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Watson LA, McGlashan EM, Hosken IT, Anderson C, Phillips AJK, Cain SW. Sleep and circadian instability in delayed sleep-wake phase disorder. J Clin Sleep Med 2021; 16:1431-1436. [PMID: 32347206 DOI: 10.5664/jcsm.8516] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES In patients with delayed sleep-wake phase disorder (DSWPD), the circadian clock may be more easily affected by light at night. This creates a potential vulnerability, whereby individuals with irregular schedules may have less stable circadian rhythms. We investigated the stability of circadian timing and regularity of sleep in patients with DSWPD and healthy controls. METHODS Participants completed 2 dim-light melatonin onset (DLMO) assessments approximately 2 weeks apart while keeping their habitual sleep/wake schedule. After the second DLMO assessment, light sensitivity was assessed using the phase-resetting response to a 6.5-hour 150-lux stimulus. The change in DLMO timing (DLMO instability) was assessed and related to light sensitivity and the sleep regularity index. RESULTS Relative to healthy controls, patients with DSWPD had later sleep rhythm timing relative to clock time, earlier sleep rhythm timing relative to DLMO, lower sleep regularity index, and greater DLMO instability. Greater DLMO instability was associated with increased light sensitivity across all participants, but not within groups. CONCLUSIONS We find that circadian timing is less stable and sleep is less regular in patients with DSWPD, which could contribute to etiology of the disorder. Measures of light sensitivity may be informative in generating DSWPD treatment plans.
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Affiliation(s)
- Lauren A Watson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Elise M McGlashan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Ihaia T Hosken
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Clare Anderson
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia; *Contributed equally
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2
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van Andel E, Bijlenga D, Vogel SWN, Beekman ATF, Kooij JJS. Effects of chronotherapy on circadian rhythm and ADHD symptoms in adults with attention-deficit/hyperactivity disorder and delayed sleep phase syndrome: a randomized clinical trial. Chronobiol Int 2020; 38:260-269. [PMID: 33121289 DOI: 10.1080/07420528.2020.1835943] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18-55 y) with ADHD and DSPS received sleep education and 3 weeks of (1) 0.5 mg/d placebo, (2) 0.5 mg/d melatonin, or (3) 0.5 mg/d melatonin plus 30 minutes of 10,000 lux bright light therapy (BLT) between 07:00 and 08:00 h. Placebo/melatonin conditions were double-blind. Treatment took place in the participants' naturalistic home settings. Dim-light melatonin onset (DLMO) was measured in saliva as marker of internal circadian rhythm. Melatonin or placebo administration followed individual schedules, starting 3 hours before the individual DLMO and weekly advancing by 1 h. DLMO and ADHD Rating Scale score were assessed at baseline, directly after 3-week treatment, and two weeks after the end of treatment. Results show that at baseline 77% had a DLMO after 21:00 h with an average DLMO at 23:43 h ± 1h46. Directly after treatment, melatonin had advanced DLMO by 1h28 (p = .001), and melatonin plus BLT by 1h58 (p < .001). Placebo did not affect DLMO. ADHD symptoms reduced by 14% (p = .038) directly after melatonin treatment. Placebo and melatonin plus BLT did not impact ADHD symptoms. Two weeks after end of treatment, ADHD symptoms and DLMO had returned to baseline levels. It can be concluded that low doses of melatonin advanced the circadian rhythm and reduced self-reported ADHD symptoms. Given the large number of adult ADHD patients with concurrent DSPS, treating delayed sleep with melatonin is an important component of effective ADHD treatment.
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Affiliation(s)
- Emma van Andel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Denise Bijlenga
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Suzan W N Vogel
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands
| | - Aartjan T F Beekman
- Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
| | - J J Sandra Kooij
- PsyQ, Expertise Center Adult ADHD , The Hague, The Netherlands.,Department of Psychiatry, Amsterdam Public Health Research Institute, VU University Medical Center , Amsterdam, The Netherlands
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3
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Stone JE, McGlashan EM, Quin N, Skinner K, Stephenson JJ, Cain SW, Phillips AJK. The Role of Light Sensitivity and Intrinsic Circadian Period in Predicting Individual Circadian Timing. J Biol Rhythms 2020; 35:628-640. [PMID: 33063595 DOI: 10.1177/0748730420962598] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
There is large interindividual variability in circadian timing, which is underestimated by mathematical models of the circadian clock. Interindividual differences in timing have traditionally been modeled by changing the intrinsic circadian period, but recent findings reveal an additional potential source of variability: large interindividual differences in light sensitivity. Using an established model of the human circadian clock with real-world light recordings, we investigated whether changes in light sensitivity parameters or intrinsic circadian period could capture variability in circadian timing between and within individuals. Healthy participants (n = 12, aged 18-26 years) underwent continuous light monitoring for 3 weeks (Actiwatch Spectrum). Salivary dim-light melatonin onset (DLMO) was measured each week. Using the recorded light patterns, a sensitivity analysis for predicted DLMO times was performed, varying 3 model parameters within physiological ranges: (1) a parameter determining the steepness of the dose-response curve to light (p), (2) a parameter determining the shape of the phase-response curve to light (K), and (3) the intrinsic circadian period (tau). These parameters were then fitted to obtain optimal predictions of the three DLMO times for each individual. The sensitivity analysis showed that the range of variation in the average predicted DLMO times across participants was 0.65 h for p, 4.28 h for K, and 3.26 h for tau. The default model predicted the DLMO times with a mean absolute error of 1.02 h, whereas fitting all 3 parameters reduced the mean absolute error to 0.28 h. Fitting the parameters independently, we found mean absolute errors of 0.83 h for p, 0.53 h for K, and 0.42 h for tau. Fitting p and K together reduced the mean absolute error to 0.44 h. Light sensitivity parameters captured similar variability in phase compared with intrinsic circadian period, indicating they are viable targets for individualizing circadian phase predictions. Future prospective work is needed that uses measures of light sensitivity to validate this approach.
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Affiliation(s)
- Julia E Stone
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Elise M McGlashan
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Nina Quin
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Kayan Skinner
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Jessica J Stephenson
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Sean W Cain
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
| | - Andrew J K Phillips
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Australia
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4
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Coleman MY, McGlashan EM, Vidafar P, Phillips AJK, Cain SW. Advanced melatonin onset relative to sleep in women with unmedicated major depressive disorder. Chronobiol Int 2019; 36:1373-1383. [PMID: 31368377 DOI: 10.1080/07420528.2019.1644652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Studies on circadian timing in depression have produced variable results, with some investigations suggesting phase advances and others phase delays. This variability may be attributable to differences in participant diagnosis, medication use, and methodology between studies. This study examined circadian timing in a sample of unmedicated women with and without unipolar major depressive disorder. Participants were aged 18-28 years, had no comorbid medical conditions, and were not taking medications. Eight women were experiencing a major depressive episode, nine had previously experienced an episode, and 31 were control participants with no history of mental illness. Following at least one week of actigraphic sleep monitoring, timing of salivary dim light melatonin onset (DLMO) was assessed in light of <1 lux. In currently depressed participants, melatonin onset occurred significantly earlier relative to sleep than in controls, with a large effect size. Earlier melatonin onset relative to sleep was also correlated with poorer mood for all participants. Our results indicate that during a unipolar major depressive episode, endogenous circadian phase is advanced relative to sleep time. This is consistent with the early-morning awakenings often seen in depression. Circadian misalignment may represent a precipitating or perpetuating factor that could be targeted for personalized treatment of major depression.
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Affiliation(s)
- Michelle Y Coleman
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Elise M McGlashan
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Parisa Vidafar
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Andrew J K Phillips
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
| | - Sean W Cain
- School of Psychological Sciences and Turner Institute for Brain and Mental Health, Monash University , Clayton , Australia
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5
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Efficacy and safety of melatonin for sleep onset insomnia in children and adolescents: a meta-analysis of randomized controlled trials. Sleep Med 2019; 68:1-8. [PMID: 31982807 DOI: 10.1016/j.sleep.2019.02.017] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 02/23/2019] [Accepted: 02/25/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate the efficacy and safety of melatonin in the treatment of sleep onset insomnia in children and adolescents. METHODS Electronic databases and bibliographies of relevant reports were searched for randomized, placebo-controlled, clinical trials that used melatonin in children and adolescents with sleep onset insomnia. The quality of the included studies was assessed by the Cochrane Collaboration's risk-of-bias method. The mean differences (MD) and the odds ratios (OR) with 95% confidence interval (CI) were estimated by a random-effects model. Primary outcomes were sleep onset time (SOT), drop-out for all causes and drop-out for adverse events. Secondary outcomes included dim light melatonin onset (DLMO), sleep onset latency (SOL), total sleep time (TST), light-off time, and wake-up time. RESULTS Seven trials with 387 participants were finally included after a systematic search. The overall quality of the included studies was low to moderate. SOT in patients receiving melatonin advanced more than patients receiving placebo (MD = -0.62 h, 95% CI -0.80, -0.45), as well as DLMO (MD = -0.82 h, 95% CI -1.23, -0.41). No differences were found in the outcome of drop-out for all causes (OR = 1.51, 95% CI 0.57, 4.05) or drop-out for adverse events (OR = 3.35, 95% CI 0.13, 86.03). Severe adverse events, migraine, and mild generalized epilepsy were reported in two cases. SOL decreased and TST increased, MD = -0.36 h (95% CI -0.49, -0.24) and MD = 0.38 h (95% CI 0.09, 0.66), respectively. Light-off time and wake-up time did not differ significantly. CONCLUSIONS Melatonin was an effective and tolerable drug in the short-term treatment of sleep onset insomnia in children and adolescents. More studies, especially in adolescents, are needed to investigate the efficacy and safety of melatonin.
