Melatonin secretion and poor sleep quality in patients with tetraplegia: A pilot study

Abstract

We evaluated the secretion of melatonin, the sleep quality and the relation between both in tetraplegics versus paraplegic patients and healthy volunteers. This observational non-randomised study was conducted from April 2015 to November 2016 includes tetraplegics versus paraplegics and healthy volunteers. Urinary 6-sulfatoxy-melatonin (U6SM) was measured during 5 period per dey (8 h–12 h; 12 h–16 h; 16 h–20 h; 20 h–00 h; 00 h–8 h). Sleep quality was evaluated on Pittsburgh Sleep Quality Index and sleepiness on Epworth Sleepiness Scale. Correlation between U6SM dosage and sleep quality and sleepiness was analyzed. Twenty-two tetraplegic patients (20 men and 2 women), and 4 paraplegics were included in the study. Fifteen tetraplegic patients (68.1%) had an absence of melatonin secretion, 6 (27.2%) had a decreased secretion with a shift of melatonin secretion. The melatonin secretion was normal in one C5 AIS-A patient (4.5%). The Pittsburgh Sleep Quality Index showed a poor sleep quality in tetraplegics (9.28 ± 4.90) and Epworth Sleepiness Scale showed a moderate sleepiness in tetraplegics (9.14 ± 5.12). We did not observe a significant correlation between melatonin secretion and sleep quality. There was a significant correlation between melatonin secretion and sleepiness. Unlike data of the literature, secretion of melatonin was not strictly normal in paraplegic patients. Secretion of melatonin is abnormal in patients with tetraplegia. It may partly explain sleep impairment of patients with tetraplegia. Further studies are needed to better understand the impact of this absence of melatonin secretion and to assess the effect of melatonin treatment in this population of patients.