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ARrest RESpiraTory Failure From PNEUMONIA (ARREST PNEUMONIA) (ARREST)
The purpose of this study is to establish the effectiveness of a combination of an inhaled corticosteroid and a beta agonist compared to placebo for the prevention of acute respiratory failure (ARF) in hospitalized patients with pneumonia and hypoxemia.
Randomized, Double-Blind, Cross-Over Study Comparing the Efficacy of
Immediate and Extended-Release Melatonin as a supplement affecting the sleep cycle in patients with Parkinson disease and Rapid Eye Movement Sleep Behavior Disorder
The primary aim of this study is to compare effectiveness of immediate versus extended-release melatonin as a supplement affecting the sleep cycle among patients with Parkinson’s disease as assessed by modified Mayo Sleep Questionnaire (MSQ). The secondary aim is to evaluate the superiority and effect of immediate and extended-release melatonin versus not taking any melatonin on sleep cycle among patients with Parkinson’s disease as assessed by modified Mayo Sleep Questionnaire (MSQ).
Rapid eye movement (REM) sleep behavior disorder (RBD) is very common in patients with Parkinson disease and manifests with the loss of REM sleep atony, vigorous motor jerks, nocturnal vocalizations and dream enactment. Melatonin is commonly used as symptomatic management for RBD, but its efficacy is only supported by observational studies and a few controlled trials with relatively small number of participants. Melatonin may influence sleep cycle and affect clinical manifestations of RBD by decreasing muscle tonicity during REM sleep.
Sleep normally cycles through REM and non-rapid eye movement (NREM) stages on average 4 to 6 times during the night. As the night progresses, fewer NREM stages occur, and the duration of REM sleep episodes increases. In a US-based randomized, crossover pharmacokinetic (PK) evaluation study, an extended-release melatonin (ERM) exceeded the targeted sleep maintenance threshold for a median of 6.7 hours, compared with 3.7 hours with the immediate- release melatonin (IRM). We hypothesize that extended-release melatonin would be more helpful in regulating sleep cycle and affecting RBD, since REM density increases as night progresses. To our knowledge, no study that compares the efficacy of extended versus immediate-release melatonin on sleep cycle and its effect on RBD in patients with Parkinson disease has been done.