151
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Shah J, Langmuir V, Gupta SK. Feasibility and functionality of OROS melatonin in healthy subjects. J Clin Pharmacol 1999; 39:606-12. [PMID: 10354964 DOI: 10.1177/00912709922008218] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OROS (melatonin), an oral osmotic system for controlled drug delivery, was evaluated in an open-label, two-way crossover study to test the feasibility of continuous overnight melatonin delivery. Twelve healthy subjects with no sleep disorders, ranging from 60 to 73 years of age, were enrolled in the study. Two doses of melatonin (1 x 110 micrograms and 4 x 110 micrograms) were administered on two separate occasions. Endogenous baseline nighttime serum melatonin concentrations were measured the night before each treatment. Following treatment at 2100 hours, the lights were extinguished at 2200 hours and remained so, except during blood sample collection, which was performed under dim light (< 50 lux) at specified times. Serum samples were analyzed for melatonin by an LC/MS/MS method. In addition, safety measurements such as vitals and serum samples for endocrine functions were measured both prior to and after melatonin dosing. The serum melatonin concentration profile following OROS (melatonin) dosing mimicked the normal endogenous serum melatonin concentration-time profile. The mean maximal melatonin concentration occurred at 3 a.m. The mean AUCs of endogenous melatonin before the two treatment days were 248 and 234 pg.h/mL, respectively. Serum concentrations of melatonin corrected for endogenous production increased proportionally with dose, with AUCs of 288 and 1069 pg.h/mL, respectively. Deconvolution of the serum concentration data showed good correlation between the in vitro amount released and the in vivo amount absorbed, suggesting continuous absorption throughout the gastrointestinal tract. Less than 5% residual content was observed in the recovered OROS system. Minimal changes in serum hormone concentrations (luteinizing hormone, follicular stimulating hormone, and prolactin) and no serious adverse events were observed following OROS treatment in these subjects. Delivery of melatonin with OROS formulation may result in a physiologic nocturnal profile in elderly subjects.
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Affiliation(s)
- J Shah
- Department of Clinical Pharmacology, ALZA Corporation, Mountain View, California 94039-7210, USA
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152
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Monti JM, Alvariño F, Cardinali D, Savio I, Pintos A. Polysomnographic study of the effect of melatonin on sleep in elderly patients with chronic primary insomnia. Arch Gerontol Geriatr 1999; 28:85-98. [PMID: 15374088 DOI: 10.1016/s0167-4943(98)00129-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/1998] [Revised: 10/06/1998] [Accepted: 10/12/1998] [Indexed: 10/18/2022]
Abstract
The effect of 3-mg melatonin capsules p.o. on sleep in ten elderly patients suffering from chronic primary insomnia was assessed by polysomnographic recordings. In general, melatonin significantly reduced wake time after sleep onset and increased total sleep time and sleep efficiency during the 2-week treatment period. In five of the ten patients treated with melatonin, the increase in total sleep time was clinically significant. Side effects were absent during the period of drug administration. A slight increase of power density in the delta and the theta regions was found during the early phase (i.e. nights 4-5) of melatonin administration, whereas the opposite changes were observed at a late phase of treatment (i.e. nights 15-16). No strict correlation was found between prior 6-sulphatoxymelatonin levels in urine and subsequent sleep improvement after receiving melatonin. Our results further support the proposal that melatonin is beneficial for sleep disturbances in elderly insomniacs.
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Affiliation(s)
- J M Monti
- Department of Pharmacology and Therapeutics, Clinics Hospital, Av. Italia s/n, J. Zudañez 2833/602, Montevideo, 11300, Uruguay
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153
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Dijk DJ, Duffy JF. Circadian regulation of human sleep and age-related changes in its timing, consolidation and EEG characteristics. Ann Med 1999; 31:130-40. [PMID: 10344586 DOI: 10.3109/07853899908998789] [Citation(s) in RCA: 99] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The light-entrainable circadian pacemaker located in the suprachiasmatic nucleus of the hypothalamus regulates the timing and consolidation of sleep by generating a paradoxical rhythm of sleep propensity; the circadian drive for wakefulness peaks at the end of the day spent awake, ie close to the onset of melatonin secretion at 21.00-22.00 h and the circadian drive for sleep crests shortly before habitual waking-up time. With advancing age, ie after early adulthood, sleep consolidation declines, and time of awakening and the rhythms of body temperature, plasma melatonin and cortisol shift to an earlier clock hour. The variability of the phase relationship between the sleep-wake cycle and circadian rhythms increases, and in old age sleep is more susceptible to internal arousing stimuli associated with circadian misalignment. The propensity to awaken from sleep advances relative to the body temperature nadir in older people, a change that is opposite to the phase delay of awakening relative to internal circadian rhythms associated with morningness in young people. Age-related changes do not appear to be associated with a shortening of the circadian period or a reduction of the circadian drive for wake maintenance. These changes may be related to changes in the sleep process itself, such as reductions in slow-wave sleep and sleep spindles as well as a reduced strength of the circadian signal promoting sleep in the early morning hours. Putative mediators and modulators of circadian sleep regulation are discussed.
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Affiliation(s)
- D J Dijk
- Circadian, Neuroendocrine and Sleep Disorders Section, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA.
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154
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Lee BJ, Ryu SG, Cui JH. Formulation and release characteristics of hydroxypropyl methylcellulose matrix tablet containing melatonin. Drug Dev Ind Pharm 1999; 25:493-501. [PMID: 10194604 DOI: 10.1081/ddc-100102199] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
A hydroxypropyl methylcellulose (HPMC) matrix tablet containing melatonin (MT) was formulated as a function of HPMC viscosity, drug loading, type and amount of disintegrant, lubricant and glidant, and aqueous polymeric coating level and was compared with two commercial products. The release characteristics of the HPMC matrix tablet were investigated in the gastric fluid for 2 hr followed by study in intestinal fluid. The surface morphology of an uncoated HPMC matrix tablet using scanning electron microscopy (SEM) was crude, showing aggregated particles and rough crystals or pores, but it became smoother as the coating levels increased. As the HPMC polymer viscosity increased, the release rate had a tendency to decrease. As the drug loadings increased, the release rate slightly decreased. When Polyplasdone XL, Primojel, and Ac-Di-Sol, except Avicel, were incorporated in the HPMC matrix tablet, the release rate was markedly increased. There was no significant difference in release profiles when a mixture of lubricants and glidants (magnesium stearate, talc, and Cab-O-Sil), except for magnesium stearate alone, was incorporated into low and high viscosity grade HPMC matrix tablets. As the coating level increased, the release rate gradually decreased, giving an increased lag time. The sustained-release HPMC matrix tablet with optimizing formulations may provide an alternative for oral controlled delivery of MT and be helpful in the future treatment of circadian rhythmic disorders.
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Affiliation(s)
- B J Lee
- Biological Rhythm and Controlled Release Laboratory, College of Pharmacy, Kangwon National University, Chuncheon, Korea.
