A Cross-Sectional Study Examining the Correlation between Nocturnal Melatonin Level and Sleep Quality in Patients Admitted To the Cardiac Care Unit
Keywords:Sleep Quality, Melatonin, Light, Cardiac Care Unit
BACKGROUND: Quality of sleep, as a basic need, is an important factor for surviving patients in hospitals. Many factors may contribute to disturbing patients sleep, such as continuous ambient light, is required for healthcare providers to monitor patients. Ambient light can influence patients' quality of sleep due to melatonin secretion.
AIM: Study aimed to determine the correlation between nocturnal melatonin levels and sleep quality in patients admitted to the Cardiac Care Units (CCU).
MATERIAL AND METHODS: This cross-sectional study was done on inpatients of CCUs at Amir-Almomenin Hospital in Kordkoy city, a cardiac referral hospital in the northeastern of Iran in 2015. Sixty-eight inpatients were selected through convenience sampling. Before data gathering light level of CCUs was measured every one hour in 2 days, the quality of nocturnal sleep was investigated through Verran and Snyder-Halpern (VSH) Sleep Scale at the second night of admission urinary melatonin level was measured at the same night in all urine excreted between 22:00 pm and 07:00 am.
RESULTS: The mean and standard deviation (SD) score of sleep quality in three dimensions of sleep disturbance, sleep effectiveness and sleep supplementation were 336.6 Â± 149.9, 269.0 Â± 82.2, and 175.2 Â± 30.7, respectively. Also, the mean and SD of nocturnal urinary melatonin levels was 323.02 Â± 136.21 pg/ml. There was not a significant correlation between level of nocturnal melatonin and three domains of sleep quality; sleep disturbance (r = 0.005, P = 0.968), sleep effectiveness (r = 0.090, P = 0.464), and sleep supplementation (r = -0.037, P = 0.763).
CONCLUSION: According to the result, most CCUs patients suffer from sleep disturbance. However, there was no correlation between the level of melatonin and sleep quality. There is a need for recognising the reasons for sleep disturbances in Cardiac Care Units. It is imperative for care providers to be able to recognise the causes of sleep disturbances and to modify environmental factors such as ambient light to improve sleep quality in hospitalised patients.
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Modanloo M, Sharifi H. Do depressed elderly heart failure patients benefit from yoga? A future direction for research. J Cardiovasc Nurs. 2018; 33(5):420-1. https://doi.org/10.1097/JCN.0000000000000512 PMid:30095754
Moeini M, Khadibi M, Bekhradi R, Mahmoudian SA, Nazari F. Effect of aromatherapy on the quality of sleep in ischemic heart disease patients hospitalized in intensive care units of heart hospitals of the Isfahan University of Medical Sciences. Iran J Nurs Midwifery Res. 2010; 15(4):234-9. PMid:22049287 PMCid:PMC3203283
Wong ND. Epidemiological studies of CHD and the evolution of preventive cardiology. Nat Rev Cardiol. 2014; 11(5):276-89. https://doi.org/10.1038/nrcardio.2014.26 PMid:24663092
Moran AE, Forouzanfar MH, Roth G, Mensah GA, Ezzati M, Flaxman A, et al. The global burden of ischemic heart disease in 1990 and 2010: the Global Burden of Disease 2010 study. Circulation. 2014; 129(14):1493-501. https://doi.org/10.1161/CIRCULATIONAHA.113.004046 PMid:24573351 PMCid:PMC4181601
Bansilal S, Castellano JM, Fuster V. Global burden of CVD: focus on secondary prevention of cardiovascular disease. International journal of cardiology. 2015; 201:S1-7. https://doi.org/10.1016/S0167-5273(15)31026-3
Sadeghi M, Haghdoost AA, Bahrampour A, Dehghani M. Modeling the burden of cardiovascular diseases in Iran from 2005 to 2025: The impact of demographic changes. Iran J Public Health. 2017; 46(4):506-516. PMid:28540267 PMCid:PMC5439040
Mirkarimi A, Khoddam H, Vakili MA, Sadeghi MB, Modanloo M. Effect of life style modification on adherence to diet and hypertension in hypertensive patients. Koomesh. 2018; 20(2):192-202.
