Chronic Fatigue Syndrome, Myalgic Encephalomyelitis
Conditions
Keywords
melatonin, zinc, fatigue, sleep quality, quality of life, pain, anxiety and depression, actigraphy, heart rate variability, orthostatic intolerance
Brief summary
The aim of the study is to investigate the effects of oral melatonin and zinc supplementation on core features in individuals with ME/CFS
Detailed description
Myalgic Encephalomyelitis, also known as Chronic Fatigue Syndrome (ME/CFS) is a heterogeneous condition characterized mainly by debilitating and prolonged fatigue, post-exertional malaise (physical, mental and emotional), unrefreshing sleep, cognitive impairment, and orthostatic intolerance with prolonged recovery that is not relieved by rest. Currently, the etiopathogenic mechanisms of ME/CFS are unknown. At present, there is no diagnostic test or effective treatment. MelatoZinc is a food supplement composed of melatonin and zinc, which could contribute to the circadian rhythm homeostasis and regulation of redox imbalance and immune response. The aim is to evaluate the efficacy and safety of oral treatment with MelatoZinc on the symptomatic complex of fatigue in a larger Spanish ME/CFS population. This is a single-center, randomized, double-blind, placebo controlled clinical trial. It will include a total of 106 ME/CFS patients who met 2011 ICC criteria for ME/CFS. All patients will take one capsule daily for 16 weeks. Group A will receive MelatoZinc (1 mg melatonin plus 10 mg zinc), and group B will receive a placebo (excipients: isomaltose and magnesium stearate). Clinical symptoms will be evaluated, and standardized questionnaires will be applied to assess the impact of fatigue, pain, anxiety-depression symptoms, sleep quality, dysautonomia, and quality of life. Heart rate variability (HRV) and orthostatic intolerance (10-min NASA Lean Test) will be performed to evaluate autonomic dysfunction. Sleep efficiency will be estimated through an actigraph sensor
Interventions
DIETARY_SUPPLEMENTmelatonin plus zinc
One capsule with melatonin 1mg plus zinc 10 mg o.d. 30 minutes before bedtime, at least 1 hour after dinner during 4 months
OTHERisomaltose and magnesium stearate
One capsule with excipients o.d. 30 minutes before bedtime, at least 1 hour after dinner during 4 months
Sponsors
Laboratorio Echevarne
Hospital Vall d'Hebron
Laboratorios Viñas, S.A.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
DOUBLE (Subject, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 65 Years
Healthy volunteers
No
Inclusion criteria
1. Patients between 18 and 65 years of age. 2. Patients with ME/CFS who met the diagnostic criteria (2011 ICC criteria) from the Central Sensitization Syndrome Unit (USSC) at the Vall d'Hebron University Hospital. 3. Patients who freely give written consent.
Exclusion criteria
1. Any active medical condition that explained chronic fatigue (untreated hypothyroidism, sleep apnea, narcolepsy, medication side-effects). 2. Previous diagnosis not unequivocally resolved (chronic hepatitis, malignancy). 3. Past or current psychiatric disorders (major depressive disorder with psychotic or melancholic features, bipolar disorder, schizophrenia, delusional disorder, dementias, anorexia nervosa, bulimia nervosa). 4. Participation in another clinical trial of the same or different nature in the 30 days prior to study inclusion. 5. In the judgment of the investigator, inability to follow the instructions or to complete the treatment satisfactorily. 6. Failure to provide signed informed consent. 7. Current consumption of medications that may interfere with the results and/or whose withdrawal may be a relevant problem. 8. Anticoagulant treatment. 9. Pregnancy or breast-feeding, or had not used oral contraceptives or other hormonal preparations in the previous 6 months. 10. Smoking, alcohol intake or substance abuse. 11. Severe obesity (class 3 BMI ≥ 40 kg/m2). 12. Hypersensitivity to melatonin and/or zinc dietary supplements.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Self-reported fatigue as assessed by the 40-item Fatigue Impact Scale (FIS-40) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The FIS-40 includes three subscales of the perceived impact of fatigue: cognitive (10 items), physical (10 items) and psychosocial functions (20 items), each item being scored from 0 (no fatigue) to 4 (severe fatigue). The total score is calculated by adding together the responses from the 40 questions (range 0-160). Higher scores indicate more functional limitations due to fatigue. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Sleep disturbances as assessed by the Pittsburgh Sleep Quality Index (PSQI) questionnaire over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The PSQI is the self-administered 19-item questionnaire. PSQI scores are obtained on each of seven components of sleep quality: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep perturbations, use of sleeping medication and daytime dysfunction. Each item is scored from 0 to 3 (0 = no sleep problems and 3 = severe sleep problems). The global PSQI score ranges from 0 to 21 points, with scores of \>5 indicating poorer sleep quality. |