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155
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Lushington K, Dawson D, Kennaway DJ, Lack L. The relationship between 6-sulphatoxymelatonin and polysomnographic sleep in good sleeping controls and wake maintenance insomniacs, aged 55-80 years. J Sleep Res 1999; 8:57-64. [PMID: 10188137 DOI: 10.1046/j.1365-2869.1999.00130.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The pineal hormone, melatonin, is reported to possess hypnotic properties. This has led to an investigation of the relationship between the endogenous melatonin rhythm and sleep. However, this relationship has yet to be fully examined in aged insomniacs and controls. From media advertisements, 16 good sleeping controls (11F, 5M) and 16 sleep maintenance insomniacs (11F, 5M), aged over 55 years, were recruited to participate in a study involving four nights of polysomnographically (PSG) measured sleep followed by a 26 h constant routine. During the constant routine, 2 h urine samples were collected and analysed for the melatonin metabolite, 6-sulphatoxymelatonin (aMT.6S). This was used to determine total melatonin excretion. As well, the following circadian melatonin parameters were calculated from fifth order polynomial curve fitting analyses, the goodness of the polynomial curve fit, peak melatonin concentration, the phase of the melatonin rhythm, and melatonin and sleep rhythm synchrony. Apart for one control, all subjects showed significant circadian melatonin rhythms. Although insomniacs showed a greater amount of wakefulness, less sleep in total, and lower sleep efficiency, no significant group differences were observed in any of the melatonin parameters. In addition, while subjects with more reliable melatonin curve fits showed shorter sleep latencies and higher sleep efficiencies, correlational analyses revealed no other significant relationships between any melatonin and PSG sleep parameters. Overall, the present results suggest that neither melatonin amplitude nor phase are related to sleep quality in the aged.
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Affiliation(s)
- K Lushington
- School of Psychology, University of South Australia, Australia
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156
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Dawson D, Rogers NL, van den Heuvel CJ, Kennaway DJ, Lushington K. Effect of sustained nocturnal transbuccal melatonin administration on sleep and temperature in elderly insomniacs. J Biol Rhythms 1998; 13:532-8. [PMID: 9850013 DOI: 10.1177/074873098129000354] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Previous research has suggested a role for the pineal hormone melatonin in the control of the body's sleep-wake and thermoregulatory systems. In the elderly population, there have been reports of decreased nighttime secretion of melatonin and suggestions that this may, in turn, be responsible for the increased incidence of sleep disorders reported by this age group. On this basis, it has been suggested that augmented nocturnal melatonin levels may improve sleep quality in age-related sleep disorders. Following screening assessments, 12 elderly (> 55 years) subjects with sleep maintenance insomnia were treated with either 0.5 mg transbuccal melatonin or a placebo for two sessions of 4 consecutive nights, at least 3 days apart. Subjects self-selected lights-out times, and sleep was assessed using standard polysomnographic (PSG) measures. Body temperature was measured continually from 2100 to 0700 h, and sleep quality was assessed from PSG variables measured. Nightly urine samples were assayed for the melatonin metabolite 6-sulfatoxy-melatonin (aMT.6S). Compared to the placebo, transbuccal melatonin administration significantly increased mean nocturnal aMT.6S excretion (mean +/- SEM: 194.2 +/- 16.5 vs. 42.5 +/- 7.7 nmol). In addition, there was a significant reduction in core body temperature relative to the placebo condition (p < .05). However, sustained transbuccal melatonin treatment had no positive significant effect on any PSG measure of sleep quality. The results from the present study suggest that sustained nocturnal administration of melatonin, in the low pharmacological range, might be of limited clinical benefit in this subject population.
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Affiliation(s)
- D Dawson
- Centre for Sleep Research, Faculty of Humanities and Social Sciences, University of South Australia, Queen Elizabeth Hospital, Woodville, Australia
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157
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Waldhauser F, Kovács J, Reiter E. Age-related changes in melatonin levels in humans and its potential consequences for sleep disorders. Exp Gerontol 1998; 33:759-72. [PMID: 9951620 DOI: 10.1016/s0531-5565(98)00054-0] [Citation(s) in RCA: 65] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Prior to three months of age there is little melatonin (MLT) secretion in humans. MLT production then commences, becomes circadian, and reaches its highest nocturnal blood levels between the ages of one to three years. During the remainder of childhood, nocturnal peak levels drop progressively by 80%. In adults, these levels show an additional drop of some 10%, mainly during senescence. The large drop in serum MLT during childhood is probably the result of the increase in size of the human body, despite a constant MLT production after infancy. The additional decline of MLT with higher age may be due to a yet unidentified physiological mechanism accompanying senescence. The biological significance of these MLT alterations remains unknown. Since the discovery of MLT, an immediate sedative action of this hormone has been known. A number of recent studies have demonstrated that MLT indeed exerts a sleep-promoting action by accelerating sleep initiation, improving sleep maintenance, and marginally altering sleep architecture. The potential of MLT in the treatment of insomnia is being explored, and the results are promising. Although in most of these studies pharmacological dosages of MLT have been used, preliminary data suggest that similar effects can also be achieved by physiological hormone concentrations. The latter observation raises the question of whether MLT might be involved in the physiological control of sleep.
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Affiliation(s)
- F Waldhauser
- Department of Pediatrics, University Hospital of Vienna, Austria.
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158
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Lee BJ, Choe JS, Kim CK. Preparation and characterization of melatonin-loaded stearyl alcohol microspheres. J Microencapsul 1998; 15:775-87. [PMID: 9818955 DOI: 10.3109/02652049809008260] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A sustained release dosage form which delivers melatonin (MT), a pineal hormone, is of clinical value because of the short half-life of MT, for those who have a disordered circadian rhythm. The purpose of this study was to prepare MT-loaded microspheres by the emulsion melting/cooling method using stearyl alcohol (SA) and also dual walled chitosan and sodium alginate beads, and to evaluate the release characteristics in simulated gastric and intestinal fluid. The MT-loaded microspheres were spherical, ranging in diameter from about 250-750 microm. When polyethylene glycol 4000 (PEG), as a water-soluble or aluminium tristearate (AT), as a water-insoluble additive, was incorporated, the surface roughness was further reduced resulting in a smooth matrix structure. The dual walled chitosan and sodium alginate beads entrapping small MT-loaded microspheres were not spherical in structure. As the additives incorporated into SA microspheres increased, the drug content decreased. The release profiles of the MT-loaded microspheres were independent of pH. When the melted SA solution was cooled rapidly in 10 min to 25 degrees C, the drug content increased but the release rate of MT-loaded microspheres decreased. The release rate of drug decreased as the amount of SA increased but an increase of agitation speed and amount of AT and PEG resulted in increased release rates. The release rate of drug from dual walled chitosan beads increased slightly but was retarded in the case of dual walled alginate beads when compared to MT-loaded microspheres. The emulsion melting/cooling method used to prepare MT-loaded microspheres using SA is simple and inexpensive, and may provide an alternative for the preparation of an oral sustained release dosage form of MT without using harmful organic solvents. The dual walled chitosan and sodium alginate beads may also provide a convenient way to control the release of drugs.
