The Effects of the Exogenous Melatonin on Shift Work Sleep Disorder in Health Personnel: A Systematic Review.

Bárbara Carriedo-Diez, Javier Lucas Tosoratto-Venturi, Carmen Cantón-Manzano, Carmina Wanden-Berghe, Javier Sanz-Valero

Systematic Review International journal of environmental research and public health 2022 25 اقتباسات

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Study Design

نوع الدراسة: systematic review

التدخل: The Effects of the Exogenous Melatonin on Shift Work Sleep Disorder in Health Personnel: A Systematic Review. 1–10 mg
المقارن: Placebo
اتجاه التأثير: Positive
خطر التحيز: Moderate

Abstract

(1) Background: To know the medical documentation related to exogenous melatonin in sleep disorders caused by shift work in health personnel; (2) Methods: Systematic and critical review. Data were obtained by looking up the bibliographic data base: MEDLINE (via Pubmed), Embase, Cochrane Library, Scopus, Web of Science, Latin American and Caribbean literature in Health Sciences (LILACS) and Medicine in Spanish (MEDES). The used terms, as descriptors and text in the title and abstract record fields, were "Health Personnel", "Melatonin" and "Sleep Disorders", Circadian Rhythm, by using the following filters: "Humans", "Adult: 19+ years" and "Clinical Trial". The search update was in December 2021. The documentary quality of the articles was assessed using the CONSORT questionnaire. (3) Results: Having applied the inclusion and exclusion criteria, 10 clinical essays were selected out of 98 retrieved references. CONSORT scores ranged from a minimum of 6.0 to a maximum of 13. 7 with a median of 10.2. According to the SIGN criteria, this review presented "1-"evidence with a grade of recommendation B. The intervention dose via administration of exogenous melatonin ranged between 1 and 10 mg. It was not mentioned whether the route of administration was by fast or slow absorption. The outcomes showed decreased daytime sleepiness, lessened sleep onset latency, diminished night-time awakenings, increased total sleep period and improved daytime attention in the melatonin-treated group; (4) Conclusions: Exogenously administered melatonin is effective in shift worker health personnel that are suffering from sleep disorders, and given its low adverse effects and tolerability, it might be recommended. A great disparity was evidenced in terms of dose, follow-up periods and type of melatonin, small participant population, same age ranges and young age. Therefore, new trials would be needed to amend these observations in order to have full evidence that is able to ensure the efficacy of exogenous melatonin in the studied population.

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Figures

Figure 1

PRISMA flowchart showing the systematic literature search and screening process for studies on exogenous melatonin supplementation in health personnel with shift work sleep disorder.

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Figure 2

Summary of included study characteristics and outcomes from the systematic review on melatonin's effectiveness for shift work sleep disorder among healthcare workers.

