ABSTRACT
Sleep deprivation is extremely common in the intensive care unit (ICU), and this lack of sleep is associated with low melatonin secretion. The objective of the current study was to explore the effect of exogenous melatonin administration on sleep quality in patients hospitalized in the pulmonary intensive care unit (ICU). We performed a double-blind, placebo-controlled study in the pulmonary ICU of a tertiary care hospital. Eight adult patients hospitalized in the pulmonary ICU with respiratory failure caused by exacerbation of chronic obstructive pulmonary disease (COPD) or with pneumonia were studied. Patients received either 3 mg of controlled-release melatonin or a placebo at 22:00, and sleep quality was evaluated by wrist actigraphy. Treatment with controlled-release melatonin dramatically improved both the duration and quality of sleep in this group of patients. Our results suggest that melatonin administration to patients in intensive care units may be indicated as a treatment for sleep induction and resynchronization of the "biologic clock." This treatment may also help in the prevention of the "ICU syndrome" and accelerate the healing process.
Subject(s)
Lung Diseases, Obstructive/physiopathology , Melatonin/pharmacology , Sleep Deprivation/drug therapy , Sleep/drug effects , Adult , Aged , Delayed-Action Preparations , Double-Blind Method , Female , Humans , Intensive Care Units , Male , Melatonin/administration & dosage , Melatonin/physiology , Middle Aged , Sleep/physiology , Sleep Deprivation/physiopathologyABSTRACT
BACKGROUND: Patients hospitalized in the intensive care unit (ICU) tend to become agitated and confused, and many even develop temporary psychoses (the ICU syndrome). We wondered whether the regulation of sleep and the secretion of melatonin is abnormal in ICU patients. Therefore, we studied the association of sleep-wake pattern in patients hospitalized in the ICU, their melatonin secretion rates, and profile compared with a control group of patients in general medical wards. METHODS: Sleep was assessed by actigraphy. Urine was collected every 3 hours for 24 hours. Melatonin secretion was assessed by measuring the melatonin metabolite 6-sulphatoxymelatonin by enzyme-linked immunosorbent assay. RESULTS: Actigraphy suggested that the ICU patients lacked normal sleep behavior for the entire study period, except for occasional short naps. Compared with controls, the nocturnal peak of melatonin secretion was absent, except in two patients in the nonventilated group, and showed a flat curve. CONCLUSIONS: Our results suggest that lack of sleep is indeed a severe problem in ICU patients and is accompanied by impairment of normal melatonin secretion. The possibility that melatonin administration may prove useful in improving sleep patterns in ICU patients deserves further study.
Subject(s)
Critical Care , Melatonin/metabolism , Sleep Deprivation , Adult , Aged , Case-Control Studies , Circadian Rhythm , Enzyme-Linked Immunosorbent Assay , Female , Humans , Intensive Care Units , Male , Melatonin/analogs & derivatives , Melatonin/urine , Middle AgedSubject(s)
Amyloidosis/etiology , Jejunoileal Bypass/adverse effects , Kidney Diseases/etiology , Aged , Amyloidosis/pathology , Diabetes Mellitus, Type 2/complications , Female , Humans , Kidney Calculi/etiology , Kidney Calculi/surgery , Kidney Diseases/pathology , Kidney Failure, Chronic/etiology , Nephrectomy , Nephrotic Syndrome/etiology , Obesity, Morbid/complications , Obesity, Morbid/surgery , Time FactorsABSTRACT
BACKGROUND: Recently we observed a unique clinical phenomenon, namely, orthostatic or postural hypoxaemia in a 72-year-old female adult polycystic kidney disease (APKD) patient, maintained on CAPD. Extensive investigations failed to yield a satisfactory explanation for her ambulatory hypoxaemia. METHODS: To validate our observation, 15 dialysed patients underwent blood gases analyses in both the supine and ambulatory positions (SpO2 and ApO2 respectively). Patients were divided into two groups: group 1 (n-7) whose end-stage renal failure (ESRF) was due to APKD and group 2 (n-8) in whom ESRF was due to other causes. Both haemodialysed (HD) and CAPD patients were included. ApO2 was determined as the pO2 immediately upon standing up. Readings in HD patients were taken at the end of the dialysis session, that is, at the patients' dry weight. RESULTS: Respective SpO2 and ApO2 of the two groups were 85 +/- 17.1 and 78 +/- 20.5 vs 85.8 +/- 19 and 91 +/- 21 mmHg. Delta change in pO2 defined as the mean decrease (negative value) or mean increase (positive value) of ApO2 in relation to SpO2 was -7.85 (group 1) vs + 5.2 mmHg (group 2), P < 0.005. In group 1, six of seven patients demonstrated a negative delta. In group 2, four of eight showed a positive delta whilst the remaining four had no change in the delta value. CONCLUSION: Orthostatic hypoxaemia may occur in dialysed patients whose ESRF is due to APKD.