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Affiliation(s)
- B J Lee
- Biological Rhythm and Controlled Release Laboratory, College of Pharmacy, Kangwon National University, Chuncheon, Korea
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159
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Lee BJ, Cui JH, Parrott KA, Ayres JW, Sack RL. Percutaneous absorption and model membrane variations of melatonin in aqueous-based propylene glycol and 2-hydroxypropyl-beta-cyclodextrin vehicles. Arch Pharm Res 1998; 21:503-7. [PMID: 9875485 DOI: 10.1007/bf02975365] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Percutaneous absorption and model membrane variations of melatonin (MT) in aqueous-based propylene glycol and 2-hydroxypropyl-beta-cyclodextrin vehicles were investigated. The excised hairless mouse skin (HMS) and two synthetic ethylene vinyl acetate (EVA) and microporous polyethylene (MPE) were selected as a model membrane. The solubility of MT was determined by phase equilibrium study. The vertical Franz type cell was used for diffusion study. The concentration of MT was determined using reverse phase HPLC system. The MT solubility was the highest in a mixture of PG and 2-HP beta CD. The percutaneous absorption of MT through excised HMS increased as the solubility increased. However, the permeability coefficient decreased and then slightly increased in a mixture of PG and 2-HP beta CD. On the other hand, both flux and permeability coefficient through EVA membrane decreased as the solubility increased. No MT was detected over 12 h after starting diffusion through MPE membrane. The flux of MT was dependent on the type of membrane selected. Flux of MT was greatest in excised HMS followed by EVA and MPE membrane. Flux of MT through EVA membrane was 5-20 times lower when compared to excised HMS. Interestingly, volumes of donor phase when MPE membrane was used, significantly increased during the study period. The HMS might be applicable to expect plasma concentration of MT in human subjects based on flux and pharmacokinetic parameters as studied previously. The current studies may be applied to deliver MT transdermally using aqueous-based vehicles and to fabricate MT dosage forms.
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Affiliation(s)
- B J Lee
- Biological Rhythm and Controlled Release Lab., College of Pharmacy, Kangwon National University, Chuncheon, Korea
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160
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Jean-Louis G, von Gizycki H, Zizi F. Melatonin effects on sleep, mood, and cognition in elderly with mild cognitive impairment. J Pineal Res 1998; 25:177-83. [PMID: 9745987 DOI: 10.1111/j.1600-079x.1998.tb00557.x] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The effects of immediate-release melatonin on circadian rest-activity profiles, cognition, and mood were investigated in ten elderly individuals with self-reported sleep-wake disturbances. Melatonin (6 mg), administered 2 hr before habitual bedtime, enhanced the rest-activity rhythm and improved sleep quality as observed in a reduction in sleep onset latency and in the number of transitions from sleep to wakefulness. However, total sleep time was not significantly increased nor was wake within sleep significantly reduced. The ability to remember previously learned items improved along with a significant reduction in depressed moods. No side effects or contraindications were reported by any of our participants during the 10 day trials. These data suggest that melatonin can safely improve some aspects of sleep, memory, and mood in the elderly in short-term use.
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Affiliation(s)
- G Jean-Louis
- Department of Psychiatry, University of California, San Diego, USA.
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161
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Nishimura S, Fujino Y, Shimaoka M, Hagihira S, Taenaka N, Yoshiya I. Circadian secretion patterns of melatonin after major surgery. J Pineal Res 1998; 25:73-7. [PMID: 9755027 DOI: 10.1111/j.1600-079x.1998.tb00542.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Biorhythms, such as regular variation in core body temperature and the pattern of the secretion of melatonin, are thought to be mediated by the same biological clock. Core body temperature is affected by the inflammatory response to major surgery. Apart from the well-known inhibitory effect of bright light on its secretion, melatonin is an exceedingly good marker of one of the central generating systems of circadian rhythms. We sequentially measured the plasma melatonin concentration pattern in patients who had undergone esophagectomy with thoracotomy to elucidate the circadian rhythm after major surgery. From seven patients who had received esophagectomy with thoracotomy for esophageal cancer, plasma concentrations of melatonin were measured using an RIA method. Blood samples were collected via each patient's arterial line at 00.00, 02.00, 04.00, 06.00, 08.00, 12.00, 16.00, 20.00, and 24.00 hr on the first postoperative day for six of the patients, and, for one patient, every 2 hr until the third postoperative day and every 4 hr thereafter until the sixth postoperative day. Four patients out of seven had melatonin concentrations of over 30 pg/ml (mean 34 pg/ml) at 24.00 hr on the first postoperative day. Five patients showed circadian secretion patterns of melatonin during the first postoperative day. One patient whose melatonin concentrations were measured consecutively for 6 days showed a regular circadian secretion pattern through the 6 days of the study. Even the stress caused by extremely invasive surgery did not significantly disturb the melatonin secretion pattern.
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Affiliation(s)
- S Nishimura
- Intensive Care Unit, Osaka University Hospital, Suita, Japan
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162
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Abstract
OBJECTIVES To study afternoon serum-melatonin values in patients with sleep disordered breathing. Melatonin has a strong circadian rhythm with high values during the night-time and low values in the afternoon. Sleep disordered breathing may change the circadian rhythm of melatonin which may have diagnostic implications. SETTING The Sleep Laboratory, The Department of Internal Medicine, Avesta Hospital, Sweden, and the Department of Anaesthesiology, Glostrup University Hospital, Copenhagen, Denmark. SUBJECTS We examined 60 consecutive patients admitted for sleep disordered breathing and 10 healthy non snoring controls. The patients underwent a sleep apnoea screening test having a specificity of 100% for the obstructive sleep apnoea syndrome (OSAS) using a combination of static charge sensitive bed and oximetry. Obstructive sleep apnoea syndrome was found in 49 patients, eight patients had borderline sleep disordered breathing (BSDB) and three patients were excluded due to interfering disease. MAIN OUTCOME MEASURES Patients and controls had an afternoon determination of serum-melatonin. The Epworth Sleepiness Scale was used to score day-time sleepiness. RESULTS In comparison with normal controls patients suffering from OSAS had significantly higher serum-melatonin levels in the afternoon. However, as a diagnostic test for OSAS in patients with sleep disordered breathing serum-melatonin showed a low sensitivity but a high specificity. The results indicate that breathing disorders during sleep in general affect pineal function. CONCLUSIONS Sleep disordered breathing seems to disturb pineal function. Determination of afternoon serum-melatonin alone or together with a scoring of daytime sleepiness does not identify OSAS-patients in a heterogeneous population of patients complaining of heavy snoring and excessive daytime sleepiness.