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6
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Snitselaar MA, Smits MG, Spijker J. ADHD symptoms in adults with delayed sleep phase disorder. Sleep Biol Rhythms 2018. [DOI: 10.1007/s41105-018-0188-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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7
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Keijzer H, Spruyt K, Smits MG, de Geest A, Curfs LMG. Can dim light melatonin onset be predicted by the timing of sleep in patients with possible circadian sleep-wake rhythm disorders? BIOL RHYTHM RES 2017. [DOI: 10.1080/09291016.2017.1287817] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Henry Keijzer
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands
- Governor Kremers Centre, University Maastricht, The Netherlands
| | - Karen Spruyt
- Governor Kremers Centre, University Maastricht, The Netherlands
- Department of Developmental and Behavioral Pediatrics, Shanghai Children’s Medical Centre affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Marcel G. Smits
- Governor Kremers Centre, University Maastricht, The Netherlands
- Centre for Sleep-wake Disturbances and Chronobiology, Ede, The Netherlands
| | - Antoon de Geest
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Leopold M. G. Curfs
- Governor Kremers Centre, University Maastricht, The Netherlands
- Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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8
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van Maanen A, Meijer AM, Smits MG, van der Heijden KB, Oort FJ. Effects of Melatonin and Bright Light Treatment in Childhood Chronic Sleep Onset Insomnia With Late Melatonin Onset: A Randomized Controlled Study. Sleep 2017; 40:2666484. [DOI: 10.1093/sleep/zsw038] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2016] [Indexed: 01/31/2023] Open
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9
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Keijzer H, Snitselaar MA, Smits MG, Spruyt K, Zee PC, Ehrhart F, Curfs LM. Precision medicine in circadian rhythm sleep-wake disorders: current state and future perspectives. Per Med 2017; 14:171-182. [PMID: 29754559 DOI: 10.2217/pme-2016-0079] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
In circadian rhythm sleep-wake disorders precision medicine is less developed than in other medical disciplines mainly because homeostatic sleep and circadian timing have a very complex phenotype with multiple genetic regulation mechanisms. However, biomarkers, phenotyping and psychosocial characteristics are increasingly used. Devices for polysomnography, actigraphy and sleep-tracking applications in mobile phones and other consumer devices with eHealth technologies are increasingly used. Also sleep-related questionnaires and the assessment of co-morbidities influencing sleep in circadian rhythm sleep-wake disorders are major contributors to precision sleep medicine. To further strengthen the (pharmaco-)genetic and biomarker pillar, technology needs to be evolved further. Routinely measuring treatment results using patient-reported outcome measures and clinical neurophysiological instruments will boost precision sleep medicine.
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Affiliation(s)
- Henry Keijzer
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Department of Clinical Chemistry & Hematology, Rijnstate Hospital, Arnhem, The Netherlands
| | - Mark A Snitselaar
- Centre for Sleep-Wake Disturbances & Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands.,Pro Persona Mental Health Care, Ede, The Netherlands
| | - Marcel G Smits
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Centre for Sleep-Wake Disturbances & Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Karen Spruyt
- Rett Expertise Centre, University Maastricht, Maastricht, The Netherlands.,Faculty of Psychology & Educational Sciences, Vrije Universiteit Brussel, Belgium.,Department of Developmental & Behavioral Pediatrics, Shanghai Children's Medical Centre affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Phyllis C Zee
- Center for Circadian & Sleep Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Friederike Ehrhart
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Rett Expertise Centre, University Maastricht, Maastricht, The Netherlands.,Department of Bioinformatics, Maastricht University, Maastricht, The Netherlands
| | - Leopold Mg Curfs
- Governor Kremers Centre, University Maastricht, Maastricht, The Netherlands.,Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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10
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van Maanen A, Meijer AM, Smits MG, Oort FJ. Classical conditioning for preserving the effects of short melatonin treatment in children with delayed sleep: a pilot study. Nat Sci Sleep 2017; 9:67-79. [PMID: 28331380 PMCID: PMC5352231 DOI: 10.2147/nss.s129203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Melatonin treatment is effective in treating sleep onset problems in children with delayed melatonin onset, but effects usually disappear when treatment is discontinued. In this pilot study, we investigated whether classical conditioning might help in preserving treatment effects of melatonin in children with sleep onset problems, with and without comorbid attention deficit hyperactivity disorder (ADHD) or autism. After a baseline week, 16 children (mean age: 9.92 years, 31% ADHD/autism) received melatonin treatment for 3 weeks and then gradually discontinued the treatment. Classical conditioning was applied by having children drink organic lemonade while taking melatonin and by using a dim red light lamp that was turned on when children went to bed. Results were compared with a group of 41 children (mean age: 9.43 years, 34% ADHD/autism) who received melatonin without classical conditioning. Melatonin treatment was effective in advancing dim light melatonin onset and reducing sleep onset problems, and positive effects were found on health and behavior problems. After stopping melatonin, sleep returned to baseline levels. We found that for children without comorbidity in the experimental group, sleep latency and sleep start delayed less in the stop week, which suggests an effect of classical conditioning. However, classical conditioning seems counterproductive in children with ADHD or autism. Further research is needed to establish these results and to examine other ways to preserve melatonin treatment effects, for example, by applying morning light.
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Affiliation(s)
- Annette van Maanen
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam
| | - Anne Marie Meijer
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam
| | - Marcel G Smits
- Centre for Sleep-Wake Disorders and Chronobiology, Hospital Gelderse Vallei, Ede, the Netherlands
| | - Frans J Oort
- Research Institute Child Development and Education, University of Amsterdam, Amsterdam
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11
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Spruyt K, Braam W, Smits M, Curfs LM. Sleep Complaints and the 24-h Melatonin Level in Individuals with Smith-Magenis Syndrome: Assessment for Effective Intervention. CNS Neurosci Ther 2016; 22:928-935. [PMID: 27743421 DOI: 10.1111/cns.12653] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 09/23/2016] [Accepted: 09/28/2016] [Indexed: 11/30/2022] Open
Abstract
AIMS Individuals with Smith-Magenis syndrome (SMS) are reported to have a disrupted circadian rhythm. Our aim was to examine problematic sleeping in those attending our sleep clinic for the first time. METHODS At intake, caregivers of 50 children and nine adults with SMS were surveyed about the sleep pattern and potential melatonin administration. Sampling of salivary melatonin levels was performed. RESULTS At intake, exogenous melatonin was used by 16 children (27.1% of sample; 56.3% male) with mean age 6.8 ± 2.8 years, whereas 34 children (57.6%; 7.5 ± 4.8 years old; 64.7% male) and nine adults (15.3%; 36.8 ± 15.3 years old; 44.4% male) were not taking melatonin at intake. Participants were reported to have problems with night waking and early awakenings regardless of melatonin administration. Overall, moderate to high levels of salivary melatonin at noon were found in individuals with SMS. In particular, children with SMS showed a disrupted melatonin pattern. Furthermore, the endogenous melatonin level, age, and gender may potentially interact, yielding the severity range of sleep disturbances reported in SMS. CONCLUSION Treatment of sleep problems in SMS is complex, and our findings may support person-centered sleep and medication management. Future clinical trials including larger groups may shed light on such approaches.
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Affiliation(s)
- Karen Spruyt
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands. .,Department of Developmental and Behavioral Pediatrics, Shanghai Children's Medical Center affiliated with Shanghai Jiaotong University School of Medicine, Shanghai, China.
| | - Wiebe Braam
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,'s Heeren Loo Zuid-Veluwe, Wekerom, Netherlands
| | - Marcel Smits
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Neurology, Gelderse Vallei Hospital, Ede, Netherlands
| | - Leopold Mg Curfs
- Governor Kremers Center-Rett Expertise Center & MHeNs, Maastricht University, Maastricht, Netherlands.,Department of Genetics, Maastricht University Medical Centre, Maastricht, Netherlands
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12
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Gau J, Furtmüller PG, Obinger C, Prévost M, Van Antwerpen P, Arnhold J, Flemmig J. Flavonoids as promoters of the (pseudo-)halogenating activity of lactoperoxidase and myeloperoxidase. Free Radic Biol Med 2016; 97:307-319. [PMID: 27350402 DOI: 10.1016/j.freeradbiomed.2016.06.026] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 06/23/2016] [Accepted: 06/23/2016] [Indexed: 01/05/2023]
Abstract
In this study several flavonoids were tested for their potential to regenerate the (pseudo-)halogenating activity (hypothiocyanite formation) of the heme peroxidases lactoperoxidase (LPO) and myeloperoxidase (MPO) after hydrogen peroxide-mediated enzyme inactivation. Several flavonoid subclasses with varying hydroxylation patterns (especially of the flavonoid B-ring) were examined in order to identify structural properties of efficient enzyme regenerators. Kinetic parameters and second-order rate constants were determined. A 3',4'-dihydroxylated B-ring together with C-ring saturation and hydroxylation were found to be important structural elements, which strongly influence the flavonoid binding and oxidizability by the LPO/MPO redox intermediates Compounds I and II. In combination with docking studies these results allow an understanding of the differences between flavonoids that promote the hypothiocyanite production by LPO and MPO and those that inhibit this enzymatic reaction.
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Affiliation(s)
- Jana Gau
- Institute for Medical Physics and Biophysics, Medical Faculty, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany.
| | - Paul G Furtmüller
- Department of Chemistry, Division of Biochemistry, University of Natural Resources and Life Sciences (BOKU) Vienna, Muthgasse 18, 1190 Vienna, Austria.
| | - Christian Obinger
- Department of Chemistry, Division of Biochemistry, University of Natural Resources and Life Sciences (BOKU) Vienna, Muthgasse 18, 1190 Vienna, Austria.
| | - Martine Prévost
- Laboratory of Structure and Function of Biological Membranes, Université Libre de Bruxelles, Boulevard du Triomphe, 1050 Brussels, Belgium.
| | - Pierre Van Antwerpen
- Laboratory of Pharmaceutical Organic Chemistry, Institute of Pharmacy, Université Libre de Bruxelles, Boulevard du Triomphe, 1050 Brussels, Belgium.
| | - Jürgen Arnhold
- Institute for Medical Physics and Biophysics, Medical Faculty, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany.
| | - Jörg Flemmig
- Institute for Medical Physics and Biophysics, Medical Faculty, University of Leipzig, Härtelstraße 16-18, 04107 Leipzig, Germany.
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13
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Danielsson K, Jansson-Fröjmark M, Broman JE, Markström A. Cognitive Behavioral Therapy as an Adjunct Treatment to Light Therapy for Delayed Sleep Phase Disorder in Young Adults: A Randomized Controlled Feasibility Study. Behav Sleep Med 2016; 14:212-32. [PMID: 26244417 DOI: 10.1080/15402002.2014.981817] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Delayed sleep phase disorder (DSPD) is common among young people, but there is still no evidence-based treatment available. In the present study, the feasibility of cognitive behavioral therapy (CBT) was evaluated as an additive treatment to light therapy (LT) in DSPD. A randomized controlled trial with participants aged 16 to 26 years received LT for two weeks followed by either four weeks of CBT or no treatment (NT). LT advanced sleep-wake rhythm in both groups. Comparing LT+CBT with LT+NT, no significant group differences were observed in the primary endpoints. Although anxiety and depression scores were low at pretreatment, they decreased significantly more in LT+CBT compared to LT+NT. The results are discussed and some suggestions are given for further studies.