Li SY, Wang TJ, Vivienne Wu SF, Liang SY, Tung HH. Efficacy of controlling night-time noise and activities to improve patients' sleep quality in a surgical intensive care unit. J Clin Nurs. 2011; 20(3-4):396-407. https://doi.org/10.1111/j.1365-2702.2010.03507.x PMid:21219521
Patel M, Chipman J, Carlin BW, Shade D. Sleep in the intensive care unit setting. Crit Care Nurs Q. 2008; 31(4):309-18. https://doi.org/10.1097/01.CNQ.0000336816.89300.41 PMid:18815477
Emami Zeydi A, Jannati Y, Darvishi Khezri H, Gholipour Baradari A, Espahbodi F, Lesani M, et al. Sleep quality and its correlation with serum C-reactive protein level in hemodialysis patients. Saudi J Kidney Dis Transpl. 2014; 25(4):750-5. https://doi.org/10.4103/1319-2442.134962 PMid:24969183
Tembo AC, Parker V. Factors that impact on sleep in intensive care patients. Intensive Crit Care Nurs. 2009; 25(6):314-22. https://doi.org/10.1016/j.iccn.2009.07.002 PMid:19880319
Daneshmandi M, Neiseh F, SadeghiShermeh M, Ebadi A. Effect of eye mask on sleep quality in patients with acute coronary syndrome. J Caring Sci. 2012; 1(3):135-43. PMid:25276688 PMCid:PMC4161075
Fontana CJ, Pittiglio LI. Sleep deprivation among critical care patients. Crit Care Nurs Q. 2010; 33(1):75-81. https://doi.org/10.1097/CNQ.0b013e3181c8e030 PMid:20019513
Tordjman S, Chokron S, Delorme R, Charrier A, Bellissant E, Jaafari N, et al. Melatonin: Pharmacology, Functions and Therapeutic Benefits. Curr Neuropharmacol. 2017; 15(3):434-43. https://doi.org/10.2174/1570159X14666161228122115 PMid:28503116 PMCid:PMC5405617
Hu RF, Jiang XY, Zeng YM, Chen XY, Zhang YH. Effects of earplugs and eye masks on nocturnal sleep, melatonin and cortisol in a simulated intensive care unit environment. Crit Care. 2010; 14(2):R66. https://doi.org/10.1186/cc8965 PMid:20398302 PMCid:PMC2887188
Tamburri LM, DiBrienza R, Zozula R, Redeker NS. Nocturnal care interactions with patients in critical care units. Am J Crit Care. 2004; 13(2):102-12. PMid:15043238
Scheer FA, Van Montfrans GA, van Someren EJ, Mairuhu G, Buijs RM. Daily nighttime melatonin reduces blood pressure in male patients with essential hypertension. Hypertension. 2004; 43(2):192-7. https://doi.org/10.1161/01.HYP.0000113293.15186.3b PMid:14732734
Challet E. Minireview: Entrainment of the suprachiasmatic clockwork in diurnal and nocturnal mammals. Endocrinology. 2007; 148(12):5648-55. https://doi.org/10.1210/en.2007-0804 PMid:17901231
Meyer TJ, Eveloff SE, Bauer MS, Schwartz WA, Hill NS, Millman RP. Adverse Environmental Conditions in the Respiratory and Medical ICU Settings. Chest. 1994; 105(4):1211-6. https://doi.org/10.1378/chest.105.4.1211 PMid:8162751
Reza H, Kian N, Pouresmail Z, Masood K, Sadat Seyed Bagher M, Cheraghi MA. The effect of acupressure on quality of sleep in Iranian elderly nursing home residents. Complement Ther Clin Pract. 2010; 16(2):81-5. https://doi.org/10.1016/j.ctcp.2009.07.003 PMid:20347838
Mashayekhi F, Mirzai Saifabad R, Baghery P. Validity and Reliability of the Verran and Snyder-Halpern Sleep Scale in Iranian population. J Mazandaran Univ Med Sci. 2016; 25(132):200-9.
