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Can a Sleeping Pill Prevent Delirium?

Summary and Comment |
March 14, 2014

Can a Sleeping Pill Prevent Delirium?

  1. Steven Dubovsky, MD

Positive results with an agonist of melatonin receptors in acutely hospitalized elderly patients

  1. Steven Dubovsky, MD

Delirium is a common complication of severe medical illness, especially in elderly and demented patients. Melatonin has been found useful for decreasing risk for delirium, as has the melatonin-1 and -2 receptor agonist ramelteon in case reports. To learn more about using ramelteon to prevent delirium, investigators in Japan conducted a five-hospital, randomized, placebo-controlled study of ramelteon (8 mg/night) in 67 acutely ill patients (mean age, 78) hospitalized for stroke, infection, fracture, heart disease, or other illnesses.

During the 1-week study, 1 patient on ramelteon and 11 on placebo developed delirium (3% vs. 32%, P=0.003, relative risk, 0.09). The results remained significant when corrected for delirium risk factors such as age, dementia, and infection and for adjunctive use of hydroxyzine for sleep. Self-reported sleep parameters such as awakenings and sleep duration did not differ between groups.

Comment

Because delirium is associated with reversal or disorganization of the sleep-wake cycle, ramelteon likely reduced the risk for delirium by stabilizing this circadian rhythm. The authors suggest that ramelteon is more potent for this purpose than melatonin, as reported previously; however, the melatonin dose in that study (0.5 mg; Int J Geriatr Psychiatry 2011; 26:687) was lower than is normally needed to affect sleep onset. Evening ramelteon or melatonin should be considered for patients at high risk of delirium, as could morning bright light, which also normalizes the sleep-wake cycle.

  • Disclosures for Steven Dubovsky, MD at time of publication Grant / research support Amgen; Janssen; Otsuka; Sunovion; Takeda Editorial boards Bulletin of the Menninger Clinic; Current Psychiatry; Journal of Psychosomatic Research

Citation(s):

Reader Comments (1)

Ken Phillips, MD Physician, Critical Care Medicine

Both Dexmedetomidine and Zolpidem do not affect sleep architecture. Best ways to 'entrain' circadian rhythms are: 1) Lights OFF 1900-0700 (or so) AND 2) Reduce noise level in patient rooms -> move audible alarms OUT of patient rooms!

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