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Affiliation(s)
- Katarina Danielsson
- a Department of Neuroscience, Psychiatry , Uppsala University University Hospital
| | | | - Jan-Erik Broman
- c Department of Neuroscience, Psychiatry , Uppsala University
| | - Agneta Markström
- d Department of Medical Sciences, Respiratory Medicine and Allergology Uppsala University
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14
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Slawik H, Stoffel M, Riedl L, Veselý Z, Behr M, Lehmberg J, Pohl C, Meyer B, Wiegand M, Krieg SM. Prospective Study on Salivary Evening Melatonin and Sleep before and after Pinealectomy in Humans. J Biol Rhythms 2015; 31:82-93. [PMID: 26647380 DOI: 10.1177/0748730415616678] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Melatonin is secreted systemically from the pineal gland maximally at night but is also produced locally in many tissues. Its chronobiological function is mainly exerted by pineal melatonin. It is a feedback regulator of the main circadian pacemaker in the hypothalamic suprachiasmatic nuclei and of many peripheral oscillators. Although exogenous melatonin is approved for circadian rhythm sleep disorders and old-age insomnia, research on endogenous melatonin in humans is hindered by the great interindividual variability of its amount and circadian rhythm. Single case studies on pinealectomized patients report on disrupted but also hypersomnic sleep. This is the first systematic prospective report on sleep with respect to pinealectomy due to pinealocytoma World Health Organization grade I without chemo- or radiotherapy. Before and after pinealectomy, 8 patients completed questionnaires on sleep quality and circadian rhythm (Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and Morningness-Eveningness Questionnaire), 2 nights of polysomnography, salivary evening melatonin profiles, and qualitative assessment of 2 weeks of actigraphy and sleep logs. Six patients were assessed retrospectively up to 4 years after pinealectomy. Before pinealectomy, all but 1 patient showed an evening melatonin rise typical for indifferent chronotypes. After pinealectomy, evening saliva melatonin was markedly diminished, mostly below the detection limit of the assay (0.09 pg/mL). No systematic change in subjective sleep quality or standard measures of polysomnography was found. Mean pre- and postoperative sleep efficiency was 94% and 95%, and mean sleep-onset latency was 21 and 17 min, respectively. Sleep-wake rhythm during normal daily life did not change. Retrospective patients had a reduced sleep efficiency (90%) and more stage changes, although this was not significantly different from prospective patients. In conclusion, melatonin does seem to have a modulatory, not a regulatory, effect on standard measures of sleep. Study output is limited by small sample size and because only evening melatonin profiles were assessed.
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Affiliation(s)
- Helen Slawik
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany Universitäre Psychiatrische Kliniken, Basel, Switzerland
| | - Michael Stoffel
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany Helios Klinikum, Krefeld, Germany
| | - Lina Riedl
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Zdenko Veselý
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany Deceased
| | - Michael Behr
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Corina Pohl
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
| | - Michael Wiegand
- Center of Sleep Medicine, Department of Psychiatry and Psychotherapy, Klinikum rechts der Isar, TU München, Germany
| | - Sandro M Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, TU München, Germany
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Crowley SJ, Cain SW, Burns AC, Acebo C, Carskadon MA. Increased Sensitivity of the Circadian System to Light in Early/Mid-Puberty. J Clin Endocrinol Metab 2015; 100:4067-73. [PMID: 26301944 PMCID: PMC4702443 DOI: 10.1210/jc.2015-2775] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
CONTEXT Late adolescence is marked by a delay in sleep timing, which is partly driven by a delay shift of the circadian timing system. This study examined whether the sensitivity of the circadian system to light-the primary entraining stimulus to the circadian system-differs between pre- to mid-pubertal and late to postpubertal adolescents. OBJECTIVE The study was designed to determine the influence of puberty on the sensitivity of the circadian system to light in humans. METHODS Melatonin suppression to low and moderate light levels was assessed in 38 pre- to mid-pubertal (9.1-14.7 years) and 29 late to postpubertal (11.5-15.9 years) adolescents. They received 1 hour of four light levels on consecutive nights: approximately 0.1 (near-dark baseline condition), 15, 150, and 500 lux. One group received evening light beginning at 11:00 pm (n = 39); a second group received morning light beginning at 3:00 am (n = 28). Salivary melatonin was sampled every 30 minutes. Melatonin suppression for 15, 150, and 500 lux was calculated relative to unsuppressed baseline levels in the 0.1 lux setting, within individuals. RESULTS The pre- to mid-pubertal group showed significantly greater melatonin suppression to 15 lux (9.2 ± 20.5%), 150 lux (26.0 ± 17.7%), and 500 lux (36.9 ± 11.4%) during evening light exposure compared to the late to postpubertal group (-5.3 ± 17.7%, 12.5 ± 17.3%, and 23.9 ± 21.7%, respectively; P < .05). No significant differences were seen between developmental groups in morning melatonin suppression. CONCLUSION These results indicate support for a greater sensitivity to evening light in early pubertal children. The increased sensitivity to light in younger adolescents suggests that exposure to evening light could be particularly disruptive to sleep regulation for this group.
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Affiliation(s)
- Stephanie J Crowley
- Biological Rhythms Research Laboratory (S.J.C.), Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois 60612; School of Psychological Sciences (S.W.C., A.C.B.), Monash University, Clayton, Victoria, Australia 3800; E.P. Bradley Hospital Sleep and Chronobiology Research Laboratory (C.A., M.A.C.), Providence, Rhode Island 02906; Department of Psychiatry and Human Behavior (C.A., M.A.C.), The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906; and Centre for Sleep Research (M.A.C.), University of South Australia, Adelaide, South Australia 5001
| | - Sean W Cain
- Biological Rhythms Research Laboratory (S.J.C.), Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois 60612; School of Psychological Sciences (S.W.C., A.C.B.), Monash University, Clayton, Victoria, Australia 3800; E.P. Bradley Hospital Sleep and Chronobiology Research Laboratory (C.A., M.A.C.), Providence, Rhode Island 02906; Department of Psychiatry and Human Behavior (C.A., M.A.C.), The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906; and Centre for Sleep Research (M.A.C.), University of South Australia, Adelaide, South Australia 5001
| | - Angus C Burns
- Biological Rhythms Research Laboratory (S.J.C.), Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois 60612; School of Psychological Sciences (S.W.C., A.C.B.), Monash University, Clayton, Victoria, Australia 3800; E.P. Bradley Hospital Sleep and Chronobiology Research Laboratory (C.A., M.A.C.), Providence, Rhode Island 02906; Department of Psychiatry and Human Behavior (C.A., M.A.C.), The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906; and Centre for Sleep Research (M.A.C.), University of South Australia, Adelaide, South Australia 5001
| | - Christine Acebo
- Biological Rhythms Research Laboratory (S.J.C.), Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois 60612; School of Psychological Sciences (S.W.C., A.C.B.), Monash University, Clayton, Victoria, Australia 3800; E.P. Bradley Hospital Sleep and Chronobiology Research Laboratory (C.A., M.A.C.), Providence, Rhode Island 02906; Department of Psychiatry and Human Behavior (C.A., M.A.C.), The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906; and Centre for Sleep Research (M.A.C.), University of South Australia, Adelaide, South Australia 5001
| | - Mary A Carskadon
- Biological Rhythms Research Laboratory (S.J.C.), Department of Behavioral Sciences, Rush University Medical Center, Chicago, Illinois 60612; School of Psychological Sciences (S.W.C., A.C.B.), Monash University, Clayton, Victoria, Australia 3800; E.P. Bradley Hospital Sleep and Chronobiology Research Laboratory (C.A., M.A.C.), Providence, Rhode Island 02906; Department of Psychiatry and Human Behavior (C.A., M.A.C.), The Warren Alpert Medical School of Brown University, Providence, Rhode Island 02906; and Centre for Sleep Research (M.A.C.), University of South Australia, Adelaide, South Australia 5001
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16
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Analyses of melatonin, cytokines, and sleep in chronic renal failure. Sleep Breath 2015; 20:339-44. [PMID: 26271951 DOI: 10.1007/s11325-015-1240-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2015] [Revised: 07/14/2015] [Accepted: 08/04/2015] [Indexed: 12/16/2022]
Abstract
PURPOSE Inflammation and oxidative stress are involved in the process of chronic renal failure (CRF). CRF patients show indication of sleep disturbances, and the melatonin rhythm, which modulates sleep, is abnormal in these patients; however, it is still unclear whether inflammation could be related to the blockage of melatonin production and sleep disturbances in this population. The aim of this study was to characterize and correlate sleep, the melatonin rhythm, and the levels of the inflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-6 in patients with CRF and controls. METHODS Sleep was evaluated by the "Sleep Quality Index Pittsburgh" (PSQI) questionnaire, and melatonin and cytokine contents in saliva and blood samples, respectively, were analyzed by ELISA. RESULTS The CRF group scored higher on the global PSQI, which indicates a lower sleep quality and a higher prevalence of sleep disorders, than the control group. The CRF individuals also showed lower melatonin content than the control groups, both during the day and at night, and lacked rhythmicity in melatonin production. The CRF group also showed higher contents of TNF and IL-6 than the control group and a negative correlation between TNF and melatonin content. CONCLUSION These results suggest that the sleep disorders observed in the CRF group were probably related to the low production of melatonin observed in this population. The high level of TNF, as previously demonstrated in other pathologies, is probably involved in this blockage of melatonin production in CRF.
