Melatonin improves nighttime sleep in critically ill patients

NEW YORK (Reuters Health) - Melatonin therapy can increase the efficiency of nocturnal sleep in critically ill patients, according to a report in Critical Care published online April 18th.

Dr. Richard S. Bourne from Northern General Hospital, Sheffield, UK and colleagues examined the effect of exogenous melatonin versus placebo on nocturnal sleep in 24 patients being weaned from mechanical ventilation.

Nocturnal sleep time was 2.5 hours in the placebo group and 1 hour...

NEW YORK (Reuters Health) - Melatonin therapy can increase the efficiency of nocturnal sleep in critically ill patients, according to a report in Critical Care published online April 18th.

Dr. Richard S. Bourne from Northern General Hospital, Sheffield, UK and colleagues examined the effect of exogenous melatonin versus placebo on nocturnal sleep in 24 patients being weaned from mechanical ventilation.

Nocturnal sleep time was 2.5 hours in the placebo group and 1 hour longer in the melatonin group, the authors report, although this difference was not statistically significant.

The bispectral index (BIS) area under the curve (AUC), a measure of the quality of sleep, was significantly better in the melatonin group than in the placebo group.

"In order to get a full appreciation of the effects of melatonin on sleep in critical care patients, a continuous measure of sleep quality is probably required," Dr. Bourne said. "Although the nocturnal BIS AUC data suggested 'better' sleep after melatonin administration, polysomnography currently remains the only technique capable of providing sleep quality data."

"We would like to follow this investigation with a larger study in critical care patients using a lower dose of melatonin," Dr. Bourne commented. His team noted in the study that the 10 mg dose was probably too high as levels remained supraphysiologic in the morning.

Despite the promising results, the causes of sleep disturbances in critical care patients are multifactorial, he pointed out, so a single intervention, such as administration of melatonin, is unlikely to have a dramatic effect.

"Multicomponent interventions that include attempts to reduce environmental disturbances, ventilator dyssynchrony, and inappropriate medication, as well as attempts to reinforce a patient's circadian rhythm, are probably required," Dr. Bourne concluded.

Critical Care 2008;12:R52.