672 ASSESSMENT OF THERAPEUTIC RESPONSE TO MELATONIN IN PARKINSON’S DISEASE PATIENTS WITH SLEEP DISORDERS, A QI PROJECT

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Abstract Introduction Holistic care of patients with Parkinson’s Disease (PD) addresses motor and non-motor features. With prevalence of around two-thirds of patients, sleep disorders; including REM Sleep behaviour Disorder (RBD); can have significant negative impact on quality of life. The naturally occurring neuro-hormone, melatonin plays a role in circadian rhythm; a process disrupted in PD. In 2017, NICE suggested to ‘consider clonazepam or melatonin to treat RBD.’ Melatonin has a more favourable side effect profile than clonazepam. This QI project qualitatively evaluates a geographical subset of PD patients treated with melatonin, assessing the clinical effect of treatment and whether this medication is being used optimally. PDSA methodology identified potential for introducing a sleep scale to allow more Objective future assessment. Methods A departmental database identified all current and deceased patients treated with melatonin since 2015. The electronic patient record of a total of 26 patients were reviewed. Data on indication, dosing, response (subjectively categorised as no effect, mild, moderate, or good impact) alongside demographics were collected. Results Analysis revealed poor sleep as the most common indication for melatonin. Melatonin was well tolerated with no reported side effects. Results showed benefit in 95% of patients with an initial dose of 2 mg. Dosing was reviewed in 81% of patients at next clinic appointment. For those patients who did not have ‘good’ effect dose was increased in 62% of patients. Conclusion The subjective nature of sleep assessment makes assessing therapeutic benefit challenging however data suggests melatonin does improve sleep, a finding consistent with current limited research. Implementation of a sleep scale questionnaire for patients commencing melatonin will allow Objective analysis by the multidisciplinary team of medication effect and aid dose titration. Ongoing review is required to assess effect due to the infrequency of included patients and protracted therapeutic response period.