24 (68.6%) were diagnosed with probable RBD (pRBD) using the Japanese version of the RBD screening questionnaire. Ramelteon administration reduced the severity of sleep disturbances in patients with PD. It also lowered scores on the Japanese version of the RBD questionnaire in patients with PD and pRBD. Conclusion Ramelteon may have beneficial effects on sleep disturbances, especially on RBD in patients with PD.

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“…Although the mechanism of action is unclear, melatonin may restore RBD-related desynchronization of circadian rhythms. In contrast to clonazepam, it is also shown to decrease the number of REM epochs without atonia and decrease both phasic and tonic motor activities [77,78]. Also, recent studies have shown favorability due to better side effect profile, with reduced falls and injuries when compared to clonazepam [74,79].…”

Section: Melatoninmentioning

confidence: 99%

Rapid Eye Movement Sleep Behavior Disorder: Overview and Current Perspective

Irfan

Howell

2016

Curr Sleep Medicine Rep

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Rapid eye movement (REM) stage of sleep in normal circumstances is composed of vivid dream mentation associated with physiological skeletal muscle paralysis and thus, quiescence of motor activity. REM sleep behavior disorder (RBD) is a parasomnia characterized by disinhibition of motor control facilitating dream enactment behaviors. These nocturnal motoric behaviors due to lack of REM atonia range from benign limb movements to complex aggressive actions but are often manifested by violent, aggressive flailing, punching and kicking with vocalizations enacting action-filled hostile dreams. Polysomnographic evidence of increased electromyographic tone during REM with or without capturing clinical dream enactment together with careful history helps diagnose RBD. It is considered a prodromal feature of neurodegenerative alpha-synucleinopathies with high rate of eventual phenoconversion. The mainstay of treatment is to first ensure physical safety. When medications are necessary, options include either low-dose clonazepam, high-dose melatonin or both. Yearly surveillance with detailed neurological evaluation is vital for early detection and eventual management of neurodegenerative disorder.

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Melatonin therapy for REM sleep behavior disorder: a critical review of evidence

Cited by 160 publications

References 60 publications

A review of sleep disorders and melatonin

A review of sleep disorders and melatonin

Beneficial Effects of Ramelteon on Rapid Eye Movement Sleep Behavior Disorder Associated with Parkinson's Disease - Results of a Multicenter Open Trial

Rapid Eye Movement Sleep Behavior Disorder: Overview and Current Perspective

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