The effectiveness of melatonin for promoting healthy sleep: a rapid evidence assessment of the literature

Nutrition Journal

Patricia A Deuster³  Meredith L Sprengel¹  Cindy C Crawford¹  Meghan L O’Connell¹  Courtney C Boyd¹  Cynthia V Lentino³  Rebecca B Costello² 

[1] Samueli Institute, 1737 King Street, Suite 600, Alexandria, VA 22314, USA;Office of Dietary Supplements, National Institutes of Health, 6100 Executive Blvd., Room 3B01, MSC 7517, Bethesda, MD 20892-7517, USA;Uniformed Services University of the Health Sciences, Department of Military and Emergency Medicine, 4301 Jones Bridge Road, Bethesda, MD 20814-4799, USA

关键词: Military health;    Dietary supplements;    Rapid evidence assessment of the literature (REAL);    Systematic review;    Sleep;    Melatonin;   

Others  :  1132432
DOI  :  10.1186/1475-2891-13-106

 received in 2014-01-31, accepted in 2014-08-28,  发布年份 2014

【 摘 要 】

A systematic review was conducted using Samueli Institute’s Rapid Evidence Assessment of the Literature (REAL^©) process to determine the evidence base for melatonin as an agent to optimize sleep or improve sleep quality, and generalize the results to a military, civilian, or other healthy, active, adult population. Multiple databases were searched yielding 35 randomized controlled trials (RCTs) meeting the review’s inclusion criteria, which were assessed for methodological quality as well as for melatonin effectiveness. The majority of included studies were high quality (83.0%). Overall, according to Grading Recommendations, Assessment Development and Evaluation (GRADE) methodology, weak recommendations were made for preventing phase shifts from jet lag, for improving insomnia in both healthy volunteers and individuals with a history of insomnia, and for initiating sleep and/or improving sleep efficacy. Based on the literature to date, no recommendations for use in shift workers or to improve hormonal phase shift changes in healthy people can be made at this time. Larger and longer-duration RCTs utilizing well characterized products are needed to warrant melatonin recommendations in young, healthy adults.

