Effect of oral melatonin and wearing earplugs and eye masks on nocturnal sleep in healthy subjects in a simulated intensive care unit environment: which might be a more promising strategy for ICU sleep deprivation?

INTRODUCTION: Sleep deprivation is common in critically ill patients in the intensive care unit (ICU). Noise and light in the ICU and the reduction in plasma melatonin play the essential roles. The aim of this study was to determine the effect of simulated ICU noise and light on nocturnal sleep quality, and compare the effectiveness of melatonin and earplugs and eye masks on sleep quality in these conditions in healthy subjects. METHODS: This study was conducted in two parts. In part one, 40 healthy subjects slept under baseline night and simulated ICU noise and light (NL) by a cross-over design. In part two, 40 subjects were randomly assigned to four groups: NL, NL plus placebo (NLP), NL plus use of earplugs and eye masks (NLEE) and NL plus melatonin (NLM). 1 mg of oral melatonin or placebo was administered at 21:00 on four consecutive days in NLM and NLP. Earplugs and eye masks were made available in NLEE. The objective sleep quality was measured by polysomnography. Serum was analyzed for melatonin levels. Subjects rated their perceived sleep quality and anxiety levels. RESULTS: Subjects had shorter total sleep time (TST) and rapid eye movement (REM) sleep, longer sleep onset latency, more light sleep and awakening, poorer subjective sleep quality, higher anxiety level and lower serum melatonin level in NL night (P <0.05). NLEE had less awakenings and shorter sleep onset latency (P <0.05). NLM had longer TST and REM and shorter sleep onset latency (P <0.05). Compared with NLEE, NLM had fewer awakenings (P = 0.004). Both NLM and NLEE improved perceived sleep quality and anxiety level (P = 0.000), and NLM showed better than NLEE in perceived sleep quality (P = 0.01). Compared to baseline night, the serum melatonin levels were lower in NL night at every time point, and the average maximal serum melatonin concentration in NLM group was significantly greater than other groups (P <0.001). CONCLUSIONS: Compared with earplugs and eye masks, melatonin improves sleep quality and serum melatonin levels better in healthy subjects exposed to simulated ICU noise and light. TRIAL REGISTRATION: Chinese Clinical Trial Registry ChiCTR-IPR-14005458 . Registered 10 November 2014.

[Relationship between children's obstructive sleep apnea hypopnea syndrome and nasal diseases].

OBJECTIVE: To explore the relationship between children obstructive sleep apnea hypopnea syndrome (OSAHS) and nasal diseases. METHODS: Three hundred and thirty-eight cases of pediatric OSAHS confirmed by polysomnography (PSG) had been enrolled as the treatment group, and divided into mild subgroup, moderate subgroup and severe subgroup according to the obstructive apnea index (OAI) and apnea hypoventilation index (AHI). The other two hundred and seven pediatric vocal cord nodule cases without OSAHS had been randomly selected as the control group. The retrospective analysis of upper respiratory tract infection frequency per year, expression levels of total IgE (tIgE) and allergen-specific IgE (sIgE), results of electronic nasopharyngoscope test and nasal sinus CT scans had been performed in all the pediatric cases. The data were analyzed by SPSS 17.0. RESULTS: The upper respiratory tract infection frequency per year, ratio of cases with positive results of tIgE, ratio of cases with nasosinusitis, ratio of cases with narrow nasal cavity in the experiment group were respectively 8.7 ± 5.7, 60.9%, 79.9% and 50.0%, while those in the control group were respectively 4.4 ± 2.6, 32.8%, 12.1% and 6.3%, with significant difference between groups (t = 7.578,χ(2) value was 41.943, 237.704, 110.322, all P < 0.01). The multiple regression analysis indicated that, nasosinusitis and narrow nasal cavity were the two major risk factors of pediatric OSAHS (OR1 = 16.008, OR2 = 4.671, all P < 0.01), with combined effects (OR = 113.430, P < 0.01) . The rank test analysis in term of risk factors of severity of OSAHS had indicated that, prevalence of nasosinusitis and narrow nasal cavity were increased as rising severity of OSAHS (χ1(2) = 21.571, χ2(2) = 17.304, all P < 0.01). CONCLUSIONS: Infection and allergy are risk factors of pediatric OSAHS. Nasosinusitis and narrow nasal cavity are two major risk factors of pediatric OSAHS, which have positive relationship with the severity of OSAHS.