Department of Anaesthesiology Nursing and Intensive Care, Medical University of Gdansk, Gdansk, Poland.
Department of Human Physiology, Medical University of Gdansk, Gdansk, Poland; Department of Psychiatry, Medical University of Gdansk, Gdansk, Poland.
Sleep Med. 2020 May;69:127-134. doi: 10.1016/j.sleep.2020.01.019. Epub 2020 Jan 27.
The intensive care unit (ICU) environment contributes to the development of sleep disturbances. Sleep disturbances, sleep fragmentation, and multiple awakening episodes lead to the circadian rhythm disorder, which increases the risk of delirium. Melatonin and melatonin receptor agonist is widely used agent in the therapy of sleep disturbances. However, there is also some for its efficacy in ICU delirium. Enteral melatonin and ramelteon supplementation eliminates (partially) the delirium inducing factors.
PubMed/MEDLINE, OVID, Embase, Cochrane Library, and Web of Science databases were searched using adequate key words. We reviewed the literature on the role of melatonin and ramelteon in the prevention of sleep disturbances and delirium in intensive care units and analysed the methods of melatonin therapy in an ICU setting. Review followed the PRISMA statement. A review written protocol was not drafted.
Originally 380 studies were searched in five scientific databases. After rejecting the duplicate results, 125 results were obtained. Finally, 10 scientific studies were included in the review. In selected articles, the leading topics analysed were the role of melatonin and ramelteon in the prevention of delirium and sleep disorders. In addition, the noted effect of therapy with these agents on reducing the ventilation time of mechanical time and the demand for psychoactive substances in the ICU environment.
Reduction of either the incidence or the severity of delirium course is possible by eliminating its risk factors. Risk factors are directly related to sleep disorders. To reduce the problem, therefore, a holistic approach to the source is necessary. The efficacy of melatonin therapy in an ICU setting requires confirmation in studies including a greater number of participants as the impact of melatonin on these factors is yet to be fully elucidated. However, the prognosis is predictive because this concept provides patients with a minimally invasive and natural form of therapy.
重症监护病房（ICU）的环境会导致睡眠障碍的发生。睡眠障碍、睡眠片段化和多次觉醒会导致昼夜节律紊乱，增加谵妄的风险。褪黑素和褪黑素受体激动剂是治疗睡眠障碍的常用药物。然而，对于 ICU 谵妄的疗效也存在一些争议。肠内给予褪黑素和雷美尔酮补充剂可以消除（部分）导致谵妄的因素。
使用适当的关键词在 PubMed/MEDLINE、OVID、Embase、Cochrane 图书馆和 Web of Science 数据库中进行检索。我们综述了褪黑素和雷美尔酮在预防 ICU 睡眠障碍和谵妄中的作用，并分析了 ICU 环境中褪黑素治疗的方法。综述遵循 PRISMA 声明。未起草综述的写作方案。
最初在五个科学数据库中搜索了 380 项研究。剔除重复结果后，得到 125 项结果。最后，有 10 项科学研究纳入了综述。在选定的文章中，分析的主要主题是褪黑素和雷美尔酮在预防谵妄和睡眠障碍中的作用。此外，还注意到这些药物治疗在减少机械通气时间和 ICU 环境中对精神活性物质的需求方面的效果。
通过消除其危险因素，可以降低谵妄发生率或严重程度。危险因素与睡眠障碍直接相关。因此，需要从整体上解决这个问题。褪黑素治疗在 ICU 环境中的疗效需要在纳入更多参与者的研究中得到证实，因为褪黑素对这些因素的影响尚未完全阐明。然而，由于该概念为患者提供了一种微创且自然的治疗形式，因此预后是有预测性的。