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Affiliation(s)
- J Ulfberg
- Department of Internal Medicine, Avesta Hospital, Sweden
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163
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Jean-Louis G, Zizi F, von Gizycki H, Taub H. Effects of melatonin in two individuals with Alzheimer's disease. Percept Mot Skills 1998; 87:331-9. [PMID: 9760668 DOI: 10.2466/pms.1998.87.1.331] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Dementia has been associated with circadian rhythm disturbances expressed in several dimensions including body temperature, hormonal concentrations, sleep and wakefulness patterns, and rest-activity cycles. These disturbances may be the result of a dampening in the amplitude of the circadian rhythm. One of the symptoms associated with the aging process has been a decline in the amplitude of the melatonin rhythm. Here, the results of melatonin administration to two patients with Alzheimer's disease are presented. Melatonin administration enhanced and stabilized the circadian rest-activity rhythm in one of the patients along with some reduction of daytime sleepiness and an improvement in mood. The other patient, who was characterized by less cognitive impairment, showed no significant changes associated with melatonin ingestion. Interestingly, the acrophase of rest-activity was delayed for about one hour in both patients. These results suggest that melatonin may have beneficial effects in some patients with Alzheimer's disease.
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Affiliation(s)
- G Jean-Louis
- Department of Psychiatry, University of California, San Diego, La Jolla, CA 92037, USA.
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164
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Van Den Heuvel CJ, Kennaway DJ, Dawson D. Effects of daytime melatonin infusion in young adults. THE AMERICAN JOURNAL OF PHYSIOLOGY 1998; 275:E19-26. [PMID: 9688869 DOI: 10.1152/ajpendo.1998.275.1.e19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Daytime oral melatonin typically exerts soporific and thermoregulatory effects; however, it is not clear whether these effects reflect the normal physiological response to endogenous nocturnal melatonin production. We infused melatonin at doses that produced physiological and supraphysiological steady-state levels in 24 young adults during two daytime bed rest protocols. From 1000 to 1630, subjects were infused intravenously with saline or melatonin in counterbalanced order. Each group of eight subjects received melatonin (and saline) infusions at one dose rate: 0.04 microg . h-1 . kg body wt-1 (low), 0.08 microg . h-1 . kg-1 (medium), or 8.0 microg . h-1 . kg-1 (high). Low and medium melatonin infusions produced plasma and saliva levels within the normal nocturnal range observed in young adults. These levels were not associated with any changes in rectal, hand, forehead, or tympanic temperatures or with subjective sleepiness. High melatonin produced supraphysiological plasma and saliva levels and was associated with a significant attenuation in the daytime increase in rectal temperature, significantly increased hand temperature, and greater sleepiness. It is not yet clear whether the thermoregulatory and soporific effects of daytime supraphysiological melatonin administration are equivalent to the physiological responses to endogenous melatonin.
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Affiliation(s)
- C J Van Den Heuvel
- Department of Obstetrics and Gynaecology, University of Adelaide, Adelaide, South Australia 5005
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165
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Kunz D, Bes F, Schlattmann P, Herrmann WM. On pineal calcification and its relation to subjective sleep perception: a hypothesis-driven pilot study. Psychiatry Res 1998; 82:187-91. [PMID: 9754443 DOI: 10.1016/s0925-4927(98)00013-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
We classified the degree of pineal calcification (DOC) into seven groups using cranial Computer Tomography (cCT) and then correlated pineal DOC to chronic subjective sleep-related disturbances as measured by a sleep questionnaire in 36 patients. Analysed by logistic regression models, age and sex were not, but higher pineal DOC was significantly associated with the presence of daytime tiredness (OR = 4.15, 95% CI: 1.63, 10.54) and sleep disturbance (OR = 1.74, 95% CI: 1.10, 2.74). This study provides initial confirmation of the hypothesis that the increasing degree of pineal calcification (DOC) might indicate a decrease of melatonin production, which consecutively might lead to a disturbed circadian rhythmicity in the sleep-wake cycle, with the principal symptom being daytime tiredness.
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Affiliation(s)
- D Kunz
- Department of Psychiatry, Interdisciplinary Sleep Clinic, Freie Universität Berlin, Germany.
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166
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Wagner J, Wagner ML, Hening WA. Beyond benzodiazepines: alternative pharmacologic agents for the treatment of insomnia. Ann Pharmacother 1998; 32:680-91. [PMID: 9640488 DOI: 10.1345/aph.17111] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To review the epidemiology, etiology, and classification of insomnia and provide an overview of the pharmacologic therapy of insomnia. Novel nonbenzodiazepine hypnotics including zolpidem, zopiclone, and zaleplon, as well as nonprescription products such as valerian and melatonin, are reviewed in detail. DATA SOURCES A MEDLINE search was performed to identify relevant clinical studies, case reports, abstracts, and review articles published between April 1992 and December 1997. Key search terms included insomnia, benzodiazepines, zolpidem, zopiclone, zaleplon, Cl 284,846, melatonin, and valerian. Additional references were obtained from the lists of review articles and textbooks. DATA EXTRACTION AND SYNTHESIS Data concerning the safety and efficacy of the hypnotic agents were extracted from all available clinical trials and abstracts. Background information regarding insomnia, benzodiazepines, and other hypnotics was extracted from the most current literature, including review articles and textbooks. CONCLUSIONS New developments in benzodiazepine receptor pharmacology have introduced novel nonbenzodiazepine hypnotics that provide comparable efficacy to benzodiazepines. Although they may possess theoretical advantages over benzodiazepines based on their unique pharmacologic profiles, they offer few, if any, significant advantages in terms of adverse effects. Over-the-counter agents such as valerian and melatonin may be useful in alleviating mild, short-term insomnia, but further clinical trials are required to fully evaluate their safety and efficacy.
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Affiliation(s)
- J Wagner
- College of Pharmacy, Rutgers State University of New Jersey, Piscataway 08854, USA
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167
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Heiligenstein E, Guenther G. Over-the-counter psychotropics: a review of melatonin, St John's wort, valerian, and kava-kava. JOURNAL OF AMERICAN COLLEGE HEALTH : J OF ACH 1998; 46:271-276. [PMID: 9609974 DOI: 10.1080/07448489809596003] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
Use and availability of alternative healthcare products have revived in the last few years. The prevalence of supplement use in the United States is largely unknown but is thought to be widespread. In this article, four of the common substances used to treat emotional problems are reviewed. The plant or substance description, clinical indications, evidence of therapeutic efficacy, mechanisms of therapeutic actions, dosages and regimens, different commercially available preparations, and adverse effects and toxicities are described for melatonin, St John's wort, valerian, and kava-kava. That a product is "natural" does not mean that it is either safe or effective. Many supplements are potent drugs that lack sufficient data on safety, dose-response relationships, drug interactions, and purity.
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168
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Abstract
We examined the association between 6-sulphatoxymelatonin (6-SMT) excretion and sleep in 68 volunteers 60-79 years of age who complained of insomnia or depression. An Actillume wrist monitor was worn for 5-7 consecutive days and nights in home-living conditions. Activity was used to estimate total sleep time (TST) and wake after sleep onset (WASO). Throughout two 24 hr periods, urine was collected approximately every 2 hr during the day and after any voidings during the sleep period. During the next week, subjects spent 5 nights and 4 days in the laboratory. Sleep was measured and scored with standard polysomnographic techniques. Urine was collected, as for home recording, on days 1 and 4. Urinary concentrations of 6-SMT were assayed. Cosine-fitting of urine data across both days at home and both laboratory collections established the mesors and amplitudes of 24 hr 6-SMT excretion rhythms, but neither was significantly correlated with sleep. Mean and peak 6-SMT excretion during the sleep period was also determined. Significant correlations were found between mean 6-SMT during the laboratory sleep period and TST and WASO. However, these associations were not independent of circadian timing: sleep was better when sleep occurred near the circadian acrophase of 6-SMT excretion. These data indicate that low melatonin production may not be an important factor in insomnia among the elderly.
