Melatonin supplementation for the prevention of hospital-associated delirium

Characterized by acute alterations in cognition or consciousness, delirium is a transient neuropsychiatric syndrome that develops in a large percentage of hospitalized patients. Delirium is a robust predictor of increased morbidity, mortality, and health care costs, especially when diagnosed in the critical care setting. Although the exact pathogenesis behind delirium has yet to be defined, disturbances in the sleep-wake cycle are a core feature. Currently, no pharmacologic interventions are recommended for delirium prophylaxis. Due to the role of melatonin in regulating the sleep-wake cycle, its use in delirium has been investigated in recent years. Objective data has shown altered serum levels of melatonin and its precursor, tryptophan, in patients with delirium, further suggesting a correlation between melatonin and delirium. This article examines the available evidence and discusses considerations surrounding melatonin supplementation for the prevention of hospital-associated delirium.