Matsui Kentaro, Kuriyama Kenichi, Kobayashi Mina, Inada Ken, Nishimura Katsuji, Inoue Yuichi
Department of Clinical Laboratory, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
Department of Sleep-Wake Disorders, National Institute of Mental Health, National Center of Neurology and Psychiatry, Tokyo, Japan.
J Clin Sleep Med. 2021 Jul 1;17(7):1475-1483. doi: 10.5664/jcsm.9236.
The objective of this study was to determine the efficacy of ramelteon in treating abnormal eating behavior in patients with sleep-related eating disorder and/or night eating syndrome.
We retrospectively reviewed the medical records of patients with sleep-related eating disorder/night eating syndrome at the Yoyogi Sleep Disorder Center from November 2013 to November 2018. We categorized patients as ramelteon treatment responders when the frequency of nighttime eating per week decreased to less than half of that before treatment.
Forty-nine patients were included in the analysis. The mean frequency of eating behavior (per week) (standard deviation) at baseline and post-ramelteon treatment was significantly different, at 5.3 (2.2) and 3.2 (3.0), respectively (P < .001). Twenty-one patients (42.9%) were classified as responders. Adverse events, all of which were mild daytime somnolence, were observed in 5 patients. There were significantly more individuals using benzodiazepine derivatives and Z-drugs before treatment and those with coexisting delayed sleep-wake phase disorder in the responder group than in the nonresponder group (P < .001 and P < .05, respectively). The mean benzodiazepine derivatives and Z-drugs dose significantly decreased from baseline to post-ramelteon treatment within the responder group (P < .05). This trend was not observed in the nonresponder group. Meanwhile, the sleep midpoint of patients with sleep-related eating disorder/night eating syndrome and delayed sleep-wake phase disorder did not significantly change after treatment.
Our results indicate that ramelteon is a candidate treatment for sleep-related eating disorder/night eating syndrome. The effects of ramelteon might have occurred primarily through the reduction in benzodiazepine derivatives and Z-drugs rather than through the improvement in sleep-wake rhythm dysregulation.
本研究的目的是确定雷美替胺治疗与睡眠相关的进食障碍和/或夜间进食综合征患者异常进食行为的疗效。
我们回顾性分析了2013年11月至2018年11月在代代木睡眠障碍中心就诊的与睡眠相关的进食障碍/夜间进食综合征患者的病历。当每周夜间进食频率降至治疗前的一半以下时，我们将患者分类为雷美替胺治疗反应者。
49名患者纳入分析。基线时和雷美替胺治疗后的进食行为平均频率（每周）（标准差）有显著差异，分别为5.3（2.2）和3.2（3.0）（P <.001）。21名患者（42.9%）被分类为反应者。5名患者出现不良事件，均为轻度日间嗜睡。反应者组中治疗前使用苯二氮䓬衍生物和Z类药物的个体以及同时存在睡眠-觉醒相位延迟障碍的个体显著多于无反应者组（分别为P <.001和P <.05）。反应者组内从基线到雷美替胺治疗后，苯二氮䓬衍生物和Z类药物的平均剂量显著降低（P <.05）。无反应者组未观察到这种趋势。同时，与睡眠相关的进食障碍/夜间进食综合征和睡眠-觉醒相位延迟障碍患者的睡眠中点在治疗后没有显著变化。
我们的结果表明，雷美替胺是治疗与睡眠相关的进食障碍/夜间进食综合征的一种候选疗法。雷美替胺的作用可能主要是通过减少苯二氮䓬衍生物和Z类药物，而不是通过改善睡眠-觉醒节律失调。
