Melatonin and sleep in preventing hospitalized delirium: A randomized clinical trial
Abstract
Purpose: 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 ≥ 65, admitted to Internal Medicine wards (non-ICU). Delirium incidence was measured by bedside nurses using the confusion assessment method (CAM). 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 (p=0.19). 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±3.0 vs. 9.5±5.3 min; p=0.03). Conclusions: Melatonin given as a nightly dose of 3mg did not prevent delirium in non-ICU…
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Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 2 of 5 (High · randomized trial). Randomized trials of a reasonable size are the strongest single-study design.
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