title: Emerging Role of Melatonin and Melatonin Receptor Agonists in Sleep and Delirium in Intensive Care Unit Patients.
abstract: Delirium, an acute state of mental confusion, can lead to many adverse sequelae in intensive care unit (ICU) patients. Although the etiology of ICU delirium is often multifactorial, and at times not fully understood, sleep deprivation is considered to be a major contributing factor to its development. It has been postulated that administration of exogenous melatonin and melatonin receptor agonists such as ramelteon may prevent delirium by promoting nocturnal sleep in ICU patients. The purpose of this review is to summarize the pharmacology of melatonin and melatonin receptor agonists and investigate their potential roles in sleep promotion and delirium prevention in ICU patients. Although few studies evaluating the impact of melatonergic agents on sleep and delirium in the ICU have been completed, some data suggest their potential positive effects on sleep and delirium. However, large-scale randomized controlled trials are warranted to determine the optimal role of melatonergic agents in the prevention of ICU delirium.
authors.affiliation: Department of Pharmacy Practice, Critical Care, Western New England University College of Pharmacy, Springfield, MA, USA yoonsun.mo@wne.edu.
authors.forename: Yoonsun
authors.initials: Y
authors.lastname: Mo
authors.affiliation: Department of Pharmacy Practice, Psychiatry, Western New England University College of Pharmacy, Springfield, MA, USA.
authors.forename: Corey E
authors.initials: CE
authors.lastname: Scheer
authors.affiliation: Beth Israel Deaconess Medical Center, Boston, MA, USA.
authors.forename: George T
authors.initials: GT
authors.lastname: Abdallah
mesh_terms: D002492:Central Nervous System Depressants / Q000494:pharmacology / Q000627:therapeutic use; D003422:Critical Care; D016638:Critical Illness; D003693:Delirium / Q000188:drug therapy / Q000209:etiology / Q000517:prevention & control*; D006801:Humans; D007192:Indenes / Q000494:pharmacology / Q000627:therapeutic use; D007362:Intensive Care Units; D008550:Melatonin / Q000494:pharmacology* / Q000627:therapeutic use*; D044094:Receptors, Melatonin / Q000819:agonists*; D012890:Sleep / Q000187:drug effects*; D012892:Sleep Deprivation / Q000150:complications* / Q000188:drug therapy
chemical_list: D002492:Central Nervous System Depressants; D007192:Indenes; D044094:Receptors, Melatonin; C495910:ramelteon; D008550:Melatonin
keywords: ICU; delirium; melatonin; melatonin receptor agonists; ramelteon; sleep