The effects of melatonin on sleep–wake rhythm of daytime haemodialysis patients: a randomized, placebo‐controlled, cross‐over study (EMSCAP study)

Abstract

WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT • Disturbances of sleep-wake rhythm are frequently reported in daytime haemodialysis patients. • The melatonin rhythm, which plays an important role in synchronization of the sleep-wake rhythm, is disturbed in this patient group. • In other patient groups with disturbed melatonin rhythm, use of exogenous melatonin resulted in an improvement of sleep quality and melatonin rhythm. WHAT THIS STUDY ADDS • This is the first study on the effects of exogenous melatonin on sleep-wake rhythm in haemodialysis patients. • Due to exogenous melatonin, sleep parameters such as sleep fragmentation, sleep onset latency and subjective sleep quality improved. • Nocturnal melatonin rise was recovered. AIM The aim of this study was to investigate the effects of exogenous melatonin on sleep-wake rhythm in haemodialysis patients. METHODS The study design is a randomized, double-blind, placebo-controlled, cross-over study of 3 ¥ 6 weeks melatonin 3 mg at 22.00 h every night. Haemodialysis patients were asked to fill out a sleep questionnaire and to wear an actometer to record their sleep problems objectively. Furthermore, melatonin concentrations in saliva were sampled the night after daytime haemodialysis and the consecutive night. Actometers, the sleep questionnaire and melatonin concentrations were repeated during the study. RESULTS In total, 20 patients (six female, median age 71 years) completed the investigation. On nights after daytime dialysis, objective sleep onset latency decreased significantly from a median of 44.5 (placebo) to a median of 15.5 min with melatonin (P < 0.01). Sleep efficiency increased from 67.3 to 73.1% with melatonin (P < 0.05). Actual sleep time increased from 376 min (placebo) to 388 min with melatonin (P < 0.01), and sleep fragmentation decreased from 4.5 to 3.1 (P < 0.01). Furthermore, subjective sleep parameters improved also. Patients reported less time needed to fall asleep (P < 0.05) and fewer wake periods (P < 0.05) on the nights with and without daytime dialysis and an increase in sleep time on the night of daytime dialysis (P < 0.05). Furthermore, the nocturnal melatonin rise was recovered. CONCLUSION Treatment with melatonin resulted in an improvement of subjective and objective sleep parameters, as well as a recovered nocturnal melatonin rhythm.

Melatonin rhythms in renal transplant recipients with sleep–wake disturbances

“…Thus, since only 8 of the 18 patients with non-calculable DLMO took beta blockers; this may not be the main reason for the observed low melatonin values in the no-DLMO group. This corroborates findings in haemodialysis patients (Koch et al, 2009) where beta blockers did also not explain low melatonin values. Another reason for low melatonin could relate to the calcification of the pineal gland (Kunz et al, 1999), since a characteristic of chronic kidney disease is high vascular calcification.…”

“…Melatonin supplementation (3 mg) at 22:00 pm has shown good results in haemodialysis patients. Melatonin supplementation recovered the low nocturnal melatonin rise of these patients and improved sleep fragmentation, sleep onset latency and subjective sleep quality (Koch et al, 2009). All efforts targeting a high nocturnal melatonin and intact melatonin signalling are in favour of avoiding various illnesses (Hardeland, 2012) and keeping a well-synchronised sleep-wake cycle.…”

“…In daytime haemodialysis patients an absence (Karasek et al, 2005) in the nocturnal rise in melatonin concentration has been reported (Koch et al, 2009) probably due to the dialysis itself. Very low values were also found (Koch et al, 2010) in chronic kidney failure patients significantly correlating with failure degree (Koch et al, 2010).…”

Hyperparathyroidism in Hemodialyzed Patients – Relation to Melatonin and Reproductive Hormones Before and After Parathyroidectomy

“…In HD patients melatonin disturbances are known to occur (Kancheva et al, 2008;Koch et al, 2009aKoch et al, , 2009b. In addition, patients with end-stage renal disease suffer from a number of related disorders (Koch et al, 2010a;Lüdemann et al, 2001;Young et al, 2005) including endocrine abnormalities, psychiatric disorders and impairment of sleep parameters.…”

Can A Nursing Intervention Improve the Sleep Pattern Disorders in Patients Undergoing Hemodialysis in Morning and Afternoon Shifts?

“…On average, 50-80% of these patients suffer from delayed sleep onset and have trouble staying asleep [2,3]. A recent study carried out at Zagazig and Ain-Shams University Hospitals in Egypt revealed that more than half (56.7%) of patients undergoing hemodialysis had sleep disturbances [4].…”