Efeito da melatonina sobre o sono e a função motora na doença de Parkinson : um estudo randomizado, duplo cego e controlado com placebo

Abstract

Sleep disturbances are common in Parkinson’s disease (PD) and are associated with worse quality of life in those patients. Insomnia described as difficulty initiating and maintaining sleep, excessive daytime sleepiness and abnormal behavior during sleep are some of the most frequently described symptoms. Melatonin has been shown to improve sleep in many other clinical conditions. The main objective of this study was to evaluate the effect of four weeks melatonin administration, 3 mg one hour before bedtime, on sleep and motor disability in PD. This was a randomized, double blind placebo controlled study. We have studied 18 patients of either gender with a clinical diagnosis of PD (Hoehn and Yahr I to III). Patients were evaluated before and after treatment with the Pittsburgh sleep quality index questionnaire (PSQI), with the Epworth sleepiness scale (ESS) with the Unified Parkinson´s disease rating scale (UPDRS) and with all night polysomnography. Melatonin treatment did not influence motor disability as informed by the patient (UPDRS II, p=0,58) or by the examiner (UPDRS III, p=0,94). Also, complications related to treatment were not different after melatonin administration (UPDRS IV, p=0,897). Excessive daytime sleepiness as evaluated by the ESS was not modified by melatonin treatment (p=0,84). Sleep measures evaluated by polysomnography were also not altered by melatonin treatment. Patients treated with melatonin showed improvement in sleep measures as evaluated by the PSQI (ANCOVA, p=0,03). In summary, 3 mg of melatonin, one hour before bedtime significantly improved quality of sleep and was not associated with worsening of motor disability in PD.