Tables

Table 1

Author, Year	Studied Population	Country	Intervention Period	Intervention Type	Observed Result
Marqueze et al.,2021 [16]	Population type: NursesN total: 27H/M: 0/27Age: 37.1 ± 5.9 years	Brazil	24 weeks	Administration of 3 mg exogenous melatonin or placebo on nights when they were not working.Composite phase deviations (CPD) of mean sleep time based on actigraphy (efficiency and total sleep time) were calculated to measure circadian misalignment.	Significant 20% decrease in circadian misalignment (p < 0.001). As well as reduction in weight, waist and hip circumference.
Farahmand et al.,2018 [17]	Population type: emergency medicine residentsN total: 24 (Gc:12-Gi: 12)H/M: 14/10Age: 31.21 ± 5.23 years	Iran	4 weeks(From 19 May to 19 June 2016)	Take 3 mg melatonin, versus placebo, 1 h before bedtime for 2 consecutive days. The measurement was made using the Karolinska Sleep Scale	Melatonin therapy meaningfully lessened daytime sleepiness in comparison with placebo from the second night onwards (p = 0.003).
Sadeghniiat-Haghighi et al.,2016 [18]	Population type: Shift workers with difficulty to get to sleepN total: 50 (Gc: 25–Gi:25)H/M: Not recorded Age: Not recorded	Iran	3 nights’ treatment and 2 weeks washout period.	Take 3 mg melatonin, versus placebo, 30 min before bedtime.Total sleep time, sleep onset latency, sleep efficiency and awakening after sleep onset were analyzed.	Melatonin therapy improved sleep onset latency and decreased nocturnal awakenings, although there was no association when compared to the placebo group in relation to total sleep time and awakening after sleep onset (p > 0.05). Sleep onset latency and sleep efficiency improved significantly (p < 0.05).
Sadeghniiat-Haghighi et al.,2008 [19]	Population type: nurses with insomnia N total: 86H/M: 0/86Age: From 24 to 46 years	Iran	1 night treatment with melatonin and washing out for 4 days.	Oral intake of 5 mg melatonin taken 30 min before night-time sleep.Insomnia, subjective sleep onset latency, number of awakenings and sleep duration were measured.	While the subjects were taking melatonin (p < 0.05), sleep onset latency lessened meaningfully.There was no association when analysing the number of awakenings and sleep duration.
Cavallo et al.,2005 [20]	Population type: 2º year paediatric residents N total: 45H/M: 16/29Age: 28.6 ± 1.9 years	USA	2 Weeks	Taking melatonin (3 mg) vs. placebo before bedtime in the morning after the night shift. Standardized measures of sleep, mood and attention were assessed.	There were no significant differences in measures of sleep and mood. Significance was observed in the measure of attention (p = 0.03).
Yoon et al.,2002 [21]	Population type: Night shift nurses N total: 12H/M: 0/12Age: From 23 to 27 years	Korea	Follow-up for 9 days.	Three groups were set: placebo, melatonin, and melatonin with sunglasses. Melatonin (6 mg) was administered before bedtime for 2 days. Alertness, night-time sleep period and daytime sleep and mood were observed.	Total sleep period and total sleep times increased meaningfully with melatonin treatments (p < 0.05).Mood improved slightly. There was no significance between the melatonin treatment groups (with or without sunglasses).
Jockovich et al.,2000 [22]	Population type: emergency medicine residentsN total: 19H/M: 15/4 Age: 28.2 years	USA	3 consecutive days after each night shift.	Melatonin (1 mg) administration or placebo, 30 to 60 min before the daytime sleep session, for 3 consecutive days after each night shift.It was evaluated by Actigraph 1000 (efficiency and total sleep time). The mood profile and Stanford Sleepiness Scale were utilized to quantify mood and sleepiness.	There was no difference in sleep efficiency, duration, or latency (p > 0.05) between the melatonin group and placebo.Neither there was significance in mood profile and sleepiness (p > 0.05).
Wright et al.,1998 [23]	Population type: doctorsN total: 15H/M: 12/3Age: From 32 to 45 years	USA	36 days (4 days for intervention, 28 days for washout and 4 days for intervention)	Melatonin (5 mg) administration or placebo for 3 consecutive nights after the night shift with crossover to the opposite agent after a subsequent block of night shifts.The primary outcome measure was the overall assessment of recovery as measured by a visual analogue scale. Secondary outcome measures included sleep quality, duration and fatigue. Furthermore, the Profile of Mood States and neuropsychological tests were used.	No beneficial effect of melatonin was found for sleep quality, fatigue or cognitive function in emergency physicians after the night shift (p < 0.05). The obtained results suggest that exogenous melatonin has limited value in the recovery of doctors after the night shift.
Jorgensen et al.,1998 [24]	Population type: resident doctors N total: 18H/M: 16/2Age: From 25 to 40 years	USA	5, 4, 3 and 2-night series	Administration of 10 mg sublingual melatonin or placebo every morning after the evening urgency.During daytime sleep periods, subjective sleep data were recorded. During night shifts, alertness was assessed using the Stanford Sleepiness Scale.	Melatonin improved daytime sleep and night-time alertness (p = 0.3); however, in neither case was the improvement statistically meaningful. Exogenous melatonin had a slight benefit in terms of improved alertness (p < 0.05).
James et al.,1998 [25]	Population type: night-shifts paramedics N total: 22H/M: 17/5Age: From 20 to 41 años	USA	A total of 4 consecutive night shifts (2 melatonin, 2 placebo)	Administration of melatonin 6 mg one capsule orally 30 min before each consecutive day’s sleep. Assessment of sleep quality, post-treatment mood and workload ratings were measured daily using a Visual Analogue Scale (VAS).	No clinical benefits were observed in staff working rotating night shifts.Melatonin was associated with meaningful fewer interim awakenings during daytime sleep compared with placebo (p < 0.05).For the rest of the studied variables, no significant differences were found (p > 0.05).

