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Review
. 2020;4(2):81-87.
doi: 10.1007/s41782-020-00111-7. Epub 2020 Sep 26.

Elderly as a High-risk Group during COVID-19 Pandemic: Effect of Circadian Misalignment, Sleep Dysregulation and Melatonin Administration

Daniel P Cardinali  1 , Gregory M Brown  2 , Russel J Reiter  3 , Seithikurippu R Pandi-Perumal  4
Affiliations
Review

Elderly as a High-risk Group during COVID-19 Pandemic: Effect of Circadian Misalignment, Sleep Dysregulation and Melatonin Administration

Daniel P Cardinali et al. Sleep Vigil. 2020.

Abstract

The association of age with a higher vulnerability to COVID-19 infection is a subject of major importance. Several factors, including higher stress due to social isolation, diminished melatonin levels with age, and higher exposure of individuals to light at the evening, which reduces melatonin levels and disrupts circadian rhythmicity are relevant for maintaining the circadian health in aged individuals. Properly administered, chronotherapy restores the optimal circadian pattern of the sleep-wake cycle in the elderly. It involves adequate sleep hygiene, timed light exposure, and the use of a chronobiotic medication like melatonin, which affects the output phase of circadian rhythms thus controlling the biological clock. Besides, the therapeutic potential of melatonin as an agent to counteract the consequences of COVID-19 infections has been advocated due to its wide-ranging effects as an antioxidant, anti-inflammatory, and as an immunomodulatory agent, as well as to a possible antiviral action. This article discusses how chronotherapy may reverse the detrimental circadian condition of the elderly in the COVID-19 pandemic.

Keywords: Aging; COVID-19 pandemic; Chronotherapy; Circadian rhythms; Melatonin; Sleep–wake cycle; Social isolation.

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Conflict of interest statement

Conflict of interestThe authors have read the journal's policy and have the following potential conflicts: SRP is a stockholder and the President and Chief Executive Officer of Somnogen Canada Inc., a Canadian Corporation. He declares that he has no competing interests that might be perceived to influence the content of this article. This does not alter the authors’ adherence to all the journal policies. All remaining authors declare that they have no proprietary, financial, professional, nor any other personal interest of any nature or kind in any product or services and/or company that could be construed or considered to be a potential conflict of interest that might have influenced the views expressed in this manuscript.

Figures

Fig. 1
Fig. 1
Chronobiotic activity of melatonin. The combined use of melatonin and bright light to augment the amplitude and synchronize endogenous circadian rhythmicity in aging. Bright light in the morning together with melatonin at bedtime interact to augment the amplitude of sleep/wake cycle and other circadian rhythms. In delayed phase sleep syndrome melatonin augments the amplitude and phase-advanced the sleep/wake rhythm
Fig. 2
Fig. 2
Because of its pharmacokinetic properties. i.e., a very short half-life in the blood, when melatonin is given orally as a fast release preparation at bedtime, melatonin gives rise to a chronobiotic signal regardless of the amounts given
See this image and copyright information in PMC

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