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褪黑素对值夜班的医生和护士来说是一种可行、安全且可接受的干预措施:MIDNIGHT试验

Melatonin Is a Feasible, Safe, and Acceptable Intervention in Doctors and Nurses Working Nightshifts: The MIDNIGHT Trial.

作者信息

Thottakam Bensita M V J, Webster Nigel R, Allen Lee, Columb Malachy O, Galley Helen F

机构信息

Institute of Medical Sciences, University of Aberdeen, Aberdeen, United Kingdom.

Intensive Care Unit, Aberdeen Royal Infirmary, Aberdeen, United Kingdom.

出版信息

Front Psychiatry. 2020 Aug 27;11:872. doi: 10.3389/fpsyt.2020.00872. eCollection 2020.


DOI:10.3389/fpsyt.2020.00872
PMID:33192634
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC7481467/
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 12 h 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 Circadin™ 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 while 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. identifier ISRCTN15529655. https://www.isrctn.com/.

摘要

值夜班与睡眠剥夺、疲劳以及注意力/专注力缺陷有关,对于医护人员而言,这些可能会影响患者安全。英国的临床工作人员通常每隔1 - 3个月连续值几个12小时的夜班。我们研究了褪黑素给药交叉试验在值夜班临床工作人员中的可行性和可接受性,并探讨其对睡眠指标和注意力/专注力任务的影响。这是一项在英国一家三级转诊医院对连续值3个夜班的医生和护士进行的试点、双盲、随机、安慰剂对照交叉可行性试验。25名男性和女性受试者被随机分配,在每个连续夜班后睡前接受6毫克Circadin™缓释褪黑素或安慰剂,随后是洗脱期,之后交叉到另一个试验组。我们使用活动记录仪客观评估睡眠参数。该试验设计对参与者来说是可行且可接受的,副作用可忽略不计,但在活性组中褪黑素水平升高的时间延长了(P = 0.016)。两位数加法测试,一项注意力/专注力任务,在褪黑素治疗后得到改善(P < 0.0001)。医生或护士值夜班时警惕性或判断力的下降可能会影响患者安全,褪黑素可能是一种有用的干预措施。本研究支持这样的结论,即对这种设计进行更大规模的确证性试验是可行且安全的。标识符ISRCTN15529655。https://www.isrctn.com/

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/ed010ac50c9d/fpsyt-11-00872-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/d651e2f4786f/fpsyt-11-00872-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/77fb9648b10d/fpsyt-11-00872-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/6d8f4cfb70aa/fpsyt-11-00872-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/86c2754b89b3/fpsyt-11-00872-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/fdc5e3ffd5f7/fpsyt-11-00872-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/ed010ac50c9d/fpsyt-11-00872-g006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/d651e2f4786f/fpsyt-11-00872-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/77fb9648b10d/fpsyt-11-00872-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/6d8f4cfb70aa/fpsyt-11-00872-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/86c2754b89b3/fpsyt-11-00872-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/fdc5e3ffd5f7/fpsyt-11-00872-g005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/084e/7481467/ed010ac50c9d/fpsyt-11-00872-g006.jpg

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本文引用的文献

[1]
Anesthesiology Resident Night Float Duty Alters Sleep Patterns: An Observational Study.

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[2]
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Results of a randomized, double blind, placebo controlled, crossover trial of melatonin for treatment of Nocturia in adults with multiple sclerosis (MeNiMS).

BMC Neurol. 2018-8-6

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Chronobiol Int. 2018-2

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