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17
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Gradisar M, Smits MG, Bjorvatn B. Assessment and Treatment of Delayed Sleep Phase Disorder in Adolescents. Sleep Med Clin 2014. [DOI: 10.1016/j.jsmc.2014.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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18
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Keijzer H, Smits MG, Duffy JF, Curfs LMG. Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders. Sleep Med Rev 2013; 18:333-9. [PMID: 24388969 DOI: 10.1016/j.smrv.2013.12.001] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 12/02/2013] [Accepted: 12/02/2013] [Indexed: 11/16/2022]
Abstract
Treatment of circadian rhythm sleep disorders (CRSD) may include light therapy, chronotherapy and melatonin. Exogenous melatonin is increasingly being used in patients with insomnia or CRSD. Although pharmacopoeias and the European food safety authority (EFSA) recommend administering melatonin 1-2 h before desired bedtime, several studies have shown that melatonin is not always effective if administered according to that recommendation. Crucial for optimal treatment of CRSD, melatonin and other treatments should be administered at a time related to individual circadian timing (typically assessed using the dim light melatonin onset (DLMO)). If not administered according to the individual patient's circadian timing, melatonin and other treatments may not only be ineffective, they may even result in contrary effects. Endogenous melatonin levels can be measured reliably in saliva collected at the patient's home. A clinically reliably DLMO can be calculated using a fixed threshold. Diary and polysomnographic sleep-onset time do not reliably predict DLMO or circadian timing in patients with CRSD. Knowing the patient's individual circadian timing by assessing DLMO can improve diagnosis and treatment of CRSD with melatonin as well as other therapies such as light or chronotherapy, and optimizing treatment timing will shorten the time required to achieve results.
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Affiliation(s)
- Henry Keijzer
- Department of Clinical Chemistry and Hematology, Rijnstate Hospital, Arnhem, The Netherlands; Governor Kremers Centre, University Maastricht, The Netherlands.
| | - Marcel G Smits
- Governor Kremers Centre, University Maastricht, The Netherlands; Centre for Sleep-Wake Disturbances and Chronobiology, Gelderse Vallei Hospital, Ede, The Netherlands
| | - Jeanne F Duffy
- Division of Sleep Medicine, Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Leopold M G Curfs
- Governor Kremers Centre, University Maastricht, The Netherlands; Department of Clinical Genetics, Maastricht University Medical Centre, Maastricht, The Netherlands
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Snitselaar MA, Smits MG, van der Heijden KB, Smit A, Spijker J. Influence of methylphenidate on circadian rhythmicity and sleep in adult attention-deficit/hyperactivity disorder. Sleep Biol Rhythms 2013. [DOI: 10.1111/sbr.12033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
| | - Marcel G Smits
- Center for Sleep Disturbances and Chronobiology; Gelderse Vallei Hospital; Ede The Netherlands
| | - Kristiaan B van der Heijden
- Leiden University Institute for Brain and Cognition and Institute of Education and Child Studies; Leiden The Netherlands
| | - Annet Smit
- Pro Persona Centre for Education and Science
| | - Jan Spijker
- Pro Persona Mental Health Care; Nijmegen The Netherlands
- Radboud University; Nijmegen The Netherlands
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20
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Braam W, Keijzer H, Struijker Boudier H, Didden R, Smits M, Curfs L. CYP1A2 polymorphisms in slow melatonin metabolisers: a possible relationship with autism spectrum disorder? JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2013; 57:993-1000. [PMID: 22823064 DOI: 10.1111/j.1365-2788.2012.01595.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND In some of our patients with intellectual disabilities (ID) and sleep problems, the initial good response to melatonin disappeared within a few weeks after starting treatment. In these patients melatonin levels at noon were extremely high (>50 pg/ml). We hypothesise that the disappearing effectiveness is associated with slow metabolisation of melatonin because of a single nucleotide polymorphism (SNP) of CYP1A2. METHOD In this pilot study we analysed DNA extracted from saliva samples of 15 consecutive patients with disappearing effectiveness of melatonin. Saliva was collected at noon and 4 pm for measuring melatonin levels. RESULTS In all patients' salivary melatonin levels at noon were >50 or melatonin half time was > 5 h. A SNP was found in eight of 15 patients. The allele 1C was found in two patients and in six patients the 1F allele was found. CONCLUSIONS Of 15 patients with disappearing effectiveness of melatonin, seven were diagnosed with autism spectrum disorder, and in four of them a SNP was found. The other eight patients were known with a genetic syndrome. In six of them behaviour was considered to be autistic-type and in three of them a SNP was found. This finding may give a new direction for research into the genetic background of autism.
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Affiliation(s)
- W Braam
- Department Advisium, 's Heeren Loo Zuid-Veluwe, Wekerom, The Netherlands Department of Clinical Chemistry, Rijnstate Hospital, Arnhem, The Netherlands Department of Pharmacology and Toxicology, Maastricht University, Maastricht, The Netherlands Special Education, Behavioural Science Institute, Radboud University Nijmegen, Nijmegen, The Netherlands Department of Neurology, Gelderse Vallei Hospital, Ede, The Netherlands Department of Clinical Genetics, University Maastricht/Academic Hospital, Maastricht, The Netherlands
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Wada K, Yata S, Akimitsu O, Krejci M, Noji T, Nakade M, Takeuchi H, Harada T. A tryptophan-rich breakfast and exposure to light with low color temperature at night improve sleep and salivary melatonin level in Japanese students. J Circadian Rhythms 2013; 11:4. [PMID: 23705838 PMCID: PMC3691879 DOI: 10.1186/1740-3391-11-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 05/13/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Epidemiological studies in Japan have documented an association between morning type and a tryptophan-rich breakfast followed by exposure to sunlight in children. The association may be mediated by enhanced melatonin synthesis, which facilitates sleep at night. However, melatonin is inhibited by artificial light levels with high color-temperature common in Japanese homes at night. In this study, we investigated whether a combination of tryptophan-rich breakfast and light with low color-temperature at night could enhance melatonin secretion and encourage earlier sleep times. METHODS The intervention included having breakfast with protein- and vitamin B6 - rich foods and exposure to sunlight after breakfast plus exposure to incandescent light (low temperature light) at night (October-November, 2010). The participants were 94 members of a university soccer club, who were divided into 3 groups for the intervention (G1: no intervention; G2: asked to have protein-rich foods such as fermented soybeans and vitamin B6-rich foods such as bananas at breakfast and sunlight exposure after breakfast; G3: the same contents as G2 and incandescent light exposure at night). Salivary melatonin was measured around 11:00 p.m. on the day before the beginning, a mid-point and on the day before the last day a mid-point and on the last day of the 1 month intervention. RESULTS In G3, there was a significantly positive correlation between total hours the participants spent under incandescent light at night and the frequency of feeling sleepy during the last week (p = 0.034). The salivary melatonin concentration of G3 was significantly higher than that of G1 and G2 in combined salivary samplings at the mid-point and on the day before the last day of the 1 month intervention (p = 0.018), whereas no such significant differences were shown on the day just before the start of the intervention (p = 0.63). CONCLUSION The combined intervention on breakfast, morning sunlight and evening-lighting seems to be effective for students including athletes to keep higher melatonin secretion at night which seems to induce easy onset of the night sleep and higher quality of sleep.
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Affiliation(s)
- Kai Wada
- Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi, Japan
| | - Shota Yata
- Department of Health and Physical Education, Faculty of Education, Kochi University, Kochi, Japan
| | - Osami Akimitsu
- Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi, Japan
| | - Milada Krejci
- Department of Health Education, Faculty of Education, University of South Bohemia, České Budějovice, Czech Republic
| | - Teruki Noji
- Department of Health and Physical Education, Faculty of Education, Kochi University, Kochi, Japan
| | - Miyo Nakade
- Department of Nutritional Education, Tokai Gakuen University, Miyoshi, Aichi, Japan
| | - Hitomi Takeuchi
- Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi, Japan
| | - Tetsuo Harada
- Laboratory of Environmental Physiology, Graduate School of Integrated Arts and Sciences, Kochi University, Kochi, Japan
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Merks BT, Burger H, Willemsen J, van Gool JD, de Jong TPVM. Melatonin treatment in children with therapy-resistant monosymptomatic nocturnal enuresis. J Pediatr Urol 2012; 8:416-20. [PMID: 21945362 DOI: 10.1016/j.jpurol.2011.08.012] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2011] [Accepted: 08/21/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the effects of exogenous melatonin on the frequency of wet nights, on the sleep-wake cycle, and on the melatonin profile in children with therapy-resistant MNE. PATIENTS AND METHODS 24 patients were included. Patients had to maintain a diary including time of sleep and arousal, and whether they had a dry or a wet bed in the morning. We measured baseline melatonin profiles in saliva. Hereafter, patients were randomized to synthetic melatonin or placebo. After 3 and 6 months we evaluated the frequency of enuresis and the melatonin profiles. RESULTS 11 patients were randomized to melatonin, 13 to placebo. We evaluated melatonin profiles of 7 patients in the melatonin group and of 8 in the placebo group. We observed a change in profile in the melatonin group, but we did not observe a difference in the sleep-wake cycle or the frequency of wet nights in either group. CONCLUSION This is the first time exogenous melatonin has been evaluated in the treatment of MNE. Although we observed a change in melatonin profile after the use of exogenous melatonin, we did not observe a change in enuresis frequency or in the sleep-wake cycle of this select group of patients.
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Affiliation(s)
- B T Merks
- University Medical Center Utrecht, Heidelberglaan 100, NL 3584 CX Utrecht, The Netherlands.
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23
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Aperis G, Prakash P, Paliouras C, Papakonstantinou N, Alivanis P. The role of melatonin in patients with chronic kidney disease undergoing haemodialysis. J Ren Care 2012; 38:86-92. [PMID: 22494522 DOI: 10.1111/j.1755-6686.2012.00267.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Patients with chronic kidney disease including those undergoing haemodialysis have deranged sleep-wake pattern. In large part this is due to an abnormal circadian cycle of melatonin, a hormone secreted by the pineal gland in the evening and induces sleep. Subjects undergoing automated peritoneal dialysis or nocturnal haemodialysis have better sleep profile compared to those on daytime dialysis. Studies have shown that exogenous melatonin improves sleep-wake cycle in daytime haemodialysis patients. However, large randomised controlled trials are needed in order to establish its role in this patient population.
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Affiliation(s)
- Georgios Aperis
- Nephrology Department, General Hospital of Rhodes, Agioi Apostoloi, Rhodes, Greece.
