Melatonin as a Potential Adjuvant Treatment for COVID-19 beyond Sleep Disorders.

Adam Wichniak,Aleksander Kania,Wiesław Jerzy Cubała,Mariusz Siemiński

doi:10.3390/ijms22168623

Abstract

Melatonin is registered to treat circadian rhythm sleep–wake disorders and insomnia in patients aged 55 years and over. The essential role of the circadian sleep rhythm in the deterioration of sleep quality during COVID-19 confinement and the lack of an adverse effect of melatonin on respiratory drive indicate that melatonin has the potential to be a recommended treatment for sleep disturbances related to COVID-19. This review article describes the effects of melatonin additional to its sleep-related effects, which make this drug an attractive therapeutic option for treating patients with COVID-19. The preclinical data suggest that melatonin may inhibit COVID-19 progression. It may lower the risk of the entrance of the SARS-CoV-2 virus into cells, reduce uncontrolled hyper-inflammation and the activation of immune cells, limit the damage of tissues and multiorgan failure due to the action of free radicals, and reduce ventilator-induced lung injury and the risk of disability resulting from fibrotic changes within the lungs. Melatonin may also increase the efficacy of COVID-19 vaccination. The high safety profile of melatonin and its potential anti-SARS-CoV-2 effects make this molecule a preferable drug for treating sleep disturbances in COVID-19 patients. However, randomized clinical trials are needed to verify the clinical usefulness of melatonin in the treatment of COVID-19.

Highlights

The pandemic caused by the coronavirus disease 2019 (COVID-19) increased the awareness of several health-related factors that reduce the risk of infection and decrease the likelihood of a severe course of the disease
Taking into account that a good sleep quality plays a crucial role in the regulation of emotions [5], the clinical data strongly support the role of educational activities and interventions aimed at improving sleep quality as essential strategies to protect society against COVID-19 and help people to cope with the stress related to the COVID-19 pandemic
The pathologic cascade of COVID-19 consists of the following events: the entrance of the SARS-CoV-2 virus into the cell through binding with membrane angiotensin-converting enzyme 2, further incorporation of the virus, recognition of the virus through pattern-recognizing receptors, activation of transcription factors, further production of proinflammatory cytokines, an inflammatory response, conversion to uncontrolled hyper-inflammation, progression of multilocal damage to tissues, and in most severe cases, respiratory insufficiency and multiorgan failure, leading to death or some form of chronic disability

Summary

Introduction

The pandemic caused by the coronavirus disease 2019 (COVID-19) increased the awareness of several health-related factors that reduce the risk of infection and decrease the likelihood of a severe course of the disease. A good sleep quality is identified among those factors, as sleep plays numerous essential functions, promoting health, regenerative, and immunomodulatory processes. Taking into account that a good sleep quality plays a crucial role in the regulation of emotions [5], the clinical data strongly support the role of educational activities and interventions aimed at improving sleep quality as essential strategies to protect society against COVID-19 and help people to cope with the stress related to the COVID-19 pandemic

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