Wellness Check: Sleep

Physical activity improves sleep quality and cortisol regulation

1. In this systematic review and meta-analysis, there was moderate evidence that physical activity was associated with lower cortisol levels.

2. Additionally, physical activity was associated with improvements in qualitative measures of sleep quality.

Evidence Rating Level: 1 (Excellent)

Cortisol is the main hormone associated with stress and is strongly linked with a person’s sleep cycle. Physical activity is known to improve stress management and sleep quality. However, few studies have looked at the effects of physical activity on both cortisol levels and sleep. Therefore, the objective of this systematic review and meta-analysis was to investigate the association between physical activity and both sleep quality and cortisol regulation.

Of 4,143 identified records, 10 studies were included in the systematic review. Articles were included if they were original peer-reviewed studies investigating physical exercise programs in adults which included relevant non-exercise control groups and measures of both sleep and physiological stress. Studies were synthesized, and meta-analyses were performed for the assessment of a standardized mean differences of sleep and stress measures. Risk of bias was assessed using the Cochrane Risk of Bias tool. The systematic review was conducted following PRISMA guidelines. The primary outcome was the impact of physical activity on both cortisol levels and sleep quality. Secondary objectives included sub-group analyses between gender, age group, and different health conditions.

The study found that physical activity interventions were associated with reduced cortisol levels and improved sleep quality. Furthermore, no meaningful changes in this effect were observed in the various sub-group analyses. However, this review was limited by the study populations of the included articles, including several studies conducted on breast cancer patients and a low number of male participants, limiting the generalizability of the findings. Nonetheless, this study provided evidence of an association between exercise and both improved sleep quality and cortisol levels.

Melatonin improves sleep onset in children with autism spectrum disorder

1. In this randomized controlled trial, sleep onset latency was significantly decreased in children with autism spectrum disorder who received melatonin compared to those who received placebo.

2. Furthermore, there were no serious adverse events or deaths associated with melatonin. The most common adverse events were infections, nervous system disorders, and pharyngitis.

Evidence Rating Level: 1 (Excellent)

Autism spectrum disorder (ASD) is a neurodevelopmental disorder that can affect children’s social behaviours, cognitive aptitudes, and sleep quality. Exogenous melatonin is a known pharmacotherapy that is used to help improve sleep quality and has been studied in children with ASD. However, there has been limited evidence regarding the efficacy of this treatment. Therefore, the objective of this study was to investigate the safety and efficacy of exogenous melatonin for addressing sleep problems in children with ASD.

This randomized controlled trial conducted in Japan included outpatient children aged 6-15 years with ASD. Patients were included if they had a sleep onset latency (SOL) equal to or greater than 30 minutes and were cooperative for sleep hygiene interventions. Patients were excluded if they had severe intellectual disabilities, previous melatonin treatment, or breathing-related sleep disorders. Participants (n=229) were randomized to receive either 1-mg of melatonin, 4-mg of melatonin, or placebo 45 minutes before bedtime. SOL was measured by parents and caregivers using a sleep diary. Sleep actigraphy was also utilized for objective sleep measures, and adverse events were recorded. The primary outcome was the change in the median SOL from baseline.

Results demonstrated a significant reduction in SOL in both the 1-mg and 4-mg melatonin groups compared to the placebo group. Sub-group analyses in height, age, and weight were all significant for improvements in SOL in both 1-mg and 4-mg groups versus the placebo except of females in the 1-mg group. There were no serious adverse events or deaths, and the most common adverse events included infections, neurological disorders, and pharyngitis. However, a drawback of the study was the narrow inclusion criteria, which limited the generalizability of the results to children with ASD outside of the included age range. Nonetheless, this study identified melatonin as an effective intervention to improve sleep quality in children with ASD.

Methylprednisolone after hip replacement surgery improves pain and sleep quality

1. In this randomized controlled trial, post-operative treatment with methylprednisolone was associated with improvements in pain management and subjective sleep quality in patients following hip arthroplasty.

2. Additionally, length of hospital stay was significantly shorter for patients who received a single steroid intervention.

Evidence Rating Level: 1 (Excellent)

Advancements in total hip arthroplasty (THA) have allowed for shorter hospital stays and better recovery outcomes. Pain after surgery continues to be a key reason for extended hospital stays and additional cost to the healthcare system. Furthermore, this pain can initiate a stress response that affects the quality of sleep, which is essential for recovery. Given its anti-inflammatory effects, corticosteroids have been hypothesized to improve both pain and sleep in post-operative patients. This study investigated the effectiveness of post-operative administration of methylprednisolone on pain and sleep quality in patients who underwent THA.

This randomized controlled trial conducted in Iran included patients older than 18 undergoing elective THA. Patients were excluded if they had a history of renal, liver, or peptic ulcer disease, diabetic neuropathy, poorly controlled diabetes or hypertension, or a recent history of corticosteroid use. Patients were randomized (n=70) to receive either 125mg intravenous methylprednisolone or normal saline. The primary outcome of the study was pain, assessed using the visual analog scale, collected in the first 24 hours of surgery, and sleep quality assessed using the Pittsburgh Sleep Quality Index, collected postoperatively at 2, 6, 12, and 24 weeks.

The results of the study demonstrated a greater improvement in sleep quality at the 2-week postoperative mark in the steroid therapy group compared to the control group. Satisfactory pain control was also significantly improved in the those who received methylprednisolone. Furthermore, the average length of hospital stay was significantly shorter in the treatment group compared to the control group. However, this study was limited by the mean patient age (44.3 years) which is significantly younger than that of average THA patients, limiting the generalizability of the study findings. Nonetheless, this study identified methylprednisolone as an effective intervention to improve sleep quality and pain management after THA.

Image: PD

©2023 2 Minute Medicine, Inc. All rights reserved. No works may be reproduced without expressed written consent from 2 Minute Medicine, Inc. Inquire about licensing here. No article should be construed as medical advice and is not intended as such by the authors or by 2 Minute Medicine, Inc.