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24
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Verheggen RJHM, Jones H, Nyakayiru J, Thompson A, Groothuis JT, Atkinson G, Hopman MTE, Thijssen DHJ. Complete absence of evening melatonin increase in tetraplegics. FASEB J 2012; 26:3059-64. [PMID: 22474242 DOI: 10.1096/fj.12-205401] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Individuals with a spinal cord injury (SCI), especially with tetraplegia, experience poor sleep quality, and this may be related to impaired control of circadian rhythmicity. Here, we examined the evening onset of melatonin secretion, an important hormone for the initiation of sleep, in people with a complete cervical (tetraplegia) and thoracic (paraplegia) SCI, and age- and sex-matched able-bodied control participants. Multiple samples of salivary melatonin were obtained during the evening hours and analyzed by ELISA methods in 10 control partcipants, 9 individuals with paraplegia, and 6 individuals with tetraplegia. Sleep quality was assessed using questionnaires. Interactive effects of group and time were found for melatonin levels (P=0.022). In the control and paraplegia groups, the mean melatonin level increased significantly from 2.59 ± 1.04 and 4.28 ± 3.28 pg/ml at 7 PM to 10.62 ± 4.59 and 13.10 ± 7.39 pg/ml at 11 PM, respectively (P<0.001). In the tetraplegia group, melatonin level was 5.25 ± 3.72 at 7 PM but only 2.41 ± 1.25 pg/ml at 11 PM (P>0.05). Decreased sleep quality was more prevalent in individuals with tetraplegia (83%) and paraplegia (75%) compared with controls (20%; P=0.02). Unlike in the control and paraplegia groups, the evening increase in melatonin concentration was completely absent in the tetraplegia group. This provides biological insight into sleep regulation in humans and provides better understanding of the poor sleep quality in people with tetraplegia.
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Affiliation(s)
- Rebecca J H M Verheggen
- Department of Physiology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
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25
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Evaluation of salivary melatonin measurements for Dim Light Melatonin Onset calculations in patients with possible sleep–wake rhythm disorders. Clin Chim Acta 2011; 412:1616-20. [DOI: 10.1016/j.cca.2011.05.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2011] [Revised: 05/08/2011] [Accepted: 05/08/2011] [Indexed: 11/19/2022]
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Abstract
Daily rhythms of behavioral and physiological processes are believed to arise from endogenous circadian clocks. Unlike model organisms, genetic studies of human behavioral traits present extra challenges due to many factors such as the heterogeneous genetic background and environmental influences. Identifying molecular components of the human circadian clock were not possible until the recognition of Mendelian circadian traits in human subjects in recent years. Characterizing these rare Mendelian traits therefore established the foundation for identification of the genetic components for human circadian and sleep mechanisms. This line of investigation has proven fruitful and provided new insights into these pathways. Genetic association studies have also offered many possible genetic contributions to these mechanisms. Studies of these genes/proteins in conjunction with modeling human mutations in model organisms afford the opportunity to unravel the molecular mechanisms which in time will lead to pharmacological interventions that may not only help modify these behavioral traits but also may prove effective for treating other sleep-related disorders.
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Affiliation(s)
- Luoying Zhang
- Department of Neurology, University of California, San Francisco, USA
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27
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Braam W, van Geijlswijk I, Keijzer H, Smits MG, Didden R, Curfs LMG. Loss of response to melatonin treatment is associated with slow melatonin metabolism. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2010; 54:547-555. [PMID: 20576063 DOI: 10.1111/j.1365-2788.2010.01283.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
BACKGROUND In some of our patients with intellectual disability (ID) and sleep problems, the initial good response to melatonin disappeared within a few weeks after starting treatment, while the good response returned only after considerable dose reduction. The cause for this loss of response to melatonin is yet unknown. We hypothesise that this loss of response is associated with slow melatonin metabolism. METHOD In this study, we determined melatonin clearance in two female (aged 61 and 6 years) and one male (aged 3 years) patients who had chronic insomnia, late melatonin onset and mild ID, and whose sleep quality worsened a few weeks after initial good response to melatonin treatment, suggesting melatonin tolerance. After a 3-week washout period, patients received melatonin 1.0, 0.5 or 0.1 mg, respectively. Salivary melatonin level was measured just before melatonin administration, and 2 and 4 h thereafter. After this melatonin clearance test, melatonin treatment was resumed with a considerably lower dose. RESULTS In all patients melatonin concentrations remained >50 pg/mL at 2 and 4 h after melatonin administration. After resuming melatonin treatment sleep problems disappeared. The same procedure was followed in three patients who did not show loss of response to melatonin after 6 months of treatment. In all patients in the control group melatonin concentrations decreased between 2 and 4 h after melatonin administration with a mean of 83%. CONCLUSION We hypothesise that loss of response to melatonin treatment can be caused by slow metabolisation of exogenous melatonin. As melatonin is metabolised in the liver almost exclusively by cytochrome P450 enzyme CYP1A2, this slow melatonin metabolism is probably due to decreased activity/inducibility of CYP1A2. In patients with loss of response to melatonin, a melatonin clearance test should be considered and a considerably dose reduction is advised.
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Affiliation(s)
- W Braam
- 's Heeren Loo Zuid-Veluwe, Wekerom, Postbus 75, 6710 BB Ede, The Netherlands.
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Altered sleep architecture and higher incidence of subsyndromal depression in low endogenous melatonin secretors. Eur Arch Psychiatry Clin Neurosci 2010; 260:327-35. [PMID: 20016908 DOI: 10.1007/s00406-009-0080-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2008] [Accepted: 10/08/2009] [Indexed: 01/26/2023]
Abstract
Melatonin secretion is synchronized to the sleep/wake cycle and has been suggested to have somnogenic properties. Sleep/wake cycle disruption and alterations in the secretary pattern of melatonin is present in various psychiatric disorders. The objective of this study was to investigate the sleep architecture and the presence of depression in individuals with low endogenous melatonin levels. The study included 16 participants (mean age 30.3 +/- 14.9 years). The first night of testing included psychiatric evaluation followed by melatonin secretion profile evaluation by Dim Light Melatonin Onset test and then standard montage polysomnographic testing. On the second night, only polysomnographic testing was carried out with an imposed sleep period of 8 h. Low endogenous melatonin secretors (LEMS) showed no discernible peaks in melatonin secretion compared to normal secretors (controls). LEMS demonstrated significant alterations in rapid eye movement sleep but not in non-rapid eye movement sleep along with poor sleep initiation and quality compared to controls. 55.6% of the low melatonin secretors group presented with subsyndromal depression. Melatonin has significant bearing on sleep architecture and a lack of melatonin may desynchronize endogenous rhythms allowing subsyndromal depression to manifest.
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Van Veen MM, Kooij JJS, Boonstra AM, Gordijn MCM, Van Someren EJW. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry 2010; 67:1091-6. [PMID: 20163790 DOI: 10.1016/j.biopsych.2009.12.032] [Citation(s) in RCA: 203] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2009] [Revised: 12/16/2009] [Accepted: 12/30/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Previous studies suggest circadian rhythm disturbances in children with attention-deficit/hyperactivity disorder (ADHD) and sleep-onset insomnia (SOI). We investigate here sleep and rhythms in activity and melatonin in adults with ADHD. METHODS Sleep logs and actigraphy data were collected during 1 week in 40 adults with ADHD, of whom 31 reported SOI. Salivary melatonin levels were assessed during 1 night. Sleep measures, circadian activity variables, and dim light melatonin onset were compared between groups of ADHD adults with and without SOI and with matched healthy control subjects. RESULTS Compared with control subjects, both groups of ADHD adults had longer sleep-onset latency and lower sleep efficiency. Adults with ADHD and SOI showed a delayed start and end of their sleep period and a delayed melatonin onset compared with adults with ADHD without SOI (p = .006; p = .023; p = .02) and compared with healthy control subjects (p = .014; p = .019; p = .000). Adults with ADHD and SOI also showed an attenuated 24-hour amplitude in their rest-activity pattern, in contrast to those without SOI, who showed a higher day-to-day stability. CONCLUSIONS These findings demonstrate diurnal rhythm deviations during everyday life in the majority of adults with ADHD that have SOI and suggest that potential benefits of rhythm-improving measures should be evaluated.
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Affiliation(s)
- Maaike M Van Veen
- PsyQ Psycho-Medical Programs, Program Adult ADHD, The Hague, The Netherlands.
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van Geijlswijk IM, van der Heijden KB, Egberts ACG, Korzilius HPLM, Smits MG. Dose finding of melatonin for chronic idiopathic childhood sleep onset insomnia: an RCT. Psychopharmacology (Berl) 2010; 212:379-91. [PMID: 20668840 PMCID: PMC2952772 DOI: 10.1007/s00213-010-1962-0] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Accepted: 07/12/2010] [Indexed: 11/28/2022]
Abstract
RATIONALE Pharmacokinetics of melatonin in children might differ from that in adults. OBJECTIVES This study aims to establish a dose-response relationship for melatonin in advancing dim light melatonin onset (DLMO), sleep onset (SO), and reducing sleep onset latency (SOL) in children between 6 and 12 years with chronic sleep onset insomnia (CSOI). METHODS The method used for this study is the randomized, placebo-controlled double-blind trial. Children with CSOI (n = 72) received either melatonin 0.05, 0.1, and 0.15 mg/kg or placebo during 1 week. Sleep was assessed with log and actigraphy during this week and the week before. Outcomes were the shifts in DLMO, SO, and SOL. RESULTS Treatment with melatonin significantly advanced SO and DLMO by approximately 1 h and decreased SOL by 35 min. Within the three melatonin groups, effect size was not different, but the circadian time of administration (TOA) correlated significantly with treatment effect on DLMO (r (s) = -0.33, p = 0.022) and SO (r (s) = -0.38, p = 0.004), whereas clock TOA was correlated with SO shift (r = -0.35, p = 0.006) and not with DLMO shift. CONCLUSIONS No dose-response relationship of melatonin with SO, SOL, and DLMO is found within a dosage range of 0.05-0.15 mg/kg. The effect of exogenous melatonin on SO, SOL, and DLMO increases with an earlier circadian TOA. The soporific effects of melatonin enhance the SO shift. This study demonstrates that melatonin for treatment of CSOI in children is effective in a dosage of 0.05 mg/kg given at least 1 to 2 h before DLMO and before desired bedtime.