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Affiliation(s)
- S D Youngstedt
- Department of Psychiatry and Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla 92093-0667, USA.
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169
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Abstract
This article reviews issues involved in the diagnosis of insomnia and discusses treatment options, including pharmacologic treatment, which is indicated mainly in acute insomnia. Sleep hygiene is then discussed. Finally, the various behavioral treatments are reviewed, including light therapy, relaxation training, cognitive therapy, sleep curtailment, and stimulus control therapy.
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Affiliation(s)
- P J Hauri
- Mayo Sleep Disorders Center, Mayo Clinic, Rochester, Minnesota, USA
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170
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171
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172
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Abstract
This article reviews the evidence that melatonin, a hormone produced by the pineal gland during the dark hours, plays a major role in the regulation of the sleep-wake cycle. In recent years, our laboratory has been involved in a large-scale project aimed at investigating the role of endogenous melatonin in sleep-wake regulation and the effects of nonpharmacological levels of melatonin on sleep. Based on our finding on the precise coupling between the endogenous nocturnal increase in melatonin secretion and the opening of the nocturnal sleep gate, we propose that the role of melatonin in the induction of sleep does not involve the active induction of sleep, but is rather mediated by an inhibition of a wakefulness-producing mechanism in the central nervous system. Our studies also suggest that exogenously administered melatonin may be beneficial in certain types of insomnia that are related to disturbances in the normal secretion of the hormone.
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Affiliation(s)
- T Shochat
- Sleep Laboratory, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa
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173
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Abstract
Melatonin blanches the skin of frogs, whitens the fur of hamsters, and sometimes makes the gonads atrophy. It is remarkable that such a hormone would be put forward as a defense against ageing. We have been examining excretion of the urinary metabolite of melatonin, 6-sulphatoxymelatonin (6-SMT), in 150 postmenopausal women, in 72 volunteers over the age of 60 years who complained of insomnia or depression, and in 20 healthy younger adult controls, aged 18-40 years. The acrophase or fitted peak of 6-SMT excretion was computed as a marker of the timing of the circadian system. Total daily excretion of 6-SMT was not significantly related to total sleep time, wake-within-sleep or sleep complaints. Nevertheless, whereas the 20 controls displayed a normal range of 6-SMT acrophases from 01.32 to 05.44 h, 42% of the postmenopausal women and 48% of the symptomatic elders had acrophases outside this normal range. Those volunteers with more deviant acrophases displayed more disturbed sleep and more sleep complaints. These data suggest that melatonin is a useful marker of circadian rhythm phase disorders, but suggest a need for more caution in melatonin administration.
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Affiliation(s)
- D F Kripke
- Department of Psychiatry and the Sam and Rose Stein Institute for Research on Aging, University of California, San Diego, La Jolla 92093-0667, USA.
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174
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Abstract
Although not licensed as a drug, melatonin is widely sold as a nutritional supplement in the USA for its purported sleep-promoting and antiageing properties. In this article, we provide some guidelines for its use in sleep disorders medicine. In brief, melatonin appears to promote sleep by producing corrective circadian phase shifts, thereby improving the alignment of the endogenous sleep propensity rhythm with the desired sleep schedule. Melatonin may also have a direct soporific effect, especially when administered during the day. We suggest that the direct soporific action results from the release of accumulated sleep drive by melatonin's attenuation of the circadian alerting signal. Melatonin has not been proven safe by the usual clinical trial criteria, but to date no catastrophes have been related to its use. Also, there is little information about the safety and efficacy of chronic administration.
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Affiliation(s)
- R L Sack
- Department of Psychiatry, School of Medicine, Oregon Health Sciences University, Portland 97201, USA.
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175
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Abstract
Although compelling logic suggests that melatonin may be effective for a variety of disorders, there are few empirical clinical studies. The optimal dose of melatonin is not clear; most studies have used doses that produce supraphysiological blood levels. The timing of melatonin administration is important. Melatonin has few immediate side-effects except drowsiness, but the effects of chronic administration are unclear. Melatonin may be effective in reducing jet lag. In elderly patients with poor sleep and documented low melatonin production, melatonin may be helpful. In several studies, melatonin has been shown to shorten sleep latency. Further studies are needed to clarify the efficacy and safety of melatonin.
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Affiliation(s)
- D Avery
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle 98104-2499, USA.
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176
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Baskett JJ, Cockrem JF, Antunovich TA. Sulphatoxymelatonin excretion in older people: relationship to plasma melatonin and renal function. J Pineal Res 1998; 24:58-61. [PMID: 9468119 DOI: 10.1111/j.1600-079x.1998.tb00366.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
In order to validate measurement of urinary sulphatoxymelatonin as an accurate method of estimating plasma melatonin secretion in older people, we compared 24 h plasma melatonin secretion and sulphatoxymelatonin excretion with renal function in 20 subjects 62-89 years of age. There was a good correlation between plasma and urinary sulphatoxymelatonin over the same 24 h period (R2 = 0.797) and no relationship between creatinine clearance and sulphatoxymelatonin excretion (R2 = 0.075). The results suggest that sulphatoxymelatonin excretion estimation is a good surrogate measurement of plasma melatonin secretion in older people, at least across the range of creatinine clearance for the subjects in the study, 0.41-1.81 ml/sec.
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Affiliation(s)
- J J Baskett
- University Geriatric Unit, North Shore Hospital, Auckland, New Zealand
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177
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Johnson TA, Deckert JJ. Care of the Patient with a Sleep Disorder. Fam Med 1998. [DOI: 10.1007/978-1-4757-2947-4_56] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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178
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Abstract
The seemingly contradictory literature on the use of melatonin in insomnia is best understood by considering issues of time of administration (day or night), dose range (physiological or pharmacological), subject selection (normals or insomniacs), choice of dependent variable (self-report or electroencephalogram), and comprehensiveness of the reported variables (sleep onset or sleep maintenance). Available data on nighttime administration to normals and insomniacs are reviewed. It is concluded that there is not yet a convincing body of evidence, using generally accepted measures, that melatonin administration improves sleep in insomniacs with noncircadian sleep disturbance.
