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Khafaji AWM, Al-Zubaidy AAK, Farhood IG, Salman HR. Ameliorative effects of topical ramelteon on imiquimod-induced psoriasiform inflammation in mice. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:6231-6248. [PMID: 38446218 DOI: 10.1007/s00210-024-03017-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 02/19/2024] [Indexed: 03/07/2024]
Abstract
Psoriasis is a long-lasting, immune-related inflammatory skin disease that affects 2-3% of the global population. It is distinguished by erythematous, silvery, and scaly patches. Ramelteon is a type of melatonin agonist that is used to treat insomnia. It has enhanced non-classical immunomodulatory and anti-inflammatory activities. The aim of the study is to assess the ameliorative effects of topical ramelteon on imiquimod (IMQ)-aggravated psoriasiform-like dermatosis in mice. The 32 albino mouse males were placed into six groups of eight animals, all of them. With the exception of the control group, all groups gained a once-a-day regimen of topical imiquimod 5% cream at a dose of 62.5 mg for eight uninterrupted days, while mice in the control group gained vaseline-based ointment alternately. Immediately after an 8-day induction period in the imiquimod group, mice in the clobetasol and ramelteon treatment groups obtained a twice-daily regimen of topical clobetasol propionate 0.05% ointment and 0.1% ointment, respectively, for a further 8 days. This extends the total duration of the experimental study to 16 continuous days. The findings of our study found that ramelteon significantly mitigated the concentrations of inflammatory cytokines in the skin tissue, including interleukin (IL)-6, IL-17A, IL-23, tumor necrosis factor-α (TNF-α), and vascular endothelial growth factor (VEGF), as well as the scores associated with psoriatic lesions, including erythema, scaling, skin thickening, ear thickness, and overall cumulative PASI scores. Additionally, the anti-inflammatory impact of ramelteon was achieved by markedly increasing IL-10 levels in the skin tissue and correcting cutaneous histopathological alterations. Ramelteon ointment (0.1%) was comparable to that of clobetasol (0.05%) ointment in alleviating a mouse model of imiquimod-induced psoriasiform inflammation; this is probably due to its potential anti-inflammatory and immunomodulatory activities. Therefore, ramelteon could be a good additive option for therapeutic management of immune-triggered inflammatory conditions such as psoriasis.
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Affiliation(s)
| | | | - Iqbal Ghalib Farhood
- Section of Dermatology and Venereology, Department of Medicine, College of Medicine, Al-Nahrain University, Baghdad, Iraq
| | - Hayder Ridha Salman
- Department of Pharmacology, College of Pharmacy, Al-Mustaqbal University, 510001, Hillah, Iraq
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Akkaoui MA, Palagini L, Geoffroy PA. Sleep Immune Cross Talk and Insomnia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2023; 1411:263-273. [PMID: 36949314 DOI: 10.1007/978-981-19-7376-5_12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
Sleep and immunity have bidirectional relationships. In this chapter, we review the links between sleep and immunity, focusing on immune changes occurring in the insomnia disorder. During physiological sleep, there is a decrease of pro-inflammatory cytokines (IL-1, IL-6 and TNF-α) and a decrease of anti-inflammatory cytokines (IL-4, IL-10). Examinations of ratios of pro-inflammatory and anti-inflammatory cytokines allow to identify rather a pro-inflammatory activity at the beginning of the night and confirm then anti-inflammatory during the second part of the night. Immune cells, as NK-cells, decrease in the blood, due to their migration to secondary lymphoid organs, but their activity increases. Inversely, a short sleep duration appears associated with increased inflammatory processes and increased risk of infection.Only few studies have investigated changes in immunity in patients with insomnia disorder. These studies suggest that insomnia disorder is related to deregulation of the immune system, with an increase in the level of pro-inflammatory cytokines and change in rate of secretion and a decrease in the level of lymphocyte. Insomnia treatments, particularly cognitive behavioral therapy (CBT-I), seems to have a restorative effect not only on sleep, but also on the associated inflammation. Melatonin also seems to reduce inflammation in patients suffering from insomnia disorder.More studies are necessary to better understand the pathophysiology of changes in immune system in patients suffering from insomnia disorders and their clinical implications.