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Affiliation(s)
- Ingeborg M. van Geijlswijk
- Department of Pharmacy, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 106, 3584 CM Utrecht, The Netherlands ,Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands
| | - Kristiaan B. van der Heijden
- Department of Clinical Child and Adolescent Studies, Faculty of Social Sciences, University of Leiden, Leiden, The Netherlands
| | - A. C. G. Egberts
- Department of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, The Netherlands ,Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht, The Netherlands
| | | | - Marcel G. Smits
- Department of Sleep-Wake Disorders and Chronobiology, Gelderse Vallei Hospital Ede, Ede, The Netherlands
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Keijzer H, Endenburg SC, Smits MG, Koopmann M. Automated genomic DNA extraction from saliva using the QIAxtractor. Clin Chem Lab Med 2010; 48:641-3. [DOI: 10.1515/cclm.2010.139] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Abstract
Delayed sleep phase syndrome (DSPS) is a circadian rhythm sleep disorder in which the timing of the sleep episode occurs later than desired and is associated with difficulty falling asleep, problems awakening on time (e.g., to meet work or school obligations), and daytime sleepiness. The phase relationship between the timing of sleep and endogenous circadian rhythms is critical to the initiation and maintenance of sleep, and significant alteration leads to impairment of sleep quality and duration. The aim of this retrospective study was to determine the phase relationship between sleep-wake times and physiological markers of circadian timing in clinic patients with DSPS. Objective and subjective measures of sleep timing and circadian phase markers (core body temperature and melatonin) were measured in patients with DSPS and compared with age-matched controls. As expected, significant delays in the timing of the major sleep episode and circadian phase of body temperature and melatonin rhythms were seen in the DSPS group when allowed to sleep at their own habitual schedules, but the phase relationship between sleep-wake times and circadian phase was similar between the 2 groups. These results suggest that the symptoms of insomnia and excessive daytime sleepiness in DSPS patients living under entrained real-life conditions cannot be explained by an alteration in the phase relationship between sleep-wake patterns and other physiological circadian rhythms.
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Affiliation(s)
- Anne-Marie Chang
- Harvard Medical School, Brigham and Women's Hospital, Department of Medicine, Boston, MA 02115, USA.
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Koch BCP, Nagtegaal JE, Hagen EC, Wee PMT, Kerkhof GA. Different melatonin rhythms and sleep-wake rhythms in patients on peritoneal dialysis, daytime hemodialysis and nocturnal hemodialysis. Sleep Med 2009; 11:242-6. [PMID: 19596605 DOI: 10.1016/j.sleep.2009.04.006] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2009] [Revised: 04/07/2009] [Accepted: 04/27/2009] [Indexed: 11/24/2022]
Abstract
BACKGROUND Little comparative data on sleep-wake rhythms in different dialysis groups exist. The aim of this study was to investigate sleep-wake parameters measured with actigraphy and sleep questionnaires as well as melatonin rhythms in automated peritoneal dialysis, conventional daytime hemodialysis and nocturnal hemodialysis patients. METHODS Conventional daytime dialysis (n=20), nocturnal hemodialysis (n=13) and automated peritoneal dialysis patients (n=6) were included in the study. Melatonin in saliva was sampled at 5 time points (21:00, 23:00, 1:00, 7:00 and 9:00 h). Furthermore, actigraphy measurements and sleep questionnaires were performed. All parameters were tested by Kruskall-Wallis test (followed by post hoc Dunn test) to find significant differences (p<0.05). RESULTS Although most sleep parameters were impaired in all three groups, conventional daytime dialysis patients had the worst sleep. In nocturnal hemodialysis patients a normal nocturnal melatonin rise was found. In daytime hemodialysis and automated peritoneal dialysis patients this rise was absent. CONCLUSIONS The study showed impaired sleep parameters in all dialysis patient groups. As automated peritoneal dialysis is also performed during night time, the same effect on normalized melatonin was anticipated as was found in nocturnal hemodialysis. Melatonin seems to play a subordinate role in the sleep-wake rhythm of automated peritoneal dialysis patients.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander Medical Center, ES Amersfoort, The Netherlands.
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34
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Van der Heijden KB, Smits MG, Van Someren EJW, Gunning WB. Idiopathic Chronic Sleep Onset Insomnia in Attention‐Deficit/Hyperactivity Disorder: A Circadian Rhythm Sleep Disorder. Chronobiol Int 2009; 22:559-70. [PMID: 16076654 DOI: 10.1081/cbi-200062410] [Citation(s) in RCA: 197] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
To investigate whether ADHD-related sleep-onset insomnia (SOI) is a circadian rhythm disorder, we compared actigraphic sleep estimates, the circadian rest-activity rhythm, and dim light melatonin onset (DLMO) in ADHD children having chronic idiopathic SOI with that in ADHD children without sleep problems. Participants were 87 psychotropic-medication-naïve children, aged 6 to 12 yrs, with rigorously diagnosed ADHD and SOI (ADHD-SOI) and 33 children with ADHD without SOI (ADHD-noSOI) referred from community mental health institutions and pediatric departments of non-academic hospitals in The Netherlands. Measurements were 1 wk, 24 h actigraphy recordings and salivary DLMO. The mean (+/-SD) sleep onset time was 21:38 +/- 0:54 h in ADHD-SOI, which was significantly (p < 0.001) later than that of 20:49 +/- 0:49 h in ADHD-noSOI. DLMO was significantly later in ADHD-SOI (20:32 +/- 0:55 h), compared with ADHD-noSOI (19:47 +/- 0:49 h; p < 0.001). Wake-up time in ADHD-SOI was later than in ADHD-noSOI (p = 0.002). There were no significant between-group differences in sleep maintenance, as estimated by number of wake bouts and activity level in the least active 5 h period, or inter- and intradaily rhythm variability. We conclude that children with ADHD and chronic idiopathic sleep-onset insomnia show a delayed sleep phase and delayed DLMO, compared with ADHD children without SOI.
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Koch BCP, Nagtegaal JE, Kerkhof GA, ter Wee PM. Circadian sleep–wake rhythm disturbances in end-stage renal disease. Nat Rev Nephrol 2009; 5:407-16. [DOI: 10.1038/nrneph.2009.88] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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36
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Rahman SA, Kayumov L, Tchmoutina EA, Shapiro CM. Clinical efficacy of dim light melatonin onset testing in diagnosing delayed sleep phase syndrome. Sleep Med 2009; 10:549-55. [DOI: 10.1016/j.sleep.2008.03.020] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Revised: 03/14/2008] [Accepted: 03/26/2008] [Indexed: 01/18/2023]
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37
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Koch BCP, Nagtegaal JE, Hagen EC, van der Westerlaken MML, Boringa JBS, Kerkhof GA, Ter Wee PM. The effects of melatonin on sleep-wake rhythm of daytime haemodialysis patients: a randomized, placebo-controlled, cross-over study (EMSCAP study). Br J Clin Pharmacol 2008; 67:68-75. [PMID: 19076157 DOI: 10.1111/j.1365-2125.2008.03320.x] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
AIM The aim of this study was to investigate the effects of exogenous melatonin on sleep-wake rhythm in haemodialysis patients. METHODS The study design is a randomized, double-blind, placebo-controlled, cross-over study of 3 x 6 weeks melatonin 3 mg at 22.00 h every night. Haemodialysis patients were asked to fill out a sleep questionnaire and to wear an actometer to record their sleep problems objectively. Furthermore, melatonin concentrations in saliva were sampled the night after daytime haemodialysis and the consecutive night. Actometers, the sleep questionnaire and melatonin concentrations were repeated during the study. RESULTS In total, 20 patients (six female, median age 71 years) completed the investigation. On nights after daytime dialysis, objective sleep onset latency decreased significantly from a median of 44.5 (placebo) to a median of 15.5 min with melatonin (P < 0.01). Sleep efficiency increased from 67.3 to 73.1% with melatonin (P < 0.05). Actual sleep time increased from 376 min (placebo) to 388 min with melatonin (P < 0.01), and sleep fragmentation decreased from 4.5 to 3.1 (P < 0.01). Furthermore, subjective sleep parameters improved also. Patients reported less time needed to fall asleep (P < 0.05) and fewer wake periods (P < 0.05) on the nights with and without daytime dialysis and an increase in sleep time on the night of daytime dialysis (P < 0.05). Furthermore, the nocturnal melatonin rise was recovered. CONCLUSION Treatment with melatonin resulted in an improvement of subjective and objective sleep parameters, as well as a recovered nocturnal melatonin rhythm.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander MC, Amersfoot, The Netherlands.
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Koch BCP, Hagen EC, Nagtegaal JE, Boringa JBS, Kerkhof GA, Ter Wee PM. Effects of nocturnal hemodialysis on melatonin rhythm and sleep-wake behavior: an uncontrolled trial. Am J Kidney Dis 2008; 53:658-64. [PMID: 18950916 DOI: 10.1053/j.ajkd.2008.08.006] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2008] [Accepted: 08/01/2008] [Indexed: 11/11/2022]
Abstract
BACKGROUND End-stage renal disease and its treatment are associated with sleep disturbances such as deterioration of the circadian sleep-wake pattern. Melatonin rhythm, which has an important role in this pattern, is disturbed. The nocturnal melatonin surge is absent in this population. Whether nocturnal in-center hemodialysis changes melatonin and sleep-wake rhythms is unknown. STUDY DESIGN A nonrandomized uncontrolled trial. Patients served as their own controls. SETTING & PARTICIPANTS Thirteen daytime hemodialysis patients (median age, 58 years; 5 women) from our hospital receiving conventional daytime hemodialysis 3 times weekly for 3 to 4 hours each session. INTERVENTIONS Six months of treatment with nocturnal in-center dialysis 4 nights/wk with 8-hour sessions. OUTCOMES & MEASUREMENTS At baseline, while still on conventional hemodialysis therapy, polysomnography was performed, sleep questionnaires were filled out, and melatonin concentration in saliva was obtained. After 6 months of in-center nocturnal hemodialysis, all measurements were repeated. RESULTS After 6 months of in-center nocturnal hemodialysis, polysomnography showed significant improvements in sleep efficiency (P = 0.05) and stage 3/4 sleep (P = 0.03) in comparison to t = 0. Trends in improvement of rapid-eye-movement sleep, awake time, and oxygen saturation were seen after 6 months of in-center nocturnal hemodialysis therapy. Sleep questionnaires showed a trend in improved sleep quality and daytime function. Patients were less exhausted during the daytime. The nocturnal melatonin surge was partially restored. LIMITATIONS Small sample size and a nonrandomized uncontrolled study design. CONCLUSIONS Patients after 6 months of in-center nocturnal hemodialysis had significant improvements in subjective and objective sleep parameters and partially restored nocturnal melatonin rhythm.
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Affiliation(s)
- Birgit C P Koch
- Department of Clinical Pharmacy, Meander Medical Center, Amersfoort, The Netherlands.