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Affiliation(s)
- W B Mendelson
- Sleep Research Laboratory, University of Chicago, IL 60637, USA
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179
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Benloucif S, Masana MI, Dubocovich ML. Responsiveness to melatonin and its receptor expression in the aging circadian clock of mice. THE AMERICAN JOURNAL OF PHYSIOLOGY 1997; 273:R1855-60. [PMID: 9435637 DOI: 10.1152/ajpregu.1997.273.6.r1855] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
This study determined the effect of age on the efficacy of melatonin treatment to phase shift circadian activity rhythms and on melatonin receptor expression in the suprachiasmatic nucleus (SCN) and paraventricular nucleus of the thalamus (PVNT) of C3H/HeN mice. The circadian rhythm of 2-[125I]iodomelatonin binding, assessed at three times of the day [circadian times (CT) 2, 10, and 18], showed a modest age-related decrease in the SCN but not the PVNT of old C3H/HeN mice (24 mo). There was a tendency for age to reduce Mel1a melatonin receptor mRNA expression in the suprachiasmatic nucleus during the day, but not during the night. The magnitude of phase shifts of circadian activity rhythms (advances or delays) induced by administration of melatonin at CT 10 or CT 2 was identical in young and old C3H/HeN mice. Together, these results suggest that the decrease in melatonin receptor expression in the SCN had little effect on melatonin-induced phase shifts of circadian activity rhythms. We conclude that the responsiveness of the circadian timing system to melatonin administration does not decrease with age.
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Affiliation(s)
- S Benloucif
- Department of Molecular Pharmacology and Biological Chemistry, Northwestern University Medical School, Chicago, Illinois 60611, USA
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180
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Fainstein I, Bonetto AJ, Brusco LI, Cardinali DP. Effects of melatonin in elderly patients with sleep disturbance: a pilot study. Curr Ther Res Clin Exp 1997. [DOI: 10.1016/s0011-393x(97)80066-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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181
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Abstract
The present article reviews the evidence that melatonin possesses sleep-inducing effects and that it gates the increase in nocturnal sleepiness. It is shown that, without exception, all the studies that have investigated daytime administrations of melatonin reported increased sleepiness, even at doses that do not increase plasma levels of melatonin beyond its physiological levels. By contrast, nighttime increase in sleepiness was achieved only after administration of high doses. Based on these findings and on the precise coupling between the endogenous nocturnal increase in melatonin secretion and the opening of the sleep gate, it is suggested that melatonin participates in the regulation of the sleep-wake cycle by inhibiting the central nervous system wakefulness generating system. This inhibition allows a smooth transition from wakefulness to sleep. Clinical findings on decreased levels of nocturnal melatonin in chronic insomniacs, and on the efficacy of exogenous melatonin in improving sleep in melatonin-deficient insomniacs, are congruent with this hypothesis.
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Affiliation(s)
- P Lavie
- Sleep Laboratory, Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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182
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Ancoli-Israel S, Poceta JS, Stepnowsky C, Martin J, Gehrman P. Identification and treatment of sleep problems in the elderly. Sleep Med Rev 1997; 1:3-17. [PMID: 15310520 DOI: 10.1016/s1087-0792(97)90002-2] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
For many adults, changes in sleep occur with aging. An estimated 15 million elderly, or 50% of older Americans, experience some sleep problem. The elderly complain that their sleep is more fragmented and that as they have gotten older, they experience more daytime sleepiness. Laboratory studies have confirmed these complaints. Research has shown that it is not the need for sleep that decreases with age, but rather the ability to sleep. Circadian rhythm disturbances, sleep disorders such as sleep disordered breathing and periodic movements in sleep, medical illness, medication use, and impaired cognitive functioning all contribute to poor sleep and decreased daytime alertness. In institutionalized elderly, sleep is even more disturbed and disrupted. With careful assessment, many of these problems can be addressed and treated, and sometimes cured.
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Affiliation(s)
- S Ancoli-Israel
- Department of Psychiatry, University of California San Diego and Veterans Affairs Medical Center, USA
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183
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Abstract
Over the last several decades the pineal gland has emerged as an active neuroendocrine transducer of important environmental information. However, the current understanding of the function of its major hormone, melatonin, in humans remains ill defined and based exclusively on correlative observations. In a similar manner, the multitude of phenomenological descriptions of the effects of exogenous melatonin is contrasted by the limited understanding of the underlying mechanisms and the lack of firmly established clinical applications for the hormone. Future randomized, double-blind, placebo-controlled clinical studies will be necessary to determine the precise indications, treatment regimens, and safety of melatonin in clinical practice. The recent rapid progress in the area of melatonin research should lead to a better understanding of its role in human health and disease.
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Affiliation(s)
- P D Penev
- Department of Neurology, Northwestern University Medical School and Center for Circadian Biology and Medicine, Chicago, IL 60611, USA
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184
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Abstract
OBJECTIVE To review the use of melatonin in sleep disorders, including jet lag, shift work disorder, insomnia, and sleep cycle disorders in neurologically impaired patients. DATA SOURCE A MEDLINE search (1966 to April 1996) was performed that included clinical studies and reviews on melatonin in the English language. References used in those articles were also screened for additional information. STUDY SELECTION All published trials were considered for inclusion in this review, with an emphasis placed on more recently published studies (last 5 years). DATA SYNTHESIS There is significant evidence that links the hormone melatonin to circadian sleep cycles in humans. It has been suggested that in situations where the endogenous melatonin concentration is reduced (advancing age) or the normal circadian cycle is disrupted (jet lag, shift work, blind patients), supplementation with exogenous melatonin may improve both sleep duration and quality. Limited data from generally short-term trials and anecdotal reports suggest that melatonin may be effective in several of these sleep disorders. Melatonin use in jet lag appears to decrease jet lag symptoms and hasten the return to normal energy levels. Melatonin may be helpful in rotating shift schedules to improve sleep quality and maintain normal circadian rhythm. In some patients with insomnia, melatonin appears to induce sleep onset. The optimal dosage and timing of drug administration is still unclear. CONCLUSIONS Although there is some evidence that melatonin may have modest efficacy, especially in insomnia, jet lag, and sleep disorders in neurologically impaired patients, adequate long-term studies examining both efficacy and toxicity are lacking. In addition, further studies evaluating dose-response relationships and drug interactions are warranted.
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185
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Voderholzer U, Laakmann G, Becker U, Haag C, Baghai T, Riemann D, Demisch L. Circadian profiles of melatonin in melancholic depressed patients and healthy subjects in relation to cortisol secretion and sleep. Psychiatry Res 1997; 71:151-61. [PMID: 9271788 DOI: 10.1016/s0165-1781(97)00048-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Circadian secretion of melatonin was measured in melancholic depressed patients (n = 9) and age- and sex-matched healthy control patients (n = 9). The mean age of the depressed patients was 29 years, i.e. younger than in most earlier studies, and a drug-free interval of 3 weeks preceded the investigations. Melatonin secretion was similar in depressed patients and healthy subjects with no significant differences at any of the time points, thus not confirming earlier studies in which depressed patients were found to have lower melatonin levels than control patients. The discrepancy between our result and earlier studies may be explained by different patient characteristics such as age, duration of illness, previous treatment, and alcohol intake. It is conceivable that a diminution of nocturnal melatonin secretion in depressed patients might only occur during the long-term course of the depressive illness and/or its pharmacological treatment.