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Affiliation(s)
- Marine Ambar Akkaoui
- Centre Psychiatrique d'Orientation et d'Accueil (CPOA), GHU Paris - Psychiatry & Neurosciences, Paris, France
- Etablissement Publique de Santé Mentale de Ville Evrard, Neuilly Sur Marne, France
| | - Laura Palagini
- Psychiatric Clinic, Department of Neuroscience and Rehabilitation, University of Ferrara, Ferrara, Italy
- Psychiatric Clinic Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Pierre A Geoffroy
- Département de psychiatrie et d'addictologie, AP-HP, GHU Paris Nord, DMU Neurosciences, Hôpital Bichat - Claude Bernard, Paris, France
- GHU Paris - Psychiatry & Neurosciences, Paris, France
- Université de Paris, NeuroDiderot, Inserm, Paris, France
- CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences, Strasbourg, France
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Yuksel TN, Yayla M, Kose D, Halici Z, Bozkurt E, Toktay T. Protective effects of melatonin receptor agonists on endotoxin-induced uveitis in rats. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2023; 26:540-548. [PMID: 37051104 PMCID: PMC10083838 DOI: 10.22038/ijbms.2023.67297.14749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 02/05/2023] [Indexed: 04/14/2023]
Abstract
Objectives Melatonin has an important role in regulating a variety of physiological functions of the body. We investigated the protective effects of Agomelatine (AGO) and Ramelteon (RAME) on Endotoxin-Induced Uveitis (EIU) in rats. Materials and Methods 70 rats were randomly divided into fourteen groups. Healthy group normal saline, (IP), Uveitis group (200 μg/kg lipopolysaccharide (LPS), SC), DEX group (200 μg/kg LPS plus 1 mg/kg dexamethasone, IP), AGO20 group received 200 μg/kg LPS plus 20 mg/kg AGO, AGO40 group received 200 μg/kg LPS plus 40 mg/kg AGO, RAME2 group received 200 μg/kg LPS plus 2 mg/kg RAME, and group RAME4 received 200 μg/kg LPS plus 4 mg/kg RAME. Each group had two subgroups: the 3rd and 24th hr. The eye tissues were collected and investigated biomicroscopically (clinical manifestations and scoring, molecularly(qRT-PCR analyses of tumor necrosis factor-α (TNF-α), vascular endothelial growth factor (VEGF), and caspase 3 and caspase 9 mRNA expression), biochemically (Superoxide dismutase activity (SOD), Glutathione (GSH), and malondialdehyde levels (MDA)) and histopathologically (staining with Harris Hematoxylin and Eosin Y). Results Melatonin receptor agonist treatment reduced the clinical score count of ocular inflammation in the uveitic rats. TNF-α, VEGF, caspase 9, and caspase 3 levels markedly decreased in the uveitic rats. Melatonin receptor agonists significantly ameliorated fixed changes in GSH, SOD, and MDA levels. Melatonin receptor agonists also ameliorated histopathological injury in eye tissues associated with uveitis. Conclusion Melatonin receptor agonists ameliorated the inflammatory response in EIU. These findings suggest that melatonin receptor agonists may represent a potential novel therapeutic drug for uveitis treatment.
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Affiliation(s)
- Tugba Nurcan Yuksel
- Department of Pharmacology, Faculty of Medicine, Tekirdag Namık Kemal University, Tekirdag, Turkey
- Corresponding author: Tugba Nurcan Yuksel. Department of Pharmacology, Faculty of Medicine, Tekirdag Namik Kemal University, Tekirdag, Turkey. Tel: +90 546 573 8141; +90 282 250 5742;
| | - Muhammed Yayla
- Department of Pharmacology, Faculty of Medicine, Kafkas University, Kars, Turkey
| | - Duygu Kose
- Department of Pharmacology, Faculty of Medicine, Sutcu Imam University, Kahramanmaraş, Turkey
| | - Zekai Halici
- Department of Pharmacology, Faculty of Medicine, Ataturk University, Erzurum, Turkey
- Clinical Research, Development and Design Application and Research Center, Ataturk University, Erzurum, Turkey
| | - Erdinc Bozkurt
- Department of Ophthalmology, University of Health Science, Ümraniye Education and Research Hospital, Department of Ophthalmology, Istanbul, Turkey
| | - Toktay Toktay
- Department of Histology and Embryology, Faculty of Medicine, Kafkas University, Kars, Turkey
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Mehdipoor M, Mirmotahari SA, Nouriyani S, Salehirad M, Darbeheshti S, Motaghinejad M. Ramelteon, as a Melatonin Agonist, is Expected to be Effective on COVID-19 Induced Organ Damage: The Hypothetic Role of NF-κB Signaling Pathway. Adv Biomed Res 2022; 11:101. [PMID: 36660753 PMCID: PMC9843598 DOI: 10.4103/abr.abr_60_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 09/01/2021] [Accepted: 09/05/2021] [Indexed: 01/21/2023] Open
Affiliation(s)
- Mahdis Mehdipoor
- Department of Medicinal Chemistry, School of Pharmacy and Pharmaceutical Sciences, Isfahan University of Medical Sciences, Isfahan, I.R. Iran
