The treatment efficacy of pharmacotherapies for rapid eye movement sleep behavior disorder with polysomnography evaluation: A systematic review and meta-analysis.
Level 2 - randomized trial
Systematic review and meta-analysis that includes non-randomized controlled trials alongside randomized trials
PubMed 36387478 · doi:10.1016/j.heliyon.2022.e11425
What was done
A systematic review and meta-analysis of randomized and non-randomized controlled trials from PubMed, Embase, and Cochrane evaluated the efficacy of pharmacotherapies (clonazepam, melatonin, pramipexole, ramelteon, rotigotine) in rapid eye movement (REM) sleep behavior disorder (RBD) using objective polysomnography (PSG) outcomes. Thirteen eligible studies were included.
What was found
Compared to baseline: - Clonazepam significantly decreased the percentage of stage 2 sleep [4.00 (95% CI: 0.90 to 7.10)]. - Melatonin significantly improved sleep efficiency [2.51 (95% CI: 0.75 to 4.28)], reduced time spent in bed [-11.71 (95% CI: -23.05 to -0.37)], phasic activity [-25.79 (95% CI: -42.13 to -9.46)], and tonic activity [-10.44 (95% CI: -12.24 to -8.64)]. - Ramelteon significantly improved REM sleep without atonia [-5.87 (95% CI: -8.25 to -3.50)]. - Pramipexole significantly increased total sleep time [27.17 (95% CI: 0.06 to 54.29)] and reduced the periodic limb movements of sleep index [-11.42 (95% CI: -21.38 to -1.47)], with differing effects in idiopathic versus secondary RBD.
Why it matters
This review provides objective PSG-derived evidence on how different RBD medications alter sleep architecture, tonic/phasic motor activity, and limb movements to help guide clinical selection.
Limits
The review included only 13 studies and mixed non-randomized with randomized trials. Total participant count, clinical behavioral symptom outcomes, safety/adverse events, drug doses, and durations were not reported in the abstract.
Cited by
- supports Melatonin is an effective clinical treatment for REM sleep behavior disorder.