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Pandi-Perumal SR, Srinivasan V, Spence DW, Cardinali DP. Role of the melatonin system in the control of sleep: therapeutic implications. CNS Drugs 2008; 21:995-1018. [PMID: 18020480 DOI: 10.2165/00023210-200721120-00004] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The circadian rhythm of pineal melatonin secretion, which is controlled by the suprachiasmatic nucleus (SCN), is reflective of mechanisms that are involved in the control of the sleep/wake cycle. Melatonin can influence sleep-promoting and sleep/wake rhythm-regulating actions through the specific activation of MT(1) (melatonin 1a) and MT(2) (melatonin 1b) receptors, the two major melatonin receptor subtypes found in mammals. Both receptors are highly concentrated in the SCN. In diurnal animals, exogenous melatonin induces sleep over a wide range of doses. In healthy humans, melatonin also induces sleep, although its maximum hypnotic effectiveness, as shown by studies of the timing of dose administration, is influenced by the circadian phase. In both young and elderly individuals with primary insomnia, nocturnal plasma melatonin levels tend to be lower than those in healthy controls. There are data indicating that, in affected individuals, melatonin therapy may be beneficial for ameliorating insomnia symptoms. Melatonin has been successfully used to treat insomnia in children with attention-deficit hyperactivity disorder or autism, as well as in other neurodevelopmental disorders in which sleep disturbance is commonly reported. In circadian rhythm sleep disorders, such as delayed sleep-phase syndrome, melatonin can significantly advance the phase of the sleep/wake rhythm. Similarly, among shift workers or individuals experiencing jet lag, melatonin is beneficial for promoting adjustment to work schedules and improving sleep quality. The hypnotic and rhythm-regulating properties of melatonin and its agonists (ramelteon, agomelatine) make them an important addition to the armamentarium of drugs for treating primary and secondary insomnia and circadian rhythm sleep disorders.
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Affiliation(s)
- Seithikurippu R Pandi-Perumal
- Comprehensive Center for Sleep Medicine, Department of Pulmonary, Critical Care, and Sleep Medicine, Mt Sinai School of Medicine, New York, New York 10029, USA.
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40
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Braam W, Didden R, Smits M, Curfs L. Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2008; 52:256-264. [PMID: 18261024 DOI: 10.1111/j.1365-2788.2007.01016.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
BACKGROUND While several small-number or open-label studies suggest that melatonin improves sleep in individuals with intellectual disabilities (ID) with chronic sleep disturbance, a larger randomized control trial is necessary to validate these promising results. METHODS The effectiveness of melatonin for the treatment of chronic sleep disturbance was assessed in a randomized double-blind placebo-controlled trial with 51 individuals with ID. All of these individuals presented with chronic ideopatic sleep disturbance for more than 1 year. The study consisted of a 1-week baseline, followed by 4 weeks of treatment. Parents or other caregivers recorded lights off time, sleep onset time, night waking, wake up time and epileptic seizures. Endogenous melatonin cycle was measured in saliva before and after treatment. RESULTS Compared with placebo, melatonin significantly advanced mean sleep onset time by 34 min, decreased mean sleep latency by 29 min, increased mean total sleep time by 48 min, reduced the mean number of times the person awoke during the night by 0.4, decreased the mean duration of these night waking periods by 17 min and advanced endogenous melatonin onset at night by an average of 2.01 h. Lights off time, sleep offset time and the number of nights per week with night waking did not change. Only few minor or temporary adverse reactions and no changes in seizure frequency were reported. CONCLUSIONS Melatonin treatment improves some aspects of chronic sleep disturbance in individuals with ID.
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Affiliation(s)
- W Braam
- 's Heeren Loo Zuid, Wekerom, The Netherlands.
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41
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Jet lag: therapeutic use of melatonin and possible application of melatonin analogs. Travel Med Infect Dis 2008; 6:17-28. [PMID: 18342269 DOI: 10.1016/j.tmaid.2007.12.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2007] [Revised: 12/04/2007] [Accepted: 12/13/2007] [Indexed: 01/28/2023]
Abstract
Each year millions of travelers undertake long distance flights over one or more continents. These multiple time zone flights produce a constellation of symptoms known as jet lag. Familiar to almost every intercontinental traveler is the experience of fatigue upon arrival in a new time zone, but almost as problematic are a number of other jet lag symptoms. These include reduced alertness, nighttime insomnia, loss of appetite, depressed mood, poor psychomotor coordination and reduced cognitive skills, all symptoms which are closely affected by both the length and direction of travel. The most important jet lag symptoms are due to disruptions to the body's sleep/wake cycle. Clinical and pathophysiological studies also indicate that jet lag can exacerbate existing affective disorders. It has been suggested that dysregulation of melatonin secretion and occurrence of circadian rhythm disturbances may be the common links which underlie jet lag and affective disorders. Largely because of its regulatory effects on the circadian system, melatonin has proven to be highly effective for treating the range of symptoms that accompany transmeridian air travel. Additionally, it has been found to be of value in treating mood disorders like seasonal affective disorder. Melatonin acts on MT(1) and MT(2) melatonin receptors located in the hypothalamic suprachiasmatic nuclei, the site of the body's master circadian clock. Melatonin resets disturbed circadian rhythms and promotes sleep in jet lag and other circadian rhythm sleep disorders, including delayed sleep phase syndrome and shift-work disorder. Although post-flight melatonin administration works efficiently in transmeridian flights across less than 7-8 times zones, in the case longer distances, melatonin should be given by 2-3 days in advance to the flight. To deal with the unwanted side effects which usually accompany this pre-departure treatment (acute soporific and sedative effects in times that may not be wanted), the suppression of circadian rhythmicity by covering symmetrically the phase delay and the phase advance portions of the phase response curve for light, together with the administration of melatonin at local bedtime to resynchronize the circadian oscillator, have been proposed. The current view that sleep loss is a major cause of jet lag has focused interest on two recently developed pharmacological agents. Ramelteon and agomelatine are melatonin receptor agonists which, compared to melatonin itself, have a longer half-life and greater affinity for melatonin receptors and consequently are thought to hold promise for treating a variety of circadian disruptions.
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Kayumov L, Lowe A, Rahman SA, Casper RF, Shapiro CM. Prevention of melatonin suppression by nocturnal lighting: relevance to cancer. Eur J Cancer Prev 2007; 16:357-62. [PMID: 17554209 DOI: 10.1097/01.cej.0000215622.59122.d4] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The decreased melatonin production in humans and animals caused by environmental lighting, especially short wavelength lighting (between 470 and 525 nm) has been shown to be associated with an increased risk of cancer. The purpose of this study was to investigate whether blocking light in this wavelength range under bright light may prevent the suppression of melatonin, which could help to prevent cancer. Optical filter lenses were designed, allowing selective exclusion of all wavelengths below 530 nm. Salivary melatonin levels were measured under dim light (<5 lux), bright light (800 lux) and filtered light (800 lux) at hourly intervals between 2000 and 0800 h in 11 healthy young male participants (mean age 23.5+/-1.5 years). The measurements were taken during three nonconsecutive nights over a 2-week period. The Dim Light Melatonin Onset test was used as a marker of circadian phase. Nine of the 11 participants demonstrated preserved melatonin levels in filtered light similar to their dim light secretion profile. With filtered light, the participants had a mean relative amount of melatonin of 91.2 (P>0.05 between dim light and experimental condition). Unfiltered bright light drastically suppressed melatonin production with a mean relative amount of melatonin of 25.4 (P<0.05 between dim light and experimental condition). Preventing melatonin deficiencies using lenses that block light of low wavelength from reaching the retina presents a cost-effective, practical solution to the problem of increased malignancy rates in shift workers.
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Affiliation(s)
- Leonid Kayumov
- Sleep Research Laboratory, University Health Network, University of Toronto, Ontario, Canada
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Van Someren EJW, Nagtegaal E. Improving melatonin circadian phase estimates. Sleep Med 2007; 8:590-601. [PMID: 17493871 DOI: 10.1016/j.sleep.2007.03.012] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2006] [Revised: 01/18/2007] [Accepted: 03/02/2007] [Indexed: 10/23/2022]
Abstract
The quality and quantity of sleep is to a large extent determined by whether the sleep period is in alignment with the most favorable circadian time window for sleep. Misalignment results in compromised sleep. In order to determine this circadian time window, the 24-h profile of melatonin secretion is generally considered to provide the most optimal estimate. Melatonin secretion occurs only during the night, and several methods to determine its onset and offset markers have been proposed. In spite of the usefulness of determining circadian phase estimates from melatonin, its feasibility is somewhat restricted because the required number of repeated measurements comes at a high cost for compliance and laboratory assays. In addition, the complexity of some of the previously proposed methods to analyze data and obtain phase estimates may require a statistician. We here propose a set of novel functions to better describe the typical melatonin profile, which usually has a rather fixed baseline level during the day, has differences in the steepness of its rising and falling limbs, and may have a nocturnal plateau or even two peaks instead of one during the night. The functions can easily be fitted, even to incomplete or noisy melatonin data, with the most common statistical software packages, and the resulting parameters give direct information on the mentioned characteristics, which provide important additions to complete the usual restricted information on phase and amplitude. We show that the proposed curves fit better than single- to three-harmonic cosine curves to the typical melatonin profiles of both healthy subjects (n=13) and subjects diagnosed with Delayed Sleep Phase Syndrome (DSPS, n=27), Disorders of Initiating and Maintaining Sleep (DIMS, n=9), or sleep complaints not otherwise specified (n=7). Of note, because the functions provide a parsimonious description of the melatonin profile, phase estimates derived from them are more reliable (i.e., robust for noise and data loss). We illustrate that phase estimates deviate on average only by about 10 min in case of the loss of some of the data points and in case of the addition of noise. Finally, we introduce a sparse-sampling schedule tailored to capture the most important aspects of the melatonin curve. It is shown that such schedule - reducing the number of samples by more than 50% - in combination with the proposed functions results in reliable melatonin onset phase estimates, deviating only about 10 min from estimates based on 24 samples. The proposed methods strongly contribute to the feasibility, in terms of both cost and analysis availability, for researchers and clinicians to include the most reliable marker of the circadian timing system in their diagnosis and treatment evaluations.
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Affiliation(s)
- Eus J W Van Someren
- Netherlands Institute for Neuroscience, Meibergdreef 47, 1105 BA Amsterdam, The Netherlands.
