Studies suggest that melatonin may prevent delirium, a condition of acute brain dysfunction occurring in 20%-30% of hospitalized older adults that is associated with increased morbidity and mortality. We examined the effect of melatonin on delirium prevention in hospitalized older adults while measuring sleep parameters as a possible underlying mechanism.
Methods
This was a randomized clinical trial measuring the impact of 3 mg of melatonin nightly on incident delirium and both objective and subjective sleep in inpatients age ā„65 years, admitted to internal medicine wards (non-intensive care units). Delirium incidence was measured by bedside nurses using the confusion assessment method. Objective sleep measurements (nighttime sleep duration, total sleep time per 24 hours, and sleep fragmentation as determined by average sleep bout length) were obtained via actigraphy. Subjective sleep quality was measured using the Richards Campbell Sleep Questionnaire.
Results
Delirium occurred in 22.2% (8/36) of subjects who received melatonin vs in 9.1% (3/33) who received placebo (PāÆ=āÆ.19). Melatonin did not significantly change objective or subjective sleep measurements. Nighttime sleep duration and total sleep time did not differ between subjects who became delirious vs those who did not, but delirious subjects had more sleep fragmentation (sleep bout length 7.0 Ā± 3.0 vs 9.5 Ā± 5.3 min;Ā PāÆ=āÆ.03).
Conclusions
Melatonin given as a nightly dose of 3 mg did not prevent delirium in non-intensive care unit hospitalized patients or improve subjective or objective sleep.
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-Stuti J. Jaiswal, MD, PhD, Thomas J. McCarthy, MD, Nathan E. Wineinger, PhD, Dae Y. Kang, PhD, Janet Song, Solana Garcia, Christoffel J. van Niekerk, MD, Cathy Y. Lu, Melissa Loeks, MPH, Robert L. Owens, MD
This article originally appeared in the September issueĀ ofĀ The American Journal of Medicine.