| | - Seyedeh Azin Mirmotahari
- Department of Pharmaceutical Biomaterials and Medical Biomaterials Research Center, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Shima Nouriyani
- School of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mahsa Salehirad
- Department of Pharmaceutical Chemistry, Faculty of Pharmaceutical Chemistry, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Sepideh Darbeheshti
- Department of Clinical Biochemistry, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Majid Motaghinejad
- Chronic Respiratory Disease Research Center (CRDRC), National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran,Address for correspondence: Dr. Majid Motaghinejad, Masih Daneshvari Hospital, Darabad Avenue, Shahid Bahonar Roundabout, Tehran, Iran. Tel/Fax: +98 (21): 26109484- 26109680, Iran. E-mail:
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Aslankoc R, Savran M, Doğuç DK, Sevimli M, Tekin H, Kaynak M. Ameliorating effects of ramelteon on oxidative stress, inflammation, apoptosis, and autophagy markers in methotrexate-induced cerebral toxicity. IRANIAN JOURNAL OF BASIC MEDICAL SCIENCES 2022; 25:1183-1189. [PMID: 36311194 PMCID: PMC9588322 DOI: 10.22038/ijbms.2022.62955.13913] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 08/30/2022] [Indexed: 11/20/2022]
Abstract
Objectives Methotrexate (MTX) is a widely used chemotherapeutic agent that, however, is known to have serious side effects such as neurotoxicity. In the present study, we aimed to evaluate the possible favorable effects of ramelteon (RMLT) on MTX-induced cerebral toxicity. Materials and Methods Thirty-two male Wistar albino rats were divided into four groups: Control group, MTX group (20 mg/kg MTX, IP, single dose), MTX+RMLT group (20 mg/kg MTX, IP, single dose + 10 mg/kg RMLT, by gavage, 7 days), and RMLT group (10 mg/kg RMLT, by gavage, 7 days). Results In the MTX group, increased levels of total oxidant status (TOS) and oxidative stress index (OSI) levels and decreased levels of total antioxidant status (TAS) level were observed. RMLT significantly reversed oxidative stress parameters. Real-time PCR analysis revealed that MTX increased the expressions of Beclin-1 and autophagy-related gene 12 (ATG12). These expressions were significantly decreased by RMLT. Vacuolar changes, apoptotic cells, and inflammatory cell infiltration induced by MTX were ameliorated by RMLT treatment. Increased tumor necrosis factor-α (TNF- α) and Caspase-3 activities induced by MTX were returned to their normal levels by RMLT. Conclusion All our results demonstrate that RMLT alleviates the harmful effects of MTX on the cerebral cortex tissue. Therefore, RMLT may be considered for supportive therapy for preventing side effects of MTX in patients needing MTX therapy.
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Affiliation(s)
- Rahime Aslankoc
- Süleyman Demirel University, Faculty of Medicine, Department of Physiology, Isparta, Turkey,Corresponding author: Rahime Aslankoc. Süleyman Demirel University, Faculty of Medicine, Department of Physiology 32260 Isparta, Turkey. Tel: +90-2462113606; Fax: +902462371165;
| | - Mehtap Savran
- Süleyman Demirel University, Faculty of Medicine, Department of Pharmacology, Isparta, Turkey
| | - Duygu Kumbul Doğuç
- Süleyman Demirel University, Faculty of Medicine, Department of Biochemistry, Isparta, Turkey
| | - Murat Sevimli
- Süleyman Demirel University, Faculty of Medicine, Department of Histology and Embryology, Isparta, Turkey
| | - Hale Tekin
- Süleyman Demirel University, Graduate School of Natural and Applied Sciences, Department of Bioengineering, Isparta, Turkey
| | - Mine Kaynak
- Süleyman Demirel University, Faculty of Medicine, Department of Pharmacology, Isparta, Turkey
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Abstract
This review presents data on changes in measures of innate and adaptive immunity associated with the state of sleep. The effects of restricted and prolonged sleep duration on measures of morbidity, mortality, and susceptibility to infectious diseases and the effects of vaccination are discussed. Measures of immunity in patients with insomnia and changes on the background of correction of sleep impairments are presented.
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Affiliation(s)
- M G Poluektov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Abstract
Changes in innate and adaptive immunity depending on sleep state and the influence of prolonged and restricted sleep time on morbidity and mortality as well as vulnerability to infections and effect of vaccination are discussed. Patients with insomnia have compromised immunity that could be reversed with the successful treatment of disordered sleep.