【 授权许可】

   
2014 Costello et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Bliwise DL, Ansari FP: Insomnia associated with valerian and melatonin usage in the 2002 National Health Interview Survey. Sleep 2007, 30:881-884.
• [2]Peterson AL, Goodie JL, Satterfield WA, Brim WL: Sleep disturbance during military deployment. Mil Med 2008, 173:230-235.
• [3]Seelig AD, Jacobson IG, Smith B, Hooper TI, Boyko EJ, Gackstetter GD, Gehrman P, Macera CA, Smith TC: Sleep patterns before, during, and after deployment to Iraq and Afghanistan. Sleep 2010, 33:1615-1622.
• [4]Lentino C, Purvis D, Murphy K, Deuster P: Sleep as a component of the performance triad: the importance of sleep in a military population. US Army Med Dep J 2013, Oct-Dec:98-108.
• [5]Van Camp R: Zolpidem in fatigue management for surge operations of remotely piloted aircraft. Aviat Space Environ Med 2009, 80:553-555.
• [6]Stranks E, Crowe S: The acute cognitive effects of zopiclone, zolpidem, zaleplon, and eszopiclone: A systematic review and meta-analysis. J Clin Exp Neuropsychol 2014, 16:1-10.
• [7]Paulke A, Wunder C, Toennes S: Sleep self-intoxication and sleep driving as rare zolpidem-induced complex behaviour. Int J Legal Med 2014. (Epub ahead of print) 2014, April 27
• [8]Wagner J, Wagner ML, Hening WA: Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Ann Pharmacother 1998, 32:680-691.
• [9]Pandi-Perumal S, Srinivasan V, Spence D, Cardinali D: Role of the melatonin system in the control of sleep: therapeutic implications. CNS Drugs 2007, 21:995-1018.
• [10]Pevet P, Challet E: Melatonin: both master clock output and internal time-giver in the circadian clocks network. J Physiol Paris 2011, 105:170-182.
• [11]Dawson D, Heuvel C: Integrating the actions of melatonin on human physiology. Ann Med 1998, 30:95-102.
• [12]Krauchi K, Cajochen C, Pache M, Flammer J, Wirz-Justice A: Thermoregulatory effects of melatonin in relation to sleepiness. Chronobiol Int 2006, 23:475-484.
• [13]Zhdanova I: Melatonin as a hypnotic: Pro. Sleep Med Rev 2005, 9:51-65.
• [14]Energy drink consumption and its association with sleep problems among U.S. service members on a combat deployment - Afghanistan, 2010 MMWR Morb Mortal Wkly Rep[http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6144a3.htm webcite]
• [15]Capaldi VF 2nd, Guerrero ML, Killgore WD: Sleep disruptions among returning combat veterans from Iraq and Afghanistan. Mil Med 2011, 176:879-888.
• [16]Collen J, Orr N, Lettieri CJ, Carter K, Holley AB: Sleep disturbances among soldiers with combat-related traumatic brain injury. Chest 2012, 142:622-630.
• [17]Crowley SK, Wilkinson LL, Burroughs EL, Muraca ST, Wigfall LT, Louis-Nance T, Williams EM, Glover SH, Youngstedt SD: Sleep during basic combat training: a qualitative study. Mil Med 2012, 177:823-828.
• [18]Eliasson A, Kashani M, Dela Cruz G, Vernalis M: Readiness and associated health behaviors and symptoms in recently deployed Army National Guard solders. Mil Med 2012, 177:1254-1260.
• [19]Luxton DD, Greenburg D, Ryan J, Niven A, Wheeler G, Mysliwiec V: Prevalence and impact of short sleep duration in redeployed OIF soldiers. Sleep 2011, 34:1189-1195.
• [20]Macera CA, Aralis HJ, Rauh MJ, Macgregor AJ: Do Sleep Problems Mediate the Relationship between Traumatic Brain Injury and Development of Mental Health Symptoms after Deployment? Sleep 2013, 36:83-90.
• [21]Mackowiak PA, Billings FT 3rd, Wasserman SS: Sleepless vigilance: “Stonewall” Jackson and the duty hours controversy. Am J Med Sci 2012, 343:146-149.
• [22]McGowan J, Sampson M: Systematic reviews need systematic searches. J Med Libr Assoc 2005, 93:74-80.
• [23]SIGN 50: A guideline developer's handbook. [http://www.sign.ac.uk/guidelines/fulltext/50/ webcite]
• [24]Grading of Recommendations Assessment, Development and Evaluation (GRADE). [http://www.gradingworkinggroup.org webcite]
• [25]Paul MA, Gray G, Kenny G, Pigeau RA: Impact of Melatonin, Zaleplon, Zopiclone, and Temazepam on Psychomotor Performance. Aviat Space Environ Med 2003, 74:1263-1270.
• [26]Rajaratnam SM, Dijk DJ, Middleton B, Stone BM, Arendt J: Melatonin phase-shifts human circadian rhythms with no evidence of changes in the duration of endogenous melatonin secretion or the 24-hour production of reproductive hormones. J Clin Endocrinol Metab 2003, 88:4303-4309.
• [27]Rajaratnam SM, Middleton B, Stone BM, Arendt J, Dijk DJ: Melatonin advances the circadian timing of EEG sleep and directly facilitates sleep without altering its duration in extended sleep opportunities in humans. J Physiol 2004, 561:339-351.