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Pandi-Perumal SR, Srinivasan V, Poeggeler B, Hardeland R, Cardinali DP. Drug Insight: the use of melatonergic agonists for the treatment of insomnia-focus on ramelteon. ACTA ACUST UNITED AC 2007; 3:221-8. [PMID: 17410109 DOI: 10.1038/ncpneuro0467] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2006] [Accepted: 01/30/2007] [Indexed: 12/27/2022]
Abstract
Melatonin, a chronobiotic that participates in the control of the circadian system, is known for its sleep-promoting effects, which include shortening of sleep latency and lengthening of sleep duration. As a result of its short half-life, melatonin does not exhibit undesirable side effects, and its broad applicability for a variety of sleep problems has been the focus of numerous scientific studies. Melatonin has not, however, received regulatory approval from the US FDA as a drug, because it can be sold freely as a food supplement. Consequently, there has been an active search for patentable melatonin receptor ligands in recent years. Ramelteon, an agonist that acts solely on melatonin MT(1) and MT(2) receptors, is of particular interest, and preliminary research indicates that it holds considerable promise for clinical applications. Ramelteon has been shown to induce sleep initiation and maintenance in various animal models and in clinical trials. In chronic insomnia, ramelteon decreases sleep latency and increases total sleep time and sleep efficiency, without causing hangover, addiction or withdrawal effects. Ramelteon is thought to promote sleep by influencing homeostatic sleep signaling mediated by the suprachiasmatic nucleus. Although ramelteon's metabolism and pharmacokinetics differ from those of melatonin, its safety seems to be sufficient for short-term application. Its long-term effects remain to be determined.
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Affiliation(s)
- Seithikurippu R Pandi-Perumal
- Comprehensive Center for Sleep Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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Van der Heijden KB, Smits MG, Van Someren EJW, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry 2007; 46:233-41. [PMID: 17242627 DOI: 10.1097/01.chi.0000246055.76167.0d] [Citation(s) in RCA: 217] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate the effect of melatonin treatment on sleep, behavior, cognition, and quality of life in children with attention-deficit/hyperactivity disorder (ADHD) and chronic sleep onset insomnia. METHOD A total of 105 medication-free children, ages 6 to 12 years, with rigorously diagnosed ADHD and chronic sleep onset insomnia participated in a randomized, double-blind, placebo-controlled trial using 3 or 6 mg melatonin (depending on body weight), or placebo for 4 weeks. Primary outcome parameters were actigraphy-derived sleep onset, total time asleep, and salivary dim light melatonin onset. RESULTS Sleep onset advanced by 26.9 +/- 47.8 minutes with melatonin and delayed by 10.5 +/- 37.4 minutes with placebo (p < .0001). There was an advance in dim light melatonin onset of 44.4 +/- 67.9 minutes in melatonin and a delay of 12.8 +/- 60.0 minutes in placebo (p < .0001). Total time asleep increased with melatonin (19.8 +/- 61.9 minutes) as compared to placebo (-13.6 +/- 50.6 minutes; p = .01). There was no significant effect on behavior, cognition, and quality of life, and significant adverse events did not occur. CONCLUSION Melatonin advanced circadian rhythms of sleep-wake and endogenous melatonin and enhanced total time asleep in children with ADHD and chronic sleep onset insomnia; however, no effect was found on problem behavior, cognitive performance, or quality of life.
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van Heukelom RO, Prins JB, Smits MG, Bleijenberg G. Influence of melatonin on fatigue severity in patients with chronic fatigue syndrome and late melatonin secretion. Eur J Neurol 2006; 13:55-60. [PMID: 16420393 DOI: 10.1111/j.1468-1331.2006.01132.x] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effect of melatonin, a chronobiotic drug, was explored in 29 patients with chronic fatigue syndrome (CFS) and Dim Light Melatonin onset (DLMO) later than 21.30 hours, reflective of delayed circadian rhythmicity. The patients took 5 mg of melatonin orally, 5 h before DLMO during 3 months. Their responses to the checklist individual strength (CIS), a reliable questionnaire measuring the severity of personally experienced fatigue, were assessed twice with a 6-week interval immediately before the treatment and once after 3 months treatment. In the pre-treatment period the fatigue sub-score improved significantly. After treatment, the total CIS score and the sub-scores for fatigue, concentration, motivation and activity improved significantly. The sub-score fatigue normalized in two of the 29 patients in the pre-treatment period and in eight of 27 patients during treatment. This change was significant. In the patients with DLMO later than 22.00 hours (n=21) the total CIS score and the sub-scores for fatigue, concentration and activity improved significantly more than in the patients (n=8) with DLMO earlier than 22.00 hours. Melatonin may be an effective treatment for patients with CFS and late DLMO, especially in those with DLMO later than 22.00 hours.
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Affiliation(s)
- R O van Heukelom
- Department of Neurology, Sleep-Wake Disorders and Chronobiology, Hospital De Gelderse Vallei, Ede, and Department of Medical Psychology, Radbound University Medical Centre, Nijmegen, The Netherlands
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van der Heijden KB, Blok MJ, Spee K, Archer SN, Smits MG, Curfs LM, Gunning WB. No evidence to support an association ofPER3clock gene polymorphism with ADHD-related idiopathic chronic sleep onset insomnia. BIOL RHYTHM RES 2005. [DOI: 10.1080/09291010500218449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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van der Heijden KB, Smits MG, van Someren EJW, Boudewijn Gunning W. Prediction of melatonin efficacy by pretreatment dim light melatonin onset in children with idiopathic chronic sleep onset insomnia. J Sleep Res 2005; 14:187-94. [PMID: 15910516 DOI: 10.1111/j.1365-2869.2005.00451.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Research has shown efficacy of melatonin treatment to advance sleep-wake rhythms in insomnia. In healthy adults, direction and magnitude of the phase shift depends on the timing of administration relative to the phase position of the circadian system. Therefore, in the present study we investigated whether in children with chronic sleep onset insomnia (SOI) efficacy of melatonin treatment in the early evening could be predicted from dim light melatonin onset (DLMO), a phase marker of the circadian system. We combined data of two previously published double blind, randomized, placebo-controlled trials in 110 participants, aged 6-12 years. Sleep was actigraphically estimated, and saliva collected, at baseline and in the third week of a 4-week treatment period with 5 mg melatonin or placebo at 18:00 or 19:00 hours. Primary outcome measures were pre- to post-treatment changes in dim light melatonin onset (DeltaDLMO), sleep onset (DeltaSO), sleep latency (DeltaSL), and total sleep duration (DeltaTSD). Melatonin advanced DLMO with +1:12 h (P < 0.001), SO with +0:42 h (P = 0.004), SL decreased with 25 min (P = 0.019), and TSD did not change significantly, as compared with placebo. In the melatonin-treated group, but not in the placebo-treated group, pretreatment DLMO was significantly related to DeltaDLMO [F(1, 29) = 7.28, P = 0.012] and DeltaSO [F(1, 25) = 7.72, P = 0.010]. The time interval between treatment administration and pretreatment DLMO (INT) was only significantly related to DeltaSO [F(1,26) = 5.40, P = 0.028]. The results suggest that in children with SOI, the efficacy of early evening melatonin to advance sleep onset and endogenous melatonin onset increases the later the pretreatment DLMO is.
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Borugian MJ, Gallagher RP, Friesen MC, Switzer TF, Aronson KJ. Twenty-Four-Hour Light Exposure and Melatonin Levels Among Shift Workers. J Occup Environ Med 2005; 47:1268-75. [PMID: 16340708 DOI: 10.1097/01.jom.0000184855.87223.77] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We sought to measure melatonin levels and 24-hour light intensity exposure in health care workers over a 7-day period in natural occupational and residential settings. METHODS Five office workers and 17 nurses working either days or rotating night and day shifts wore a device to record light intensity exposure for one or two 7-day periods, completed a questionnaire, and provided three saliva samples for melatonin. RESULTS Rotating shift workers had irregular light exposure patterns and abnormal melatonin levels compared with those working days. In addition to lower-than-normal melatonin levels during sleep periods, rotating shift workers exhibited higher-than-normal melatonin levels on arising and during work. Self-reported years of shift work were correlated with measured melatonin and light. CONCLUSIONS Rotating shift work is supported as a surrogate for exposure to light-at-night and circadian disruption.
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Affiliation(s)
- Marilyn J Borugian
- Cancer Control Research Program, British Columbia Cancer Research Centre, Vancouver, British Columbia, Canada.
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Smits MG, van Stel HF, van der Heijden K, Meijer AM, Coenen AML, Kerkhof GA. Melatonin improves health status and sleep in children with idiopathic chronic sleep-onset insomnia: a randomized placebo-controlled trial. J Am Acad Child Adolesc Psychiatry 2003; 42:1286-93. [PMID: 14566165 DOI: 10.1097/01.chi.0000085756.71002.86] [Citation(s) in RCA: 104] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate the effect of melatonin treatment on health status and sleep in children with idiopathic sleep-onset insomnia. METHOD A randomized, double-blind, placebo-controlled trial was conducted in a Dutch sleep center, involving 62 children, 6 to 12 years of age, who suffered more than 1 year from idiopathic chronic sleep-onset insomnia. Patients received either 5 mg melatonin or placebo at 7 pm. The study consisted of a 1-week baseline period, followed by a 4-week treatment. Health status was measured with the RAND General Health Rating Index (RAND-GHRI) and Functional Status II (FS-II) questionnaires. Lights-off time, sleep onset, and wake-up time were recorded in a diary, and endogenous dim light melatonin onset was measured in saliva. RESULTS The total scores of the RAND-GHRI and FS-II improved significantly more during melatonin treatment compared to placebo. The magnitude of change was much higher in the melatonin group than in the placebo group, with standardized response means for the RAND-GHRI of 0.69 versus 0.07 and for the FS-II of 1.61 versus 0.64. Melatonin treatment also significantly advanced sleep onset by 57 minutes, sleep offset by 9 minutes, and melatonin onset by 82 minutes, and decreased sleep latency by 17 minutes. Lights-off time and total sleep time did not change. CONCLUSIONS Melatonin improves health status and advances the sleep-wake rhythm in children with idiopathic chronic sleep-onset insomnia.
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Affiliation(s)
- Marcel G Smits
- Sleep Centre, Hospital Gelderse Vallei, Willy Brandtlaan 10, Box 9025, 6710 HN Ede, the Netherlands.
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