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Affiliation(s)
- M G Poluektov
- Sechenov First Moscow State Medical University, Moscow, Russia
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Wu GC, Peng CK, Liao WI, Pao HP, Huang KL, Chu SJ. Melatonin receptor agonist protects against acute lung injury induced by ventilator through up-regulation of IL-10 production. Respir Res 2020; 21:65. [PMID: 32143642 PMCID: PMC7059294 DOI: 10.1186/s12931-020-1325-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 02/17/2020] [Indexed: 02/06/2023] Open
Abstract
Background It is well known that ventilation with high volume or pressure may damage healthy lungs or worsen injured lungs. Melatonin has been reported to be effective in animal models of acute lung injury. Melatonin exerts its beneficial effects by acting as a direct antioxidant and via melatonin receptor activation. However, it is not clear whether melatonin receptor agonist has a protective effect in ventilator-induced lung injury (VILI). Therefore, in this study, we determined whether ramelteon (a melatonin receptor agonist) can attenuate VILI and explore the possible mechanism for protection. Methods VILI was induced by high tidal volume ventilation in a rat model. The rats were randomly allotted into the following groups: control, control+melatonin, control+ramelteon, control+luzindole, VILI, VILI+luzindole, VILI + melatonin, VILI + melatonin + luzindole (melatonin receptor antagonist), VILI + ramelteon, and VILI + ramelteon + luzindole (n = 6 per group). The role of interleukin-10 (IL-10) in the melatonin- or ramelteon-mediated protection against VILI was also investigated. Results Ramelteon treatment markedly reduced lung edema, serum malondialdehyde levels, the concentration of inflammatory cytokines in bronchoalveolar lavage fluid (BALF), NF-κB activation, iNOS levels, and apoptosis in the lung tissue. Additionally, ramelteon treatment significantly increased heat shock protein 70 expression in the lung tissue and IL-10 levels in BALF. The protective effect of ramelteon was mitigated by the administration of luzindole or an anti-IL-10 antibody. Conclusions Our results suggest that a melatonin receptor agonist has a protective effect against VILI, and its protective mechanism is based on the upregulation of IL-10 production.
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Affiliation(s)
- Geng-Chin Wu
- The Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan.,Department of Internal Medicine, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
| | - Chung-Kan Peng
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Wen-I Liao
- Department of Emergency Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hsin-Ping Pao
- The Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei, Taiwan
| | - Kun-Lun Huang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. .,Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan.
| | - Shi-Jye Chu
- Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, No. 325, Section 2, Chenggong Road, Neihu, Taipei, 114, Taiwan.
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Abstract
Sleep has increasingly been found to play a role in the overall health of an individual, but sleep quality has also been decreasing with the invasion of technology into the bedroom, “always-on” lifestyles, and increasing demands on one’s time when awake. We have herein reviewed the literature to assess the impact of sleep on erectile dysfunction, lower urinary tract symptoms, hypogonadal symptoms, low testosterone, and male infertility. We find that erectile dysfunction, lower urinary tract symptoms, and hypogonadal symptoms all have a linear relationship with sleep, as worse symptoms occur with poorer sleep. Male infertility, interestingly, has an inverse U-shaped relation to sleep in which men with too little and too much sleep seem to be more at risk for infertility than those with 7–8 hours of sleep. Finally, the literature has not demonstrated a significant clinical relationship between hypogonadal symptoms or testosterone levels and sleep. Overall, a large number of men experience poor quality sleep. Given the impact that poor sleep can have on general health and men’s health, in particular, screening for poor sleep quality and recommending interventions to improve sleep are becoming imperative during clinical evaluation and treatment.