Table 2

	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15	16	17	18	19	20	21	22	23	24	25	Total	%
Marqueze et al.,2021 [16]	0.5	1	1	1	1	1	1	1	1	0	0	1	1	1	0	1	1	1	0	1	1	1	1	1	1	20.5	13.71
Farahmand et al.,2018 [17]	1	1	1	1	1	0.5	0.5	1	0	0	0	0.5	1	0.5	1	1	1	1	0	1	1	1	0	1	1	18	12.04
Sadeghniiat-Haghighi et al.,2016 [18]	1	1	1	1	1	1	0	0	0	0	0	1	1	1	0	0	1	1	0	1	1	1	0	0	1	15	10.03
Sadeghniiat-Haghighi et al.,2008 [19]	1	1	0	1	1	0	0	0.5	0	0	0	0.5	0.5	0	1	1	1	1	1	1	1	1	0	0	1	14.5	9.69
Cavallo et al.,2005 [20]	0.5	1	1	1	1	1	1	0.5	0	1	0	1	1	0.5	1	1	1	1	1	1	1	1	0	0	1	19.5	13.04
Yoon et al.,2002 [21]	0.5	0.5	0.5	1	1	0.5	0	0	0	0	0	1	0.5	0.5	1	1	1	1	0	1	0	1	0	0	0	12	8.02
Jockovich et al.,2000 [22]	0.5	1	1	1	1	0.5	0.5	0	0	0	0	1	0.5	0.5	0	0	0	0	0	1	0	1	0	0	0	9.5	6.35
Wright et al.,1998 [23]	0.5	1	0.5	1	1	0.5	0	0	0	1	0.5	0.5	1	0.5	1	1	1	0	1	1	1	1	0	0	1	16	10.70
Jorgensen et al.,1998 [24]	0.5	0.5	1	1	1	0	0	0.5	0	0	1	0	0	0	0	0	0	0	0	1	1	0.5	0	0	1	9	6.02
James et al.,1998 [25]	1	1	1	1	1	1	1	0.5	0	1	0	0.5	1	0	0	1	0.5	0	1	1	1	1	0	0	0	15.5	10.36

Table 3

	1	2	3	4	5	6	7
Marqueze et al. [16]	No	No	Yes	Yes	No	No	No
Farahmand et al. [17]	No	No	No	Yes	Yes	No	No
Sadeghniiat-Haghighi et al. [18]	No	No	Yes	Yes	Yes	No	No
Sadeghniiat-Haghighi et al. [19]	No	No	No	No	Yes	No	No
Cavallo et al. [20]	No	No	No	No	Yes	Yes	Yes
Yoon et al. [21]	No	No	No	No	Yes	Yes	No
Jockovich et al. [22]	No	No	No	No	Unclear	Yes	Yes
Wright et al. [23]	No	Unclear	Unclear	Unclear	Yes	Yes	No
Jorgensen et al. [24]	No	No	No	No	Yes	No	Yes
James et al. [25]	No	No	Unclear	Yes	Yes	No	Yes
Selection bias (Generation of random sequences) Selection bias (Concealment of allocation) Performance bias (Blinding of participants and staff) Detection bias (Blinding of outcome assessment) Attrition bias (Unfinished result data) Reporting bias (Selective reporting) Other biases (Description of other sources of bias)

References

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Used In Evidence Reviews

A Melatonin لـ الأرق

A Melatonin لـ صعوبة بدء النوم

A Melatonin لـ اضطراب الإيقاع اليوماوي

A Melatonin لـ اضطراب نوم العمل بنظام الورديات

The Effects of the Exogenous Melatonin on Shift Work Sleep Disorder in Health Personnel: A Systematic Review.

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