Valerian for Sleep Disturbance in Healthy Older Adults

描述（由申请人提供）：睡眠障碍在老年人中非常常见。多达40%的老年人抱怨睡眠问题，包括无法快速入睡，夜间频繁醒来或清晨醒来。未经治疗的睡眠障碍可能会增加抑郁症和早期死亡的风险。老年人经常使用处方催眠药和非处方药作为睡眠辅助剂，尽管观察到这些药物会进一步扰乱睡眠模式并产生不良副作用。草药作为膳食补充剂已经非常受欢迎，并且在未来几十年内可能会被越来越多的成年人使用。替代草药，如2001年美国最畅销的20种草药产品之一的缬草，有可能增强睡眠，但其疗效需要在老年人中确定。缬草含有多种化合物，包括缬草酸及其衍生物。尚未报道缬属成分的药代动力学特性，并且对于缬属成分与客观睡眠测量相关的药代动力学特性一无所知。小样本安慰剂对照试验的有限文献表明，缬草可以改善睡眠，副作用发生率非常低。这项初步研究的具体目的是确定推荐剂量的缬草根的睡眠增强作用，并描述其在患有睡眠障碍的老年人中的药代动力学特性。我们已经开发了一种缬草酸的测定方法，并将描述单次给药后和连续治疗两周后稳态时缬草酸的药代动力学，并将多导睡眠图显示的睡眠增强作用与缬草酸PK联系起来。我们的工作假设是，每天晚上服用两周后，缬草根会增强睡眠（慢性），但单次服用后不太可能增强睡眠（急性）。该设计将是一项单组、双盲、安慰剂对照的交叉试验，在20名相对健康的55至80岁的老年女性和男性中进行。我们希望研究结果将提供初步数据，支持一项大型随机临床试验，研究缬草根对老年人主观和客观睡眠质量的影响。

DESCRIPTION (provided by applicant): Sleep disturbances are very common in the elderly. As many as 40% of older adults complain about sleep problems, including inability to fall asleep quickly, frequent nocturnal awakenings, or early morning awakenings. Untreated sleep disturbances may increase the risk for depression and early mortality. Older adults frequently use prescription hypnotic and over-the-counter medications as sleep aids, despite observations these drugs further disrupt sleep patterns and have untoward side effects. Herbal medicines as dietary supplements are already quite popular and likely to be used by increasing numbers of adults in the next few decades. Alternative herbal medicines, such as valerian, which was in the top 20 best selling herbal products in the United States in 2001, have the potential to enhance sleep but their efficacy needs to be established in older adults. Valerian contains a variety of compounds including valerenic acid and its derivatives. The pharmacokinetic properties of the valerian constituents have not been reported and there is nothing known about the pharmacokinetic properties of valerian constituents in relation to objective sleep measures. A limited literature of small-sample placebo-controlled trials suggests that valerian may improve sleep and has a very low rate of side effects. The specific aims of this preliminary study are to determine the sleep enhancing effects of a recommended dose of valerian and to describe its pharmacokinetic properties in older adults with a complaint of sleep disturbance. We have developed an assay for valerenic acid and will describe the pharmacokinetics of valerian after a single dose and at steady state following two weeks of continuous treatment and relate the sleep enhancing effects as shown by polysomnography to valerian PK. Our working hypothesis is that valerian will enhance sleep after two weeks of daily nighttime dosing (chronic), but is not likely to enhance sleep after a single dose (acute). The design will be a single group, double-blind, placebo controlled cross-over trial in 20 relatively healthy older adult women and men, 55 to 80 years old. We expect the study outcomes will provide preliminary data in support of a large randomized clinical trial of valerian effects on subjective and objective sleep quality in older adults.