Circadian rhythm disruption in severe sepsis: the effect of ambient light on urinary 6-sulfatoxymelatonin secretion

Verceles, Avelino C.; Silhan, Leann; Terrin, Michael L.; Netzer, Giora; Shanholtz, Carl; Scharf, Steven M.

doi:10.1007/s00134-012-2494-3

Cited by 65 publications

(70 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is also well-known from previous research (Verceles et al, 2012). Eight of these nine patients also reported nightmares or visions and seven slept badly and were mechanically ventilated.…”

Section: Reflections On the Findingsmentioning

confidence: 53%

“…Lighting is sometimes used at high levels at night, during treatments, examinations and nursing activities and this may risk disrupting the circadian rhythm (Dunn et al, 2010). Mean illumination levels measured in four different ICUs ranged at night from 2.4 to 145 lx and in the day from 55.3 to 165 lx (Dennis et al, 2010;Frisk et al, 2004;Meriläinen et al, 2010;Verceles et al, 2012). These measurements highlight two main problems, a pattern of low illumination levels by day and high levels by night.…”

Section: Critically Illness Light and Circadian Rhythmmentioning

confidence: 95%

See 1 more Smart Citation

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

Engwall

Fridh

Johansson

et al. 2015

Intensive and Critical Care Nursing

109

View full