Department of Psychiatry, Tokyo Medical University, Tokyo, Japan.
Department of Sleep and Psychiatry, Kanno Hospital, Saitama, Japan.
J Clin Sleep Med. 2022 Dec 1;18(12):2861-2865. doi: 10.5664/jcsm.10188.
Delayed sleep-wake phase disorder (DSWPD) is a common circadian sleep-wake phase disorders brings serious social impairment of the patients. Melatonin is the main medication option; however, it has not been approved in some countries, and over-the-counter melatonin is under poor quality control. The melatonin receptor agonist ramelteon might be a potential treatment option, but there are few reports regarding its use in DSWPD patients. Existing pharmacological and chronobiological studies suggest that an ultra-low dose of ramelteon in the early night is beneficial for DSWPD. Here, we present our clinical experience together with a pharmacological review and discussion. Twenty-three DSWPD patients, of whom 18 patients had a treatment history of a normal dose of ramelteon, were prescribed low-dose ramelteon (median: 0.571 mg, 1/14 of a tablet) to be taken in the early night (mean: 18:10). After the treatment, the mean sleep schedule was significantly advanced, and clinical symptoms were improved.
Shimura A, Kanno T, Inoue T. Ultra-low-dose early night ramelteon administration for the treatment of delayed sleep-wake phase disorder: case reports with a pharmacological review. . 2022;18(12):2861-2865.
延迟睡眠-觉醒时相障碍（DSWPD）是一种常见的昼夜节律睡眠-觉醒时相障碍，会给患者带来严重的社交障碍。褪黑素是主要的药物治疗选择；然而，在一些国家尚未获得批准，并且非处方褪黑素的质量控制较差。褪黑素受体激动剂雷美尔酮可能是一种潜在的治疗选择，但关于其在 DSWPD 患者中的应用的报道很少。现有的药理学和时间生物学研究表明，夜间早期给予超低剂量的雷美尔酮对 DSWPD 有益。在这里，我们结合药理学综述和讨论介绍我们的临床经验。23 例 DSWPD 患者，其中 18 例有雷美尔酮常规剂量的治疗史，被开处低剂量雷美尔酮（中位数：0.571mg，1/14 片）在夜间早期（平均：18:10）服用。治疗后，平均睡眠时间明显提前，临床症状改善。
Shimura A, Kanno T, Inoue T. 夜间早期给予超低剂量雷美尔酮治疗延迟睡眠-觉醒时相障碍：病例报告及药理学综述。. 2022;18(12):2861-2865.
