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. 2024 Feb;30(2):e14569.
doi: 10.1111/cns.14569.

Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Maria P Mogavero  1   2 , Raffaele Ferri  3 , Sara Marelli  1   2 , Giuseppe Lanza  3   4 , Michele Terzaghi  5   6 , Alessandra Castelnuovo  1   2 , Lourdes M DelRosso  7 , Carlos H Schenck  8 , Luigi Ferini-Strambi  1   2
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Polysomnographic features associated with clonazepam and melatonin treatment in isolated REM sleep behavior disorder: Time for new therapeutic approaches?

Maria P Mogavero et al. CNS Neurosci Ther. 2024 Feb.

Abstract

Aims: Although clonazepam (CLO) and melatonin (MLT) are the most frequently used treatments for REM sleep behavior disorder, the polysomnographic features associated with their use are little known. The aim of this study was to evaluate polysomnographic and clinical parameters of patients with idiopathic/isolated REM sleep behavior disorder (iRBD) treated chronically with CLO, sustained-release MLT, alone or in combination, and in a group of drug-free iRBD patients.

Methods: A total of 96 patients were enrolled: 43 drug-free, 21 with CLO (0.5-2 mg), 20 with sustained-release MLT (1-4 mg), and 12 taking a combination of them (same doses). Clinical variables and polysomnography were collected.

Results: Although clinical improvement was reported in all groups, MLT impacted sleep architecture more than the other treatments, with significant and large increase in N3 stage, moderate reduction in N2 and REM sleep, and moderate increase in REM latency. CLO moderately increased the percentage of both REM sleep and especially N2, while reducing N1 and wakefulness. Patients treated with both CLO and MLT did not show major changes in sleep architecture.

Conclusion: These results suggest that the administration of MLT or CLO impacts (positively) on sleep parameters of iRBD patients. However, there is a need to better stratify patients, in order to treat them in a targeted manner, depending on the patient's individual sleep architecture and expected differential effects of these agents.

Keywords: REM sleep behavior disorder; clonazepam; drugs; melatonin; polysomnographic parameters.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Graphic representation of sleep stage distribution in the four groups of patients.
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