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Affiliation(s)
- Taylor P Kohn
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jaden R Kohn
- Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Nora M Haney
- The James Buchanan Brady Urological Institute and Department of Urology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Alexander W Pastuszak
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Larry I Lipshultz
- Scott Department of Urology, Baylor College of Medicine, Houston, TX, USA.,Center for Reproductive Medicine, Baylor College of Medicine, Houston, TX, USA
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Dennis JA, Alazzeh A, Kumfer AM, McDonald-Thomas R, Peiris AN. The Association of Unreported Sleep Disturbances and Systemic Inflammation: Findings from the 2005-2008 NHANES. SLEEP DISORDERS 2018; 2018:5987064. [PMID: 30402295 PMCID: PMC6198565 DOI: 10.1155/2018/5987064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 08/15/2018] [Accepted: 09/24/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/OBJECTIVE Sleep apnea is associated with elevated inflammatory markers. A subgroup of patients never report sleep disturbances to their physician. The inflammatory status of this subgroup is not known. The present study aims to evaluate two inflammatory markers, C-reactive protein (CRP) and red cell distribution width (RDW), in those with unreported sleep disturbances and compares these findings to those with and without reported sleep disorders. We also investigate the utility of RDW as an inflammatory marker in sleep disorders. METHODS Sample includes 9,901 noninstitutionalized, civilian, nonpregnant adults from the 2005-2008 National Health and Nutrition Examination Survey, a nationally representative, cross-sectional U.S. study. Sleep questionnaire and laboratory data were used to compare inflammatory markers (CRP and RDW) in five subgroups of individuals: reporting physician-diagnosed sleep apnea, reporting another physician-diagnosed sleep disorder, reported sleep disturbance to physician with no resulting diagnosis, unreported sleep disturbance (poor sleep quality not reported to physician), and no diagnosed sleep disorder or sleep disturbance. RESULTS Individuals with unreported sleep disturbance had significantly higher odds of elevated RDW (>13.6%) when compared to those without a sleep disturbance in adjusted models (OR=1.33). Those with unreported sleep disturbance had significantly higher odds of elevated CRP levels (>1 mg/L) than those without sleep disturbances (OR 1.34), although the association was not significant when adjusted for obesity and other controls. CONCLUSION Self-identified unreported sleep disturbances are associated with significantly higher odds of elevated RDW than those without sleep disturbances. RDW may serve as a valuable indicator in identifying individuals at higher risk for sleep apnea and other sleep disorders.
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Affiliation(s)
- Jeff A. Dennis
- Department of Public Health, Texas Tech University Health Sciences Center, 3601 4th St., MS 9430, Lubbock, TX 79430, USA
| | - Ahmad Alazzeh
- Department of Pulmonary and Critical Care, East Tennessee State University, Quillen College of Medicine, VA Bldg. 1, Johnson City, TN 37614-0622, USA
| | - Ann Marie Kumfer
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
| | - Rebecca McDonald-Thomas
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
| | - Alan N. Peiris
- Department of Internal Medicine, Texas Tech University Health Sciences Center, 3601 4th St., MS 9410, Lubbock, TX 79430, USA
- Clinical Research Institute, Texas Tech University Health Sciences Center, 3601 4th St., MS 8183, Lubbock, TX 79430, USA
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Thom R, Bui M, Rosner B, Teslyar P, Levy-Carrick N, Wolfe D, Klompas M. Ramelteon is Not Associated With Improved Outcomes Among Critically Ill Delirious Patients: A Single-Center Retrospective Cohort Study. PSYCHOSOMATICS 2018; 60:289-297. [PMID: 30193784 DOI: 10.1016/j.psym.2018.07.015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 07/23/2018] [Accepted: 07/24/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Delirium commonly affects critically ill patients and is associated with high morbidity and mortality. Some studies have suggested that ramelteon may prevent delirium, but ramelteon's impact on treating delirium is unknown. OBJECTIVE To compare outcomes of critically ill delirious patients treated with ramelteon versus those who were not. METHODS Retrospective cohort study of 322 intensive care unit patients stratified based on ramelteon exposure after a nonnegative Confusion Assessment Method-ICU score. MAIN OUTCOMES Primary outcomes were hours alive without delirium or coma and likelihood of delirium-coma resolution. Secondary outcomes were ventilator-free hours, likelihood of extubation, and mortality. RESULTS Hazard ratios for delirium-coma resolution, extubation, and 10-day mortality were 1.05 (95% confidence interval 0.54-2.01), 1.20 (95% confidence interval 0.47-3.03), and 0.31 (95% confidence interval 0.07-1.32), respectively. Median delirium-coma free hours did not differ between ramelteon exposed and unexposed patients. Median ventilator-free hours were higher in the ramelteon group, however, ramelteon was administered postextubation in 92% of cases. CONCLUSIONS Ramelteon was not associated with increased likelihood of delirium-coma resolution, extubation, or changes in mortality.
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Affiliation(s)
- Robyn Thom
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA.
| | - Melissa Bui
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA
| | - Bernard Rosner
- Brigham and Women's Hospital, Channing Division of Network Medicine, Boston, MA; Harvard University T H Chan School of Public Health, Boston, MA
| | - Polina Teslyar
- Beth Israel Deaconess Medical Center, Department of Psychiatry, Boston, MA; Harvard Medical School, Department of Psychiatry, Boston, MA
| | | | - David Wolfe
- Brigham and Women's Hospital, Department of Psychiatry, Boston, MA
| | - Michael Klompas
- Brigham and Women's Hospital, Department of Infectious Disease, Boston, MA; Harvard Medical School and Harvard Pilgrim Health Care Institute, Department of Population Medicine, Boston, MA
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