Melatonergic agents influence the sleep-wake and circadian rhythms in healthy and psychiatric participants: a systematic review and meta-analysis of randomized controlled trials.
Study Goal
The researchers aimed to summarize current knowledge about the effects of melatonin supplements and melatonin agonists on the sleep-wake cycle and circadian rhythm in healthy participants and psychiatric patients.
Results Summary
Melatonergic supplements and agonists showed advancing effects on the sleep-wake cycle in healthy participants, with similar findings in psychiatric patients, though larger trials are needed to confirm efficacy in psychiatric disorders.
Population
Healthy participants (1294) and patients with psychiatric disorders (687).
Effective Dosage
Not specified
Duration
Not specified
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
exogenous melatonergic agents | decrease | insomnia and sleep disturbance | - | - | are widely used to treat | #1 |
exogenous melatonergic agents | neutral | circadian rhythms | - | - | might also modulate | #2 |
melatonin supplements and melatonin agonists | increase | sleep-wake cycle | healthy participants | -0.639[-0.968 to -0.310] | showed advancing effects on | #3 |
melatonergic supplements and agonists | increase | sleep-wake cycle | healthy participants | -0.639[-0.968 to -0.310] | showed advancing effects on | #4 |
melatonergic agents | neutral | circadian rhythms | psychiatric patients | - | findings seemed similar to those with healthy participants | #5 |
Exogenous melatonergic agents are widely used to treat insomnia and sleep disturbance. Several studies have shown that they might also modulate circadian rhythms. The purpose of this systematic review and meta-analysis was to summarize current knowledge about the effects of melatonin supplements and melatonin agonists on the sleep-wake cycle as well as on the circadian rhythm of melatonin in healthy participants and in patients with psychiatric disorders. The following electronic databases were searched: EMBASE, PubMed, Web of Science, CINAHL, and Cochrane Library. Of the 12,719 articles, we finally selected 30 studies including 1294 healthy participants and 8 studies including 687 patients with psychiatric disorders. Cochrane risk of bias tool was used to assess the risk of bias. Using meta-ANOVA, studies on healthy participants showed advancing effects of melatonergic supplements and agonists on sleep-wake cycle according to dosing time and dosage, despite the fact that the original individual melatonin rhythm was within a normal range (fixed effect model standardized mean difference [95% Confidence Interval] = -0.639[-0.968 to -0.310]). In a limited number of randomized controlled trials with psychiatric patients, the findings seemed similar to those with healthy participants, despite the psychiatric disorders and treatment related factors affecting circadian rhythms. Given the unmet clinical need for evidence-based treatments to correct circadian rhythms in psychiatric disorders, efficacy of melatonergic agents seen in healthy participants, and similarity of findings among psychiatric patients, large scale, well-designed randomized controlled trials are needed to test efficacy on circadian parameters in psychiatric disorders.