• [28]Wade AG, Ford I, Crawford G, McConnachie A, Nir T, Laudon M, Zisapel N: Nightly treatment of primary insomnia with prolonged release melatonin for 6 months: A randomized placebo controlled trial on age and endogenous melatonin as predictors of efficacy and safety. BMC Med 2010, 16:51.
• [29]Jorgensen KM, Witting MD: Does exogenous melatonin improve day sleep or night alertness in emergency physicians working night shifts? Ann Emerg Med 1998, 31:699-704.
• [30]James M, Tremea MO, Jones JS, Krohmer JR: Can melatonin improve adaptation to night shift? Am J Emerg Med 1998, 16:367-370.
• [31]Sadeghniiat-Haghighi K, Aminian O, Pouryaghoub G, Yazdi Z: Efficacy and hypnotic effects of melatonin in shift-work nurses: Double-blind, placebo-controlled crossover trial. J Circadian Rhythms 2008, 6:10. BioMed Central Full Text
• [32]Bjorvatn B, Stangenes K, Oyane N, Forberg K, Lowden A, Holsten F, Akerstedt T: Randomized placebo-controlled field study of the effects of bright light and melatonin in adaptation to night work. Scand J Work Environ Health 2007, 33:204-214.
• [33]Cavallo A, Ris D, Succop P, Jaskiewicz J: Melatonin treatment of pediatric residents for adoption to night shift work. Ambul Pediatr 2005, 5:172-177.
• [34]Wright SW, Lawrence LM, Wrenn KD, Haynes ML, Welch LW, Schlack HM: Randomized clinical trial of melatonin after night-shift work: efficacy and neuropsychologic effects. Ann Emerg Med 1998, 32:334-340.
• [35]Sharkey KM, Fogg LF, Eastman CI: Effects of melatonin administration on daytime sleep after simulated night shift work. J Sleep Res 2001, 10:181-192.
• [36]Jockovich M, Cosentino D, Cosentino L, Wears RL, Seaberg DC: Effect of exogenous melatonin on mood and sleep efficiency in emergency medicine residents working night shifts. Acad Emerg Med 2000, 7:955-958.
• [37]Arendt J, Aldhouse M, English J, Marks V, Arendt J, Marks M, Folkard S: Some effects of jet-lag and their alleviation by melatonin. Ergonomics 1987, 30:1379-1393.
• [38]Spitzer RL, Terman M, Williams JB, Terman JS, Malt UF, Singer F, Lewy AJ: Jet lag: clinical features, validation of a new syndrome-specific scale, and lack of response to melatonin in a randomized, double-blind trial. Am J Psychiatry 1999, 156:1392-1396.
• [39]Claustrat B, Brun J, David M, Sassolas G, Chazot G: Melatonin and jet lag: confirmatory result using a simplified protocol. Biol Psychiatry 1992, 32:705-711.
• [40]Beaumont M, Batejat D, Pierard C, Van Beers P, Denis JB, Coste O, Doireau P, Chauffard F, French J, Lagarde D: Caffeine or melatonin effects on sleep and sleepiness after rapid eastward transmeridian travel. J Appl Physiol 2004, 96:50-58.
• [41]Petrie K, Conaglen JV, Thompson L, Chamberlain K: Effect of melatonin on jet lag after long haul flights. BMJ 1989, 298:705-707.
• [42]Suhner A, Schlagenhauf P, Hofer I, Johnson R, Tschopp A, Steffen R: Effectiveness and tolerability of melatonin and zolpidem for the alleviation of jet lag. Aviat Space Environ Med 2001, 72:638-646.
• [43]Suhner A, Schlagenhauf P, Johnson R, Tschopp A, Steffen R: Comparative study to determine the optimal melatonin dosage form for the alleviation of jet lag. Chronobiol Int 1998, 15:655-666.
• [44]Petrie K, Dawson AG, Thompson L, Brook R: A double-blind trial of melatonin as a treatment for jet lag in international cabin crew. Biol Psychiatry 1993, 33:526-530.
• [45]Almeida Montes LG, Ontiveros Uribe MP, Cortes Sotres J, Heinze Martin G: Treatment of primary insomnia with melatonin: a double-blind, placebo-controlled, crossover study. J Psychiatry Neurosci 2003, 28:191-196.
• [46]Wade AG, Crawford G, Ford I, McConnachie A, Nir T, Laudon M, Zisapel N: Prolonged release melatonin in the treatment of primary insomnia: evaluation of the age cut-off for short- and long-term response. Curr Med Res Opin 2011, 27:87-98.
• [47]Garfinkel D, Zisapel N, Wainstein J, Laudon M: Facilitation of benzodiazepine discontinuation by melatonin: A new clinical approach. Arch Intern Med 1999, 159:2456-2460.
• [48]James SP, Sack DA, Rosenthal NE, Mendelson WB: Melatonin administration in insomnia. Neuropsychopharmacology 1990, 3:19-23.
• [49]Paul MA, Gray G, MacLellan M, Pigeau RA: Sleep-inducing pharmaceuticals: a comparison of melatonin, zaleplon, zopiclone, and temazepam. Aviat Space Environ Med 2004, 75:512-519.
• [50]James SP, Mendelson WB, Sack DA, Rosenthal NE, Wehr TE: The effect of melatonin on normal sleep. Neuropsychopharmacology 1987, 1:41-44.
• [51]Nave R, Herer P, Haimov I, Shlitner A, Lavie P: Hypnotic and hypothermic effects of melatonin on daytime sleep in humans: lack of antagonism by flumazenil. Neurosci Lett 1996, 214:123-126.
• [52]Middleton B, Arendt J, Stone BM: Complex effects of melatonin on human circadian rhythms in constant dim light. J Biol Rhythms 1997, 12:467-477.
• [53]Aeschbach D, Lockyer BJ, Dijk DJ, Lockley SW, Nuwayser ES, Nichols LD, Czeisler CA: Use of transdermal melatonin delivery to improve sleep maintenance during daytime. Clin Pharmacol Ther 2009, 86:378-382.
• [54]Attenburrow ME, Cowen PJ, Sharpley AL: Low dose melatonin improves sleep in healthy middle-aged subjects. Psychopharmacology (Berl) 1996, 126:179-181.
• [55]Van Den Heuvel CJ, Reid KJ, Dawson D: Effect of atenolol on nocturnal sleep and temperature in young men: reversal by pharmacological doses of melatonin. Physiol Behav 1997, 61:795-802.
• [56]Rose DA, Kahan TL: Melatonin and sleep qualities in healthy adults: pharmacological and expectancy effects. J Gen Psychol 2001, 128:401-421.
• [57]Rogers NL, Kennaway DJ, Dawson D: Neurobehavioural performance effects of daytime melatonin and temazepam administration. J Sleep Res 2003, 12:207-212.
• [58]Krauchi K, Cajochen C, Wirz-Justice A: A relationship between heat loss and sleepiness: effects of postural change and melatonin administration. J Appl Physiol 1997, 83:134-139.
• [59]Bonafide CP, Aucutt-Walter N, Divittore N, King T, Bixler EO, Cronin AJ: Remifentanil inhibits rapid eye movement sleep but not the nocturnal melatonin surge in humans. Anesthesiology 2008, 108:627-633.
• [60]Luboshitzky R, Levi M, Shen-Orr Z, Blumenfeld Z, Herer P, Lavie P: Long-term melatonin administration does not alter pituitary-gonadal hormone secretion in normal men. Hum Reprod 2000, 15:60-65.
• [61]Gorfine T, Assaf Y, Goshen-Gottstein Y, Yeshurun Y, Zisapel N: Sleep-anticipating effects of melatonin in the human brain. Neuroimage 2006, 31:410-418.
• [62]Vandewalle G, Middleton B, Rajaratnam SM, Stone BM, Thorleifsdottir B, Arendt J, Dijk DJ: Robust circadian rhythm in heart rate and its variability: influence of exogenous melatonin and photoperiod. J Sleep Res 2007, 16:148-155.
• [63]Paul MA, Gray GW, Lieberman HR, Love RJ, Miller JC, Trouborst M, Arendt J: Phase advance with separate and combined melatonin and light treatment. Psychopharmacology (Berl) 2011, 214:515-523.
• [64]Jellin J, Gregory PJ (Eds): Melatonin monograph. Stockton: Therapeutic Research Facility; 2013.
• [65]Buscemi N, Vandermeer B, Hooton N, Pandya R, Tjosvold L, Hartling L, Baker G, Klassen TP, Vohra S: The efficacy and safety of exogenous melatonin for primary sleep disorders. A meta-analysis. J Gen Intern Med 2005, 20:1151-1158.
• [66]Ferracioli-Oda E, Qawasmi A, Bloch MH: Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One 2013, 8:e63773.
• [67]Bramoweth A, Germain A: Deployment-related insomnia in military personnel and veterans. Curr Psychiatry Rep 2013, 15:401.
• [68]Egger M, Juni P, Bartlett C, Holenstein F, Sterne J: How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess 2003, 7:1-76.
• [69]Hopewell S, McDonald S, Clarke M, Egger M: Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev 2007, MR000010.
• [70]Moher D, Pham B, Klassen TP, Schulz KF, Berlin JA, Jadad AR, Liberati A: What contributions do languages other than English make on the results of meta-analyses? J Clin Epidemiol 2000, 53:964-972.
• [71]Singh BB, Khorsan R, Vinjamury SP, Der-Martirosian C, Kizhakkeveettil A, Anderson TM: Herbal treatments of asthma: a systematic review. J Asthma 2007, 44:685-698.
• [72]Watt A, Cameron A, Sturm L, Lathlean T, Babidge W, Blamey S: Rapid versus full systematic reviews: validity in clinical practice? ANZ J Surg 2008, 78:1037-1040.
• [73]Cagnacci A, Soldani R, Yen SS: Contemporaneous melatonin administration modifies the circadian response to nocturnal bright light stimuli. Am J Physiol 1997, 272:R482-486.
• [74]Brzezinski A, Wurtman R: Melatonin. In Encyclopedia of Dietary Supplements. 2nd edition. Edited by Coates P. Informa Healthcare; 2010:538-549.
• [75]Satoh K, Mishima K: Hypothermic action of exogenously administered melatonin is dose-dependent in humans. Clin Neuropharmacol 2001, 24:334-340.
• [76]Lewy AJ, Ahmed S, Jackson JML, Sack RL: Melatonin shifts human circadian-rhythms according to a phase response curve. Chronobiol Int 1992, 9:380-392.
• [77]Benloucif S, Burgess HJ, Klerman EB, Lewy AJ, Middleton B, Murphy PJ, Parry BL, Revell VL: Measuring melatonin in humans. J Clin Sleep Med 2008, 4:66-69.
• [78]Melatonin: Prototype monograph summary. [http://www.nap.edu/openbook.php?record_id=10882&page=367#p2000ba488960367001 webcite]
• [79]Institute of Medicine Committee on Dietary Supplement Use by Military Personnel. Use of Dietary Supplements by Military Personnel. [http://www.ncbi.nlm.nih.gov/books/NBK3977/pdf/TOC.pdf webcite]