| Sleepiness as assessed by the Epworth Sleepiness Scale (ESS) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The ESS is a short, self-administered questionnaire that consists of eight questions asking to rate how likely it is to fall asleep in everyday situations (each question can be scored from 0 to 3 points: '0' indicates no sleepiness, and '3' indicates significant sleepiness). It provides a total score which has been shown to relate to the subject's level of daytime sleepiness (total score is ranging from 0 to 24 points). |
| Sleep latency as assessed by an actigraph sensor over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device was programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables were recorded and stored in the device's memory for data analysis. |
| Sleep onset as assessed by an actigraph sensor over the baseline in the study participants | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device is programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables will be recorded and stored in the device's memory for further data analysis. |
| Sleep efficiency as assessed by an actigraph sensor over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device is programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables will be recorded and stored in the device's memory for further data analysis. |
| Total sleep time as assessed by an actigraph sensor over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device is programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables will be recorded and stored in the device's memory for further data analysis. |
| The health-related quality of life (HRQoL) as assessed by the Short-Form 36-Item Health Survey (SF-36) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The SF-36 is a broadly-based self-reported survey on health-related physical and mental functioning status. It assesses functioning on eight subscales, including domains of physical functioning, physical role, bodily pain, general health, social functioning, vitality, emotional role and mental health, and two general subscales covering the physical and mental health domains on a 0-100 score. Lower scores indicate a more negative impact of an individual's health on functioning. |
| Number of awakenings as assessed by an actigraph sensor over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device is programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables will be recorded and stored in the device's memory for further data analysis. |
| Heart rate variability (HRV) as recorded by the FitLab software over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | Changes in the cardiovagal autonomic dysfuntion will be continuously assessed and recorded for the R-R intervals over 5-min periods at rest and in the supine position on different days using the FitLab software. |
| Orthostatic intolerance as assessed by the active standing test (10-minute NASA Lean test) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The 10-minute NLT is a well-established non-invasive procedure used to assess impaired cardiovascular responses to standing and to diagnose OI phenotypes. It records objective hemodynamic parameters (blood pressure and heart rate). The participants will be first asked to lie down during 5 minutes and then to stand and lean against a wall, with heels 6-8 inches from the wall. Throughout the recording, participants will be asked to remain motionless, quiet and any talking or movement will be discouraged, except for reporting any symptoms of concern. |
| Pain intensity as assessed by a visual analog scale (VAS) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The pain VAS is a continuous and unidimensional measure of pain intensity. It comprised of a horizontal line of 10-centimeters in length, anchored by 2 verbal descriptors, one for each symptom extreme. No pain (score of 0) and pain as bad as it could be or worst imaginable pain(score of 10). |
| Anxiety and depression symptoms as assessed by the Hospital Anxiety and Depression Scale (HADS) over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | The HADS is a validated self-reported tool composed of 14 items (seven related to anxiety symptoms and seven to depression). Each item is scored from 0-3, and thus, scores range from 0 to 21; scores of 0-7 are interpreted as normal, 8-10 as mild, 11-14 as moderate, and 15-21 as severe for either anxiety or depression. The total HADS score ranges from 0 (no anxiety or depression) to 42 (severe anxiety and depression). |
| Side effect of treatment | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | Treatment side effects will be collected from each participant during clinical trial. |
| Wake time as assessed by an actigraph sensor over the baseline in the study participants. | During 4 months of treatment and 8 weeks after discontinuation of dietary therapy | An actigraph (Actiwatch Spectrum Plus® from Philips Respironics, Linton Instrumentation, UK) on the wrist of the non-dominant arm is continuously recording for seven days. The same device is programmed to collect data on motor activity (accelerometer) and light type/intensity (lux) at one minute intervals. These variables will be recorded and stored in the device's memory for further data analysis. |
Countries
Spain
Contacts
Primary ContactJosé Alegre, MD, PhD
Backup ContactJesús Castro, PhD
Outcome results
None listed