Does Melatonin Decrease the Use of As-Needed Antipsychotics or Benzodiazepines in Noncritically Ill Hospitalized...

Area of Science:

• Neuroscience and Pharmacology
• Clinical Medicine and Geriatrics

Background:

• Delirium is a prevalent neuropsychiatric syndrome lacking FDA-approved treatments, necessitating effective prevention strategies.
• Sleep-wake cycle disturbances are implicated in delirium pathogenesis, with melatonin proposed to restore circadian rhythm synchronization.

Purpose of the Study:

• To investigate the association between melatonin, benzodiazepines (BZDs), zolpidem (ZLP), and the subsequent use of as-needed antipsychotics and BZDs for delirium management.
• To evaluate these associations in noncritically ill adult patients admitted to general hospital floors.

Main Methods:

• A multicenter retrospective cohort study involving 225 noncritically ill adult patients from August 2012 to December 2018.
• Patients received either melatonin or non-melatonin sleep aids (ZLP or BZDs).
• The primary endpoint was the proportion of patients requiring pro re nata (PRN) antipsychotics or BZDs within 5 days of initiating sleep medication.

Main Results:

• Melatonin use was associated with a significant reduction in PRN BZD administration compared to BZD or ZLP (OR 2.78, 95% CI 1.2-1.87 for BZD; OR 2.78, 95% CI 1.25-6.17 for ZLP).
• No significant association was found between melatonin and PRN antipsychotic use compared to BZD or ZLP (OR 1.09, 95% CI 0.51-2.35 for BZD; OR 1.16, 95% CI 0.56-2.4 for ZLP).
• Secondary analyses indicated similar trends in patients aged 65 and older.

Conclusions:

• Melatonin use in noncritically ill hospitalized patients is associated with decreased utilization of PRN benzodiazepines.
• These findings suggest melatonin may be a valuable adjunct in managing sleep disturbances and potentially reducing delirium incidence or severity by decreasing reliance on commonly used psychotropic medications.