Mundigler G, Delle-Karth G, Koreny M, Zehetgruber M, Steindl-Munda P, Marktl W, et al. Impaired circadian rhythm of melatonin secretion in sedated critically ill patients with severe sepsis. Crit Care Med. 2002; 30(3):536-40. https://doi.org/10.1097/00003246-200203000-00007 PMid:11990911
Redeker NS, Hedges C. Sleep during hospitalization and recovery after cardiac surgery. J Cardiovasc Nurs. 2002; 17(1):56-68. https://doi.org/10.1097/00005082-200210000-00006
Erickson VS, Westlake CA, Dracup KA, Woo MA, Hage A. Sleep disturbance symptoms in patients with heart failure. AACN Clin Issues. 2003; 14(4):477-87. https://doi.org/10.1097/00044067-200311000-00009 PMid:14595207
Stanchina ML, Abu-Hijleh M, Chaudhry BK, Carlisle CC, Millman RP. The influence of white noise on sleep in subjects exposed to ICU noise. Sleep Med. 2005; 6(5):423-8. https://doi.org/10.1016/j.sleep.2004.12.004 PMid:16139772
Weinhouse GL, Schwab RJ. Sleep in the critically ill patient. Sleep. 2006; 29(5):707-16. https://doi.org/10.1093/sleep/29.5.707
Mashayekhi F, Arab M, Pilevarzadeh M, Amiri M, Rafiei H. The effect of eye mask on sleep quality in patients of coronary care unit. Sleep Sci. 2013; 6(3):108-11.
Bourne RS, Mills GH, Minelli C. Melatonin therapy to improve nocturnal sleep in critically ill patients: encouraging results from a small randomised controlled trial. Crit Care. 2008; 12(2):R52. https://doi.org/10.1186/cc6871 PMid:18423009 PMCid:PMC2447606
Parker KP, Dunbar SB. Sleep and heart failure. J Cardiovasc Nurs. 2002; 17(1):30-41. https://doi.org/10.1097/00005082-200210000-00004
Freedman NS, Gazendam J, Levan L, Pack AI, Schwab RJ. Abnormal sleep/wake cycles and the effect of environmental noise on sleep disruption in the intensive care unit. Am J Respir Crit Care Med. 2001; 163(2):451-7. https://doi.org/10.1164/ajrccm.163.2.9912128 PMid:11179121
Golmohamadi R, Shafiee Motlagh M, Jamshidi Rastani M, Salimi N, Valizadeh Z. Assessment of Interior and Area Artificial Lighting in Hospitals of Hamadan City. Journal of Occupational Hygiene Engineering (JOHE). 2014; 1(1):47-56.
Hu RF, Hegadoren KM, Wang XY, Jiang XY. An investigation of light and sound levels on intensive care units in China. Aust Crit Care 2016; 29(2):62-7. https://doi.org/10.1016/j.aucc.2015.08.001 PMid:26307553
Gershengorn HB. Shedding light on light in the intensive care Unit. J Crit Care. 2013; 28(1):101-2. https://doi.org/10.1016/j.jcrc.2012.07.009 PMid:22999482
Richardson A, Allsop M, Coghill E, Turnock C. Earplugs and eye masks: do they improve critical care patients' sleep? Nurs Crit Care. 2007; 12(6):278-86. https://doi.org/10.1111/j.1478-5153.2007.00243.x PMid:17983362
Farud D, TAhavorgar A. Melatonin Hormone, Metabolism and its Clinical Effects: A Review. Iranian Journal of Endocrinology and Metabolism. 2013; 15(2):211-23.
Kakooei H, Zamanian Ardakani Z, Karimian S, Ayattollahi S. Twenty Four-hour circadian melatonin profile among women shift work nurses. Journal of Zanjan University of Medical Sciences. 2009; 17(68):75-84.
Shamir E, Laudon M, Barak Y, Anis Y, Rotenberg V, Elizur A, et al. Melatonin improves sleep quality of patients with chronic schizophrenia. J Clin Psychiatry. 2000; 61(5):373-7. https://doi.org/10.4088/JCP.v61n0509 PMid:10847313
Chisholm EJ, Kuchai R, McPartlin D. An objective evaluation of the waterproofing qualities, ease of insertion and comfort of commonly available earplugs. Clin Otolaryngol Allied Sci. 2004; 29(2):128-32. https://doi.org/10.1111/j.1365-2273.2004.00795.x PMid:15113295
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