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Affiliation(s)
- U Voderholzer
- Department of Psychiatry and Psychotherapy, University Hospital of the Albert-Ludwigs-Universität Freiburg, Germany
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186
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Leproult R, Van Reeth O, Byrne MM, Sturis J, Van Cauter E. Sleepiness, performance, and neuroendocrine function during sleep deprivation: effects of exposure to bright light or exercise. J Biol Rhythms 1997; 12:245-58. [PMID: 9181436 DOI: 10.1177/074873049701200306] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The temporal profiles of subjective fatigue (as assessed by the Stanford Sleepiness Scale), of cognitive performance (on a digit symbol substitution test and a symbol copying task), of body temperature, and of the peripheral concentrations of melatonin, thyroid-stimulating hormone (TSH), and cortisol were obtained simultaneously at frequent intervals in 17 normal young subjects submitted to a 43-h period of constant routine conditions involving continuous wakefulness at bed rest in dim indoor light. The subjects had knowledge of time of day. Caloric intake was exclusively in the form of an intravenous glucose infusion, and plasma glucose levels were monitored continuously in 8 of the 17 subjects. Under these conditions, fluctuations in plasma glucose reflect primarily changes in glucose use because endogenous glucose production is suppressed by the exogenous infusion. Following the completion of a baseline constant routine study, the volunteers participated in two subsequent studies using the same protocol to determine the immediate psychophysiological effects of exposure to a 3-h pulse of bright light or to a 3-h pulse of physical exercise. Sleepiness and performance varied in a mirror image, with significant negative correlations. Sleepiness scores were minimal around noon and then increased at a modest rate throughout the rest of the normal waking period. Staying awake during usual bedtime hours was associated with an acceleration in the rate of increase in sleepiness, which coincided with decreasing body temperature, rapidly rising cortisol concentrations, and maximal levels of melatonin and TSH. When body temperature reached its nadir, a further major increase in sleepiness occurred in parallel with a pronounced decrease in plasma glucose (reflecting increased glucose use). Recovery from maximal sleepiness started when blood glucose levels stopped falling and when significant decreases in cortisol and melatonin concentrations were initiated. Lower levels of subjective sleepiness resumed when glucose concentrations and body temperature had returned to levels similar to those observed prior to sleep deprivation and when melatonin and TSH concentrations had returned to daytime levels. The synchrony of behavioral, neuroendocrine, and metabolic changes suggests that circulating hormonal levels could exert modulatory influences on sleepiness and that metabolic alterations may underlie the sudden increase in fatigue consistently occurring at the end of a night of sleep deprivation. Effects of bright light or exercise exposure on subjective sleepiness appeared to be critically dependent on the timing of exposure.
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Affiliation(s)
- R Leproult
- Department of Medicine, University of Chicago, IL 60637, USA
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187
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Abstract
Anxiety and insomnia are among the more frequently encountered problems in geriatric cases. The effective clinical approach identifies underlying diagnostic syndromes or general medical conditions. An integrated approach to management combines pharmacotherapy and behavioral interventions as appropriate. Overall the prognosis for most patients is excellent.
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Affiliation(s)
- D G Folks
- Department of Psychiatry, Creighton University School of Medicine, Omaha, Nebraska, USA
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188
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Haimov I, Lavie P. Melatonin — a chronobiotic and soporific hormone. Arch Gerontol Geriatr 1997; 24:167-73. [PMID: 15374123 DOI: 10.1016/s0167-4943(96)00749-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/1996] [Revised: 08/15/1996] [Accepted: 08/16/1996] [Indexed: 11/28/2022]
Abstract
In this report we review evidence that melatonin, a hormone produced by the pineal gland during the hours of darkness, plays a major role in the synchronization of the sleep/wake cycle. The production of melatonin is regulated by a structure located in the hypothalamus called the suprachiasmatic nucleus (SCN). The activity of the SCN is strongly affected by changes in illumination and, as a consequence, melatonin levels are high during darkness and low in the light and it, therefore, reflects the cycle. Changes in sleep/wake patterns are among the hallmarks of biological aging. Complaints of difficulty in initiating and maintaining sleep, and daytime drowsiness, are more common in the elderly than in any other age group. In this report, we review evidence that impaired meltonin secretion is associated with sleep disorders in old age. Circulating melatonin levels have been found to be significantly lower in elderly insomniacs than in age-matched controls, and their onset and peak times delayed. In view of these findings, we investigated the effects of melatonin treatment on melatonin-deficient insomnia in the elderly. From the results of our study, it seems likely that melatonin replacement therapy may be beneficial in the initiation and maintenance of sleep in this population.
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Affiliation(s)
- I Haimov
- Sleep Laboratory, Faculty of Medicine, Gutwirth Building, Technion City, Haifa 32000, Israel
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189
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Abstract
Melatonin has clear acute and delayed effects on sleep and circadian rhythms. Decrements in core temperature and alertness have been found at different times of day following low pharmacological and physiological doses of melatonin. When correctly timed, melatonin induces both phase advances and phase delays of the circadian system in humans. When timed to advance, the decrement in temperature and alertness and the degree of shift are closely related to dose. In both simulation and field studies, correctly timed melatonin can alleviate some of the problems of shiftwork and jet lag, notably enhancing sleep and alertness and hastening adaptation of rhythms to the imposed schedule. Performance effects and changes in sleep architecture need to be fully evaluated. The optimization of dose and formulation is also an area that requires further work. Whether or not recently developed melatonin analogs (72) will prove more or less useful than melatonin in adapting to phase shift remains to be seen. If incorrectly timed, melatonin has the potential to induce deleterious effects. While short-term studies indicate that it has very low toxicity, there are no long-term safety data. All of the studies reported here concern healthy adult volunteers and the use of a preparation licensed for human experimental use and available on a named patient basis on prescription. There are no data on uncontrolled preparations available over the counter in some countries. Its effects in pregnancy, interaction with other medications, and many other considerations remain to be addressed. Thus, while melatonin is useful in well-controlled conditions, the indiscriminate use of unlicensed preparations is not advisable.
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Affiliation(s)
- J Arendt
- School of Biological Sciences, University of Surrey, Guildford, UK
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190
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Sicsic S, Serraz I, Andrieux J, Brémont B, Mathé-Allainmat M, Poncet A, Shen S, Langlois M. Three-dimensional quantitative structure-activity relationship of melatonin receptor ligands: a comparative molecular field analysis study. J Med Chem 1997; 40:739-48. [PMID: 9057860 DOI: 10.1021/jm960680+] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
A three-dimensional quantitative structure-activity relationship using the comparative molecular field analysis (CoMFA) paradigm applied to 57 melatonin receptor ligands belonging to diverse structural families was performed. The compounds studied which have been synthesized previously and reported to be active at chicken brain melatonin receptors were divided into a training set of 48 molecules and a test set of 9 molecules. As most of these compounds have a highly flexible ethylamido side chain, the alignments were based on the most sterically constrained molecule which contains a tricyclic phenalene structure. This tricyclic compound can adopt an axial and an equatorial conformation. Two different molecular superpositions representing possible positioning within the receptor site have been suggested previously. CoMFA was tentatively used to discriminate between alternate hypothetical biologically active conformation and between possible positionings. The best 3D quantitative structure-activity relationship model found yields significant cross-validated, conventional, and predictive r2 values equal to 0.798, 0.967, and 0.76, respectively, along with an average absolute error of prediction of 0.25 log units. These results suggest that the active conformation of the most flexible molecules including melatonin is in a folded form if we consider the spatial position of the ethylamido side chain relative to the aromatic ring.
