Melatonin Therapy for REM Sleep Behavior Disorder with Co-existing Moderate-to-Severe Sleep Apnea

J Korean Neurol Assoc > Volume 25(2); 2007 > Article

Journal of the Korean Neurological Association 2007;25(2): 187-193.

중등도 폐쇄성 무호흡증을 수반한 렘수면행동장애의 멜라토닌 치료

윤창호, 지기환 하충건

인하대학교 의과대학 신경과학교실

Melatonin Therapy for REM Sleep Behavior Disorder with Co-existing Moderate-to-Severe Sleep Apnea

Chang-Ho Yun

Department of Neurology, Inha University College of Medicine

Abstract

Background: REM sleep behavior disorder (RBD) commonly occurs in old-age group and shows very good response to clonazepam. However, clonazepam can aggravate or even precipitate sleep-disordered breathings (SDBs) that is highly prevalent among elderly people. Melatonin has been known to be effective in RBD treatment and is much less likely to increase the airway resistance. The aim is to document the efficacy of melatonin therapy in RBD with co-existing significant SDB.
Methods: We recruited consecutive patients who have both RBD and significant SDB (apnea-hypopnea index, AHI > 15) confirmed by nocturnal polysomnography. Melatonin was started at the dose of 0.5 mg/night and increased according to the clinical response. Successful response is defined when symptoms are free or reduced in frequency more than 90% and any physical injury or violence should not be present.
Results: Eleven among 16 RBD patients were eligible and enrolled (eight male, median age 69 years, range 54-89). All had significant obstructive sleep-disordered breathings (mean AHI = 28.8, range 22.6-35.2). Melatonin was prescribed(dosage 2-8 mg/night, treatment duration, 7-35 months). Nine patients showed successful response (2-8 mg/night) but two showed unsatisfactory response to 6 mg or 8 mg/night. Two of nine patients with favorable response complained of mild sleepiness.
Conclusions: Melatonin can be effective for controlling RBD with co-existing SDB. Effective dosage range is variable without intolerable adverse effect. KeyWords:Melatonin, REM sleep behavior disorder, Obstructive sleep apnea