Melatonin Increased Hospitalized Patients' Sleep Quality by 32%

Administering melatonin may improve the sleep quality of hospitalized patients, a study found.¹ The research, led by Tong Ren, MD, PhD, from HCA Oak Hill Hospital, will be presented at the SLEEP 2024 Annual Meeting in Houston.

Many hospitalized patients endure sleep problems which not only impacts their well-being but clinical outcomes. Doctors have tried non-pharmacological efforts to help their patients sleep but they provide limited benefit.

A study back in 2017 studied the efficacy of non-pharmacologic intervention on the sleep quality of inpatients in a controlled trial.² The non-pharmacologic intervention assessed was the ‘TUCK-in’ protocol, which included timed lights-off periods, reducing night-time noise, providing earplugs at bedtime, had patients go to the bathroom before bedtime, and identifying (and reducing) modifiable interruptions.

The primary outcome was the measure of self-reported duration of night-time sleep within 48 hours. However, the self-reported duration of night-time sleep did not differ between the intervention group and the control group with both groups receiving a medium sleep duration of 5 hours (P = .13).

Nonpharmacological interventions may be the recommended first-line treatment option for insomnia, but their effectiveness in the hospital is still questionable with mixed evidence.³ Research suggests the most effective interventions are a comprehensive /multi-modal approach.

Common sleep medicines prescribed to inpatients are benzodiazepines and non-benzodiazepine γ-aminobutyric acid receptor agonist agents (z-drugs: zopiclone, zaleplon, eszopiclone, and zolpidem tartrate), but they are not recommended for patients > 65 years. Doctors also often give melatonin which has the same or fewer incidence of adverse events than the other common medicines.

Since non-pharmacological efforts did not seem to help patients sleep, Ren and colleagues turned to exploring pharmacologic solutions instead, and in this case, melatonin.¹ The study aimed to improve sleep quality and quantity in hospitalized patients using melatonin.

Investigators conducted a before-and-after study of 117 participants who had sleep-related parameters assessed before and after given melatonin. Before the melatonin, participants completed a survey adapted from the Richards-Campbell Sleep Questionnaire Sleep Efficiency Index (RCSQ) and Pittsburgh Sleep Quality Index (PSQI) to assess 4 sleep dimensions: sleep latency, awakenings from sleep, sleep quality, and total sleep duration.

Sleep duration was measured in hours. Additionally, sleep latency, awakenings, and overall sleep quality were measured on a scale from 0 (the poorest sleep) to 10 (the best sleep). The team used non-parametric tests to analyze the survey data and objective sleep duration measurements.

Investigators found melatonin was associated with significant improvements in sleep parameters. Mean sleep duration increased by 17.9% from 4.9 to 5.7 hours, sleep latency increased by 22.3%, awakenings from sleep score reduced by 29.3%, and sleep quality score increased by 32%. The findings reveal melatonin has a positive impact on both objective and subjective sleep.

“Increased sleep duration, improved sleep latency, reduced awakenings, and significant subjective sleep quality improvement suggest that melatonin supplementation may be a promising intervention to enhance sleep in this population,” investigators concluded.

References

1. ^{Ren, T, Hamidullah, A, Sophia, S, et al. Improving Sleep Quality and Quantity in Hospitalized Patients with Melatonin: A Quality Improvement Project at HCA Oak Hill Hospital. Abstract presented at SLEEP 2024. Houston, TX. June 1-5, 2024.}
2. ^{Dobing S, Dey A, McAlister F, Ringrose J. Non-pharmacologic interventions to improve sleep of medicine inpatients: a controlled study. J Community Hosp Intern Med Perspect. 2017;7(5):287-295. Published 2017 Oct 18. doi:10.1080/20009666.2017.1379845}
3. ^{Salahub C, Wu PE, Burry LD, et al. Melatonin for Insomnia in Medical Inpatients: A Narrative Review. J Clin Med. 2022;12(1):256. Published 2022 Dec 29. doi:10.3390/jcm12010256}