Effects of Melatonin on Salivary Levels of Cortisol and Sleep Quality of Hemodialysis Patients: A Randomized Clinical Trial

Hasannia, Elham; Derakhshanpour, Firoozeh; Vakili, Mohammad Ali

doi:10.18502/ijps.v16i3.6256

Cited by 6 publications

(3 citation statements)

References 26 publications

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“…Night shift work is associated with disrupted melatonin production [ 51 ]. Melatonin can reduce salivary cortisol levels in haemodialysis patients at night [ 52 ]. Cortisol is a key player in the circadian system [ 53 ] and a critical secondary messenger between the central clock and all peripheral clocks [ 54 ].…”

Section: Discussionmentioning

confidence: 99%

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China

et al. 2022

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Background Currently, cardiovascular disease is the leading cause of death, and dyslipidaemia is an independent and modifiable major risk factor. Previous studies on shift work with dyslipidaemia and hair cortisol concentration (HCC) have yielded conflicting results. The aim of this study was to clarify the association between shift work, dyslipidaemia, and HCC. We further explored the mediating effect of HCC. Methods In this cohort study, baseline data were collected from participants in May 2013. The cohort included 2170 participants- 1348 shift workers and 822 non-shift workers- who were followed up for 6 years with four questionnaire surveys from July 2014, October 2015, and May to December 2019. Hair samples were collected from 340 participants during the baseline period for HCC testing with an automated radioimmunoassay. Dyslipidaemia was defined using the National Cholesterol Education Program Adult Treatment Panel III diagnostic criteria. Results Shift workers had a higher risk of dyslipidaemia than workers on the fixed day shift (two-shift RR = 1.408, 95% CI: 1.102–1.798; three-shift RR = 1.478, 95% CI: 1.134–1.926; four-shift RR = 1.589, 95% CI: 1.253–2.015). Additionally, shift workers had higher HCC levels than fixed day shift workers, with geometric mean concentration (GMC) ± geometric standard difference (GSD) = 2.625 ± 2.012 ng/g, two-shift GMC ± GSD = 3.487 ± 1.930 ng/g, three-shift GMC ± GSD = 2.994 ± 1.813 ng/g, and four-shift GMC ± GSD = 3.143 ± 1.720 ng/g. High HCC was associated with a high incidence of dyslipidaemia. After controlling for confounding factors, this study showed that HCC played a role in mediating dyslipidaemia in shift workers and accounted for 16.24% of the effect. Conclusions Shift work was linked to increased risk of dyslipidaemia compared with fixed day shift work. Higher HCC was associated with a higher prevalence of dyslipidaemia. HCC had a significant mediating effect on dyslipidaemia in shift workers.

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Section: Discussionmentioning

confidence: 99%

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China

et al. 2022

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“…reported that patients on haemodialysis frequently had abnormal diurnal cortisol rhythm and experienced worse quality of sleep compared to healthy individuals ( 31 ). Further data on the interaction between evening cortisol and sleep quality is provided by a short placebo-controlled trial of evening melatonin administration in patients on haemodialysis ( 144 ). The results show a significant improvement in PSQI, along with a reduction in salivary cortisol that is proportionally greater at night-time than in the morning.…”

Section: Disturbances In Endogenous Cortisol Regulation and Their Rel...mentioning

confidence: 99%

Cortisol excess in chronic kidney disease – A review of changes and impact on mortality

