Abstract
Nightshift working is associated with sleep deprivation, fatigue and attention/concentration deficits which, in healthcare workers, may impact on patient safety. Clinical staff in the UK routinely work several 12h nightshifts in a row at about 1-3 month intervals. We investigated the feasibility and acceptability of a crossover trial of melatonin administration in clinical staff working nightshifts with an exploration of effects on sleep measures and attention/concentration tasks. This was a pilot, double-blinded, randomized, placebo-controlled crossover feasibility trial in doctors and nurses working 3 consecutive nightshifts at a tertiary referral hospital in the UK. Twenty five male and female subjects were randomized to receive either 6mg CircadinTM slow release melatonin or placebo before sleep after each consecutive nightshift, followed by a washout period, before crossing over to the other experimental arm. We used actigraphy for objective assessment of sleep parameters. The trial design was feasible and acceptable to participants with negligible side effects, but elevated melatonin levels were prolonged during the active arm (P=0.016). Double digit addition testing, a concentration/attention task, improved with melatonin treatment (P<0.0001). Lapses of vigilance or judgement whilst doctors or nurses are working nightshifts could impact on patient safety and melatonin may be a useful intervention. This study supports the conclusion that a larger definitive trial of this design is both feasible and safe.
| Original language | English |
|---|---|
| Article number | 872 |
| Number of pages | 12 |
| Journal | Frontiers in psychiatry |
| Volume | 11 |
| DOIs | |
| Publication status | Published - 27 Aug 2020 |
Bibliographical note
Funding:The study was funded by the British Journal of Anaesthesia and the Royal College of Anaesthetists, funding partners of the National Institute of Academic Anaesthesia (grant number WKR0-2015-0027).
Acknowledgments:
We are extremely grateful to Flynn Pharma for the gift of Circadin and placebo tablets for this trial, to Gary Cameron for the assay of melatonin, and to Sally Galt for helping with recruitment. We also thank Drs Lorna Aucott and David McClernon of the medical statistics team for help with randomization. We acknowledge the members of the Trial Steering Group and the Data and Safety Monitoring Committee. Finally we thank all the doctors and nurses who took part in this trial.
Keywords
- melatonin
- randomized controlled trial
- shift work
- sleep
- healthcare workers
- PSYCHOMOTOR VIGILANCE
- SLEEP
- IMPACT
- SHIFT WORK
- PERFORMANCE
- GENDER
Access to Document
- Thottakam_et_al_FiP_MelatoninIsA_VoR
Copyright © 2020 Thottakam, Webster, Allen, Columb and Galley. This is an openaccess article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. https://creativecommons.org/licenses/by/4.0/