Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings

The purpose of the present study was to preliminarily evaluate whether knowing the dim light melatonin onset (DLMO) time is advantageous when treating delayed sleep-wake phase disorder with low-dose melatonin treatment plus behavioral interventions (ie, evening dim light and time in bed scheduling)....

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Bibliographic Details
Published in:	Journal of clinical sleep medicine Vol. 20; no. 7; p. 1131
Main Authors:	Swanson, Leslie M, de Sibour, Trevor, DuBuc, Kelley, Conroy, Deirdre A, Raglan, Greta B, Lorang, Kate, Zollars, Jennifer, Hershner, Shelley, Arnedt, J Todd, Burgess, Helen J
Format:	Journal Article
Language:	English
Published:	United States 01-07-2024
Subjects:	Actigraphy - methods Actigraphy - statistics & numerical data Adult Circadian Rhythm - drug effects Circadian Rhythm - physiology Double-Blind Method Female Humans Male Melatonin - administration & dosage Middle Aged Sleep Disorders, Circadian Rhythm - drug therapy Surveys and Questionnaires Time Factors Treatment Outcome dim light melatonin onset delayed sleep-wake phase disorder circadian rhythms melatonin
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Summary:	The purpose of the present study was to preliminarily evaluate whether knowing the dim light melatonin onset (DLMO) time is advantageous when treating delayed sleep-wake phase disorder with low-dose melatonin treatment plus behavioral interventions (ie, evening dim light and time in bed scheduling). In this randomized, controlled, double-blind trial, 40 adults with delayed sleep-wake phase disorder were randomly assigned to 4 weeks of 0.5 mg timed to be administered either 3 hours before the DLMO (measured DLMO group, n = 20) or 5 hours before sleep-onset time per actigraphy (estimated DLMO group, n = 20), in conjunction with behavioral interventions. The primary outcome was change in the DLMO (measured in-home). Secondary outcomes included sleep parameters per diary and actigraphy (sleep-onset and -offset times and total sleep time), Morningness-Eveningness Questionnaire, Multidimensional Fatigue Inventory, PROMIS-Sleep Disturbance, PROMIS-Sleep Related Impairment, and Pittsburgh Sleep Quality Index. Mixed-effects models tested for group differences in these outcome. After applying the Bonferroni correction for multiple comparisons (significant value set at < .004), there were significant main effects for visit on all outcomes except for the Pittsburgh Sleep Quality Index and total sleep time per wrist actigraphy and diary. There were no group-by-visit interactions for any of the outcomes ( > .004). Scheduled low-dose melatonin plus behavioral interventions may improve many circadian and sleep parameters regardless of whether melatonin administration is scheduled based on estimated or measured DLMO. A larger-scale trial is needed to confirm these preliminary findings. Registry: ClinicalTrials.gov; Name: The Clinical Utility of Measuring the Circadian Clock in Treatment of Delayed Sleep-Wake Phase Disorder; URL: https://clinicaltrials.gov/study/NCT03715465; Identifier: NCT03715465. Swanson LM, de Sibour T, DuBuc K, et al. Low-dose exogenous melatonin plus evening dim light and time in bed scheduling advances circadian phase irrespective of measured or estimated dim light melatonin onset time: preliminary findings. . 2024;20(7):1131-1140.
ISSN:	1550-9397
DOI:	10.5664/jcsm.11076