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Affiliation(s)
- S Sicsic
- Biocis (CNRS, ura 1843), Faculté de Pharmacie, Université de Paris-Sud, Chãtenay-Malabry, France
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191
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Affiliation(s)
- A Brzezinski
- Department of Obstetrics and Gynecology, Hebrew University Hadassah Medical School, Jerusalem, Israel
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192
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Mahle CD, Takaki KS, Watson AJ. Chapter 4. Melatonin Receptor Ligands and Their Potential Clinical Applications. ANNUAL REPORTS IN MEDICINAL CHEMISTRY 1997. [DOI: 10.1016/s0065-7743(08)61462-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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193
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Abstract
Circadian rhythms are major features of adaptation to our environment. In mammals, circadian rhythms are generated and regulated by a circadian timing system. This system consists of entertainment pathways, pacemakers, and pace-maker output to effector systems that are under circadian control. The primary entertainment pathway is the retinohypothalamic tract, which terminates in the circadian pacemakers, the suprachiasmatic nuclei of the hypothalamus. The output of the suprachiasmatic nuclei is principally to the hypothalamus, the midline thalamus, and the basal forebrain. This provides a temporal organization to the sleep-wake cycle, to many physiological and endocrine functions, and to psychomotor performance functions. Disorders of circadian timing primarily affect entertainment and pacemaker functions. The pineal hormone, melatonin, appears to be promising agent for therapy of some circadian timing disorders.
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Affiliation(s)
- R Y Moore
- Department of Psychiatry, University of Pittsburgh, Pennsylvania 15621, USA
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194
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Sumová A, Illnerová H. Melatonin instantaneously resets intrinsic circadian rhythmicity in the rat suprachiasmatic nucleus. Neurosci Lett 1996; 218:181-4. [PMID: 8945758 DOI: 10.1016/s0304-3940(96)13159-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
In order to follow resetting of the rat circadian pacemaking system by melatonin in vivo, the rhythm in the light-induced c-fos expression was used as a marker of the intrinsic rhythmicity of the suprachiasmatic nucleus (SCN). A single melatonin administration during late day to rats maintained originally under a short photoperiod with 8 h of light per day or under a long photoperiod with 16 h of light per day phase advanced immediately the evening rise in the light-induced SCN c-Fos immunochemistry by about 1.5 h. The data indicate that melatonin administration in vivo may instantaneously reset the intrinsic SCN rhythmicity.
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Affiliation(s)
- A Sumová
- Institute of Physiology, Academy of Sciences of the Czech Republic, Prague, Czech Republic
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195
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Abstract
The role exerted by melatonin in human physiology has not been completely ascertained. Melatonin levels have been measured in different physiopathological conditions, but the effects induced by melatonin administration or withdrawal have been tested only recently. Some effects have been clearly documented. Melatonin has hypothermic properties, and its nocturnal secretion generates about 40% of the amplitude of the circadian body temperature rhythm. Melatonin has sleep inducing properties, and exerts important activities in the regulation of circadian rhythms. Melatonin is capable of phase shifting human circadian rhythms, of entraining free-running circadian rhythms, and of antagonizing phase shifts induced by nighttime exposure to light. Its effect on human reproduction is not completely clear, but stimulatory effects on gonadotropin secretion have been reported in the follicular phase of the menstrual cycle. Direct actions on ovarian cells and spermatozoa have been also documented. Beside these, new important actions for melatonin may be proved. Melatonin may exert protective effects on the cardiovascular system, by reducing the risk of atherosclerosis and hypertension, and may influence immune responses. Finally, by acting as an antioxidant, melatonin could be important in slowing the processes of ageing.
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Affiliation(s)
- A Cagnacci
- Institute of Obstetrics and Gynecology, University of Modena, Italy
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196
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Abstract
A group of Vancouver health professionals, including the authors, have studied the use of oral melatonin in the treatment of chronic sleep disorders in children with disabilities since the Fall of 1991. This review article is based on the first 100 patients, half of whom were visually impaired or blind. Children with neurological, neuropsychiatric, and developmental disabilities are predisposed to chronic sleep-wake cycle disturbances. Disorders such as blindness, deaf-blindness, mental retardation, autism, and central nervous system diseases, among others, diminish the ability of these individuals to perceive and interpret the multitude of cues for synchronizing their sleep with the environment. Melatonin, which benefitted slightly over 80% of our patients, appears to be a safe, inexpensive, and a very effective treatment of sleep-wake cycle disorders. The oral dose of fast release melatonin taken at bed-time ranged from 2.5 mg to 10 mg. Side effects or the development of tolerance have not been observed. Since the causes of sleep difficulties are extremely variable, not all children are candidates for treatment. For successful melatonin treatment, clinical experience is required, and the influences of other health problems and medications need to be considered. Further clinical and laboratory research in this field is imperative because melatonin treatment offers enormous health, emotional, social, and economic benefits to society, especially since multidisabled children with chronic sleep difficulties do not respond well to current therapeutic regimes.
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Affiliation(s)
- J E Jan
- University of British Columbia, Developmental Paediatrics, and Visually Impaired Program, Sunny Hill Health Centre, Vancouver, Canada
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197
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198
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Abstract
Melatonin, produced by the pineal gland at night, has a role in regulation of the sleep-wake cycle. Among elderly people, even those who are healthy, the frequency of sleep disorders is high and there is an association with impairment of melatonin production. We investigated the effect of a controlled-release formulation of melatonin on sleep quality in 12 elderly subjects (aged 76 [SD 8] years) who were receiving various medications for chronic illnesses and who complained of insomnia. In all 12 subjects the peak excretion of the main melatonin metabolite 6-sulphatoxymelatonin during the night was lower than normal and/or delayed in comparison with non-insomniac elderly people. In a randomised, double-blind, crossover study the subjects were treated for 3 weeks with 2 mg per night of controlled-release melatonin and for 3 weeks with placebo, with a week's washout period. Sleep quality was objectively monitored by wrist actigraphy. Sleep efficiency was significantly greater after melatonin than after placebo (83 [SE 4] vs 75 [3]%, p < 0.001) and wake time after sleep onset was significantly shorter (49 [14] vs 73 [13] min, p < 0.001). Sleep latency decreased, but not significantly (19 [5] vs 33 [7] min, p = 0.088). Total sleep time was not affected. The only adverse effects reported were two cases of pruritus, one during melatonin and one during placebo treatment; both resolved spontaneously. Melatonin deficiency may have an important role in the high frequency of insomnia among elderly people. Controlled-release melatonin replacement therapy effectively improves sleep quality in this population.
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Affiliation(s)
- D Garfinkel
- Day Care Unit, E Wolfson Medical Center, Holon, Israel
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199
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Affiliation(s)
- I Haimov
- Sleep Laboratory, Faculty of Medicine, Technion - Israel Institute of Technology, Haifa
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