Research Paper Title

The efficacy of add-on ramelteon and subsequent dose reduction of benzodiazepine derivatives/Z-drugs for the treatment of sleep-related eating disorder and night eating syndrome: a retrospective analysis of consecutive cases.

Background

The objective of this study was to determine the efficacy of ramelteon in treating abnormal eating behaviour in cases with sleep-related eating disorder (SRED) and/or night eating syndrome (NES).

Methods

The researchers retrospectively reviewed the medical records of patients with SRED/NES at Yoyogi Sleep Disorder Centre from November 2013 to November 2018. They categorised patients as ramelteon treatment responders when the frequency of night time eating per week decreased to less than half of that before treatment.

Results

Forty-nine patients were included in the analysis. The mean frequency of eating behaviour (/week) (standard deviation) at baseline and post-ramelteon treatment was significantly different, at 5.3 (2.2) and 3.2 (3.0), respectively (p < .001). Twenty-one patients (42.9%) were classified as responders. Adverse events, all of which were mild daytime somnolence, were observed in 5 cases. There were significantly more individuals using benzodiazepine derivatives and Z-drugs (BZDs) before treatment and those with coexisting delayed sleep-wake phase disorder (DSWPD) in the responder group than in the non-responder group (p < .001 and p < .05, respectively). The mean BZD dose significantly decreased from baseline to post-ramelteon treatment within the responder group (p < .05). This trend was not observed in the non-responder group. Meanwhile, the sleep midpoint of patients with SRED/NES and DSWPD did not significantly change after treatment.

Conclusions

The results indicate that ramelteon is a candidate treatment for SRED/NES. The effects of ramelteon might have occurred primarily through the reduction of BZD rather than through the improvement of sleep-wake rhythm dysregulation.

Reference

Matsui, K., Kuriyama, K., Kobayashi, M., Inada, K., Nishimura, K. & Inoue, Y. (2021) The efficacy of add-on ramelteon and subsequent dose reduction of benzodiazepine derivatives/Z-drugs for the treatment of sleep-related eating disorder and night eating syndrome: a retrospective analysis of consecutive cases. Journal of Clinical Sleep Medicine. doi: 10.5664/jcsm.9236. Online ahead of print.