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

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

doi:10.1016/j.sleep.2014.09.011

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

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

Pharmacy Practice

Mayo Clinic Rochester, MN

Research output: Contribution to journal › Review article › peer-review

157 Scopus citations

Abstract

Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.

Original language	English
Pages (from-to)	19-26
Number of pages	8
Journal	Sleep Medicine
Volume	16
Issue number	1
DOIs	https://doi.org/10.1016/j.sleep.2014.09.011
State	Published - Jan 1 2015

Funding

The project described was supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health (NIH), through Grant Number 1 UL1 RR024150-01. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. EK St. Louis reports that he receives research support from the Mayo Clinic Center for Translational Science Activities (CTSA), supported by the National Center for Research Resources and the National Center for Advancing Translational Sciences , National Institutes of Health , through Grant Number 1 UL1 RR024150-01 . BF Boeve reports that he is an investigator in clinical trials sponsored by Cephalon, Inc., Allon Pharmaceuticals, and GE Healthcare. He receives royalties from the publication of a book entitled Behavioral Neurology of Dementia (CambridgeMedicine, 2009). He has received honoraria from the American Academy of Neurology. He serves on the Scientific Advisory Board of the Tau Consortium. He receives research support from the National Institute on Aging (P50 AG016574 , U01 AG006786 , RO1 AG032306 , RO1 AG041797 ) and the Mangurian Foundation.

Funders	Funder number
RO1 AG032306, P50 AG016574, RO1 AG041797, U01 AG006786
UL1RR024150
Mayo Clinic Rochester, MN

Keywords

Calmodulin
Drug therapy
Melatonin
Parasomnia
REM sleep behavior disorder

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10.1016/j.sleep.2014.09.011

Cite this

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title = "Melatonin therapy for REM sleep behavior disorder: A critical review of evidence",

abstract = "Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.",

keywords = "Calmodulin, Drug therapy, Melatonin, Parasomnia, REM sleep behavior disorder",

author = "McGrane, \{Ian R.\} and Leung, \{Jonathan G.\} and \{St. Louis\}, \{Erik K.\} and Boeve, \{Bradley F.\}",

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T1 - Melatonin therapy for REM sleep behavior disorder

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AU - McGrane, Ian R.

AU - Leung, Jonathan G.

AU - St. Louis, Erik K.

AU - Boeve, Bradley F.

PY - 2015/1/1

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N2 - Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.

AB - Rapid eye movement (REM) sleep behavior disorder (RBD) is a parasomnia associated with dream enactment often involving violent or potentially injurious behaviors during REM sleep that is strongly associated with synucleinopathy neurodegeneration. Clonazepam has long been suggested as the first-line treatment option for RBD. However, evidence supporting melatonin therapy is expanding. Melatonin appears to be beneficial for the management of RBD with reductions in clinical behavioral outcomes and decrease in muscle tonicity during REM sleep. Melatonin also has a favorable safety and tolerability profile over clonazepam with limited potential for drug-drug interactions, an important consideration especially in elderly individuals with RBD receiving polypharmacy. Prospective clinical trials are necessary to establish the evidence basis for melatonin and clonazepam as RBD therapies.

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KW - REM sleep behavior disorder

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

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Keywords

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