Shamir E, Laudon M, Barak Y, Anis Y, Rotenberg V, Elizur A, Zisapel N
Abarbanel Mental Health Center, Sackler Faculty of Medicine, Tel Aviv University, Israel.
J Clin Psychiatry. 2000 May;61(5):373-7. doi: 10.4088/jcp.v61n0509.
Accumulating evidence indicates decreased melatonin levels in patients with schizophrenia. Insomnia, mainly difficulty in falling asleep at night, is commonly reported in this population. Association of insomnia with low or abnormal melatonin rhythms has been repeatedly documented. Melatonin is an endogenous sleep promoter in humans. We hypothesized that insomnia in patients with schizophrenia may be partially due to diminished melatonin output. In this study, we measured melatonin output in patients with chronic schizophrenia and assessed the effects of melatonin replacement on their sleep quality.
In a randomized, double-blind, cross-over, clinically based trial, 19 patients with DSM-IV schizophrenia who were treated with the normal treatment regimen were given melatonin (2 mg, controlled release) or placebo for 2 treatment periods of 3 weeks each with 1 week washout between treatment periods (7 weeks total). For measuring endogenous melatonin production, urine was collected from each patient every 3 hours between 9:00 p.m. and 9:00 a.m. Actigraphy was performed for 3 consecutive nights at the end of each period. Activity- and rest-derived sleep parameters were compared for the whole population with treatment arm as the intervening variable. A separate analysis was performed for patients subgrouped into high versus low sleep efficiency.
All patients had low melatonin output. Melatonin replacement significantly improved rest-derived sleep efficiency compared with placebo (83.5% vs. 78.2%, p = .038) in this population. Improvement of sleep efficiency was significantly greater (p < .0014) in low-efficiency (80% vs. 67%) than high-efficiency sleepers (88% vs. 90%). In addition, during melatonin therapy, tendencies toward shortened sleep latency (by 40 minutes, p < .056) and increased sleep duration (by 45 minutes, p < .078) were observed in low- but not high-efficiency sleepers.
Melatonin improves sleep efficiency in patients with schizophrenia whose sleep quality is low.
越来越多的证据表明，精神分裂症患者体内褪黑素水平降低。该人群中普遍存在失眠现象，主要表现为夜间入睡困难。失眠与低褪黑素水平或异常的褪黑素节律之间的关联已被多次证实。褪黑素是人体内一种内源性的睡眠促进剂。我们推测，精神分裂症患者的失眠可能部分归因于褪黑素分泌减少。在本研究中，我们测量了慢性精神分裂症患者的褪黑素分泌量，并评估了补充褪黑素对其睡眠质量的影响。
在一项基于临床的随机、双盲、交叉试验中，19例接受常规治疗方案的DSM-IV精神分裂症患者被给予褪黑素（2mg，缓释）或安慰剂，每个治疗周期为3周，共2个治疗周期，治疗周期之间有1周的洗脱期（总共7周）。为了测量内源性褪黑素的产生，在晚上9点至上午9点期间，每隔3小时收集每位患者的尿液。在每个周期结束时，连续3晚进行活动记录仪监测。以治疗组为干预变量，比较整个人群基于活动和休息的睡眠参数。对睡眠效率分为高与低的患者亚组进行单独分析。
所有患者的褪黑素分泌量均较低。与安慰剂相比，补充褪黑素显著提高了该人群基于休息的睡眠效率（83.5%对78.2%，p = 0.038）。低睡眠效率者（80%对67%）的睡眠效率改善显著大于高睡眠效率者（88%对90%）（p < 0.0014）。此外，在褪黑素治疗期间，低睡眠效率者出现了睡眠潜伏期缩短（40分钟，p < 0.056）和睡眠时间延长（45分钟，p < 0.078）的趋势，而高睡眠效率者未出现。
褪黑素可改善睡眠质量较差的精神分裂症患者的睡眠效率。
