褪黑素对帕金森病患者睡眠质量和白天嗜睡的影响：随机安慰剂对照试验的系统回顾和荟萃分析

IF 3.8 2区医学 Q1 CLINICAL NEUROLOGY

Sleep medicine Pub Date : 2025-04-23 DOI:10.1016/j.sleep.2025.106540

Azzam Zrineh , Rami Akwan , Muhammad M. Elsharkawy , Bashar Douden , Wadi Sleibi , Mohamed Eldesouki

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引用次数: 0

摘要

背景：睡眠障碍在帕金森病（PD）中很常见，严重影响生活质量。褪黑素可能有帮助，但关于剂量、配方和治疗时间的证据仍不确定。目的定量分析褪黑素对帕金森病患者睡眠质量和日间嗜睡的影响。方法综合检索截至2025年2月的多个数据库，选取相关的随机对照试验（RCTs）。采用RevMan软件进行分析。亚组分析包括治疗持续时间（4周vs. 8-12周）、剂量（≤4mg vs. > 4mg）和制剂（速释vs.缓释）。结果共纳入5项随机对照试验（rct），共206例。剂量≤4 mg对匹兹堡睡眠质量指数（PSQI）总分无显著改善（MD = - 1.26, 95% CI: - 2.72 ~ 0.20）。剂量[gt； 4mg]表现出更强的效果（MD = - 2.90, 95% CI: - 4.02至- 1.78）。短期使用（4周）显著改善PSQI评分（MD = - 2.43, 95% CI: - 3.98至- 0.88），而较长时间治疗（8-12周）无显著效果（MD = - 1.24, 95% CI: - 3.15至0.67）。速释制剂显著改善PSQI评分（MD = - 2.20, 95% CI: - 3.32 ~ - 1.08），而缓释制剂无显著影响（MD = - 0.61, 95% CI: - 4.15 ~ 2.93）。褪黑激素适度减少了Epworth嗜睡量表（ESS）测量的日间过度嗜睡（MD: - 0.97, 95% CI: - 1.81, - 0.14）。结论褪黑素可改善PD患者的睡眠质量，减少白天嗜睡，特别是短期使用即刻释放制剂。

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The effect of melatonin on sleep quality and daytime sleepiness in Parkinson's disease: A systematic review and meta-analysis of randomized placebo-controlled trials

Background

Sleep disturbances are common in Parkinson's disease (PD), significantly impacting quality of life. Melatonin may help, but evidence regarding dosage, formulation, and treatment duration remains inconclusive.

Objective

To quantitatively analyze the effect of melatonin on sleep quality and daytime sleepiness in patients with PD.

Methods

We comprehensively searched multiple databases up to February 2025, selecting relevant randomized controlled trials (RCTs). RevMan software was used for analysis. Subgroup analyses included treatment duration (4 weeks vs. 8–12 weeks), dose (≤4 mg vs. >4 mg), and formulation (immediate-release vs. prolonged-release).

Results

Five RCTs (206 patients) were included. Doses ≤4 mg showed no significant improvement in total Pittsburgh Sleep Quality Index (PSQI) scores (MD = −1.26, 95 % CI: −2.72 to 0.20). Doses >4 mg demonstrated a stronger effect (MD = −2.90, 95 % CI: −4.02 to −1.78). Short-term use (4 weeks) significantly improved PSQI scores (MD = −2.43, 95 % CI: −3.98 to −0.88), whereas longer treatment (8–12 weeks) showed a non-significant effect (MD = −1.24, 95 % CI: −3.15 to 0.67). Immediate-release formulations significantly improved PSQI scores (MD = −2.20, 95 % CI: −3.32 to −1.08), while prolonged-release formulations showed no significant effect (MD = −0.61, 95 % CI: −4.15 to 2.93). Melatonin modestly reduced excessive daytime sleepiness measured by the Epworth Sleepiness Scale (ESS) (MD: −0.97, 95 % CI: −1.81, −0.14).

Conclusion

Melatonin may improve sleep quality and reduce daytime sleepiness in PD patients, particularly with short-term use of immediate-release formulations.

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来源期刊

Sleep medicine 医学-临床神经学

CiteScore

8.40

自引率

6.20%

发文量

1060

审稿时长

49 days

期刊介绍： Sleep Medicine aims to be a journal no one involved in clinical sleep medicine can do without. A journal primarily focussing on the human aspects of sleep, integrating the various disciplines that are involved in sleep medicine: neurology, clinical neurophysiology, internal medicine (particularly pulmonology and cardiology), psychology, psychiatry, sleep technology, pediatrics, neurosurgery, otorhinolaryngology, and dentistry. The journal publishes the following types of articles: Reviews (also intended as a way to bridge the gap between basic sleep research and clinical relevance); Original Research Articles; Full-length articles; Brief communications; Controversies; Case reports; Letters to the Editor; Journal search and commentaries; Book reviews; Meeting announcements; Listing of relevant organisations plus web sites.