Comparison of exogenous melatonin versus placebo on sleep efficiency in emergency medicine residents working night shifts: A randomized trial

doi:10.5847/wjem.j.1920-8642.2018.04.008

Abstract

Abstract:

BACKGROUND: Sleep deprivation resulting from night shifts, is a major cause of burnout among physicians. Exogenous melatonin may improve sleep quality in night-shift workers. The study aims to compare the effectiveness of melatonin versus placebo on sleep efficiency in emergency medicine (EM) residents.
METHODS: A randomized, double-blind, replicated crossover trial was performed on EM residents. This study consisted of 4 phases within a month with intervention periods of 2 nights and washouts of 6 days. In our study, EM residents had nine-hour shifts on 6 consecutive days, 2 mornings, 2 evenings and 2 nights and then 2 days off. At the end of shifts’ cycle, 24 EM residents were given 3 mg melatonin or placebo (12 in each arm of the study) for 2 consecutive nights after the second night shift with crossover to the other arm after a six-day off drug. This crossover intervention was repeated for two more another time. Finally, we created 48 cases and comparisons in each arm. Different items related to sleep quality were assessed and compared both within the same group and between the two groups.
RESULTS: In the melatonin group, daytime sleepiness (calculated by Karolinska Sleep Scale) had a significant reduction after taking the second dose of drug (P=0.003) but the same result was not observed when comparing the 2 groups. Mood status (calculated by Profile of Mood States) showed no remarkable difference between the 2 groups.
CONCLUSION: Melatonin might have a limited benefit on sleep quality in EM residents working night shifts.

Key words: Melatonin, Placebo, Emergency medicine, Night shift, Sleep

Shervin Farahmand, Masoume Vafaeian, Elnaz Vahidi, Atefeh Abdollahi, Shahram Bagheri-Hariri, Ahmad Reza Dehpour. Comparison of exogenous melatonin versus placebo on sleep efficiency in emergency medicine residents working night shifts: A randomized trial[J]. World Journal of Emergency Medicine, 2018, 9(4): 282-287.

Figures/Tables 3

Figure 1.

Table 1

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Variables	Melatonin			Placebo			P-value2	P- value3
Variables	First night	Second night	P-value⁰	First night	Second night	P-value1	P-value2	P- value3
Delay in falling asleep (extra doses needed)	1 (4.2%)	5 (20.8%)	0.219	2 (8.3%)	2 (8.3%)	1.00	0.551	0.416
Night mare	2 (8.3%)	4 (16.7%)	0.625	4 (16.7%)	3 (12.5%)	0.981	0.666	0.683
Night awakening	7 (29.2%)	11 (45.8%)	0.219	16 (66.7%)	9 (37.5%)	0.039	0.020	0.770
Early awakening	4 (16.7%)	7 (29.2%)	0.453	7 (29.2%)	5 (20.8%)	0.625	0.494	0.740
Drowsiness on the following day	16 (66.7%)	8 (33.8%)	0.021	11 (45.8%)	11 (45.8%)	1.00	0.244	0.556

Variables	Melatonin				Placebo				Mean difference (95% CI) Between groups on first night	P-value2	Mean difference (95% CI) Between groups on second night	P- value3
Variables	First night	Second night	Mean difference (95% CI)	P-value⁰	First night	Second night	Mean difference (95% CI)	P-value1	Mean difference (95% CI) Between groups on first night	P-value2	Mean difference (95% CI) Between groups on second night	P- value3
Sleep hours	7.68±1.15	6.81±1.24	0.87 (0.07, 1.67)	0.231	7.91±2.32	6.79±1.58	1.12 (0.06, 2.18)	0.315	0.22 (-0.83, 1.29)	0.826	-0.20 (-0.84, 0.80)	0.916
KSS score (drowsiness)	4.54±2.06	3.13±1.75	1.41 (0.56, 2.27)	0.003	3.33±1.20	3.67±1.12	-0.33 (-0.74, 0.07)	0.106	-1.20 (-2.19, -0.22)	0.020	0.54 (-0.31, 1.40)	0.056
VAS score (tiredness)	6.67±3.00	7.54±2.48	-0.87 (-1.77, 0.02)	0.049	6.79±3.07	6.71±2.86	0.08 (-0.66, 0.83)	0.958	0.12 (-1.64, 1.89)	0.802	-0.83 (-2.39, 0.72)	0.268
POMS score (mood status)	119.29±67.37	122.71±36.90	-3.41 (-12.53, 5.69)	0.210	115.58±35.95	123.92±36.53	-8.33 (-16.88, 0.21)	0.119	-3.70 (-25.10, 17.69)	0.812	1.20 (-20.12, 22.54)	0.721