2023

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Chronic kidney disease (CKD) describes the long-term condition of impaired kidney function from any cause. CKD is common and associated with a wide array of complications including higher mortality, cardiovascular disease, hypertension, insulin resistance, dyslipidemia, sarcopenia, osteoporosis, aberrant immune function, cognitive impairment, mood disturbances and poor sleep quality. Glucocorticoids are endogenous pleiotropic steroid hormones and their excess produces a pattern of morbidity that possesses considerable overlap with CKD. Circulating levels of cortisol, the major active glucocorticoid in humans, are determined by a complex interplay between several processes. The hypothalamic-pituitary-adrenal axis (HPA) regulates cortisol synthesis and release, 11β-hydroxysteroid dehydrogenase enzymes mediate metabolic interconversion between active and inactive forms, and clearance from the circulation depends on irreversible metabolic inactivation in the liver followed by urinary excretion. Chronic stress, inflammatory states and other aspects of CKD can disturb these processes, enhancing cortisol secretion via the HPA axis and inducing tissue-resident amplification of glucocorticoid signals. Progressive renal impairment can further impact on cortisol metabolism and urinary clearance of cortisol metabolites. Consequently, significant interest exists to precisely understand the dysregulation of cortisol in CKD and its significance for adverse clinical outcomes. In this review, we summarize the latest literature on alterations in endogenous glucocorticoid regulation in adults with CKD and evaluate the available evidence on cortisol as a mechanistic driver of excess mortality and morbidity. The emerging picture is one of subclinical hypercortisolism with blunted diurnal decline of cortisol levels, impaired negative feedback regulation and reduced cortisol clearance. An association between cortisol and adjusted all-cause mortality has been reported in observational studies for patients with end-stage renal failure, but further research is required to assess links between cortisol and clinical outcomes in CKD. We propose recommendations for future research, including therapeutic strategies that aim to reduce complications of CKD by correcting or reversing dysregulation of cortisol.

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“…This contradictory result has blurred the role of serum PTH level in the sleep disturbance associated with MHD. Furthermore, studies have shown that diet regulation and melatonin can improve the sleep quality of MHD patients ( 16 , 17 ). These lines of evidence suggest that there are many factors associated with sleep disturbance in MHD patients, and the role of some factors, such as age and PTH, needs to be confirmed by more studies.…”

Section: Introductionmentioning

confidence: 99%

Risk factors and prediction model of sleep disturbance in patients with maintenance hemodialysis: A single center study

Miao

et al. 2022

Front. Neurol.

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ObjectivesThis study aimed to explore the risk factors and develop a prediction model of sleep disturbance in maintenance hemodialysis (MHD) patients.MethodsIn this study, 193 MHD patients were enrolled and sleep quality was assessed by Pittsburgh Sleep Quality Index. Binary logistic regression analysis was used to explore the risk factors for sleep disturbance in MHD patients, including demographic, clinical and laboratory parameters, and that a prediction model was developed on the basis of risk factors by two-way stepwise regression. The final prediction model is displayed by nomogram and verified internally by bootstrap resampling procedure.ResultsThe prevalence of sleep disturbance and severe sleep disturbance in MHD patients was 63.73 and 26.42%, respectively. Independent risk factors for sleep disturbance in MHD patients included higher 0.1*age (OR = 1.476, 95% CI: 1.103–1.975, P = 0.009), lower albumin (OR = 0.863, 95% CI: 0.771–0.965, P = 0.010), and lower 10*calcium levels (OR = 0.747, 95% CI: 0.615–0.907, P = 0.003). In addition, higher 0.1*age, lower albumin levels, and anxiety were independently associated with severe sleep disturbance in MHD patients. A risk prediction model of sleep disturbance in MHD patients showed that the concordance index after calibration is 0.736, and the calibration curve is approximately distributed along the reference line.ConclusionsOlder age, lower albumin and calcium levels are higher risk factors of sleep disturbance in MHD, and the prediction model for the assessment of sleep disturbance in MHD patients has excellent discrimination and calibration.

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Effects of Melatonin on Salivary Levels of Cortisol and Sleep Quality of Hemodialysis Patients: A Randomized Clinical Trial

Cited by 6 publications

References 26 publications

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China

The relationships of shift work, hair cortisol concentration and dyslipidaemia: a cohort study in China

Cortisol excess in chronic kidney disease – A review of changes and impact on mortality

Risk factors and prediction model of sleep disturbance in patients with maintenance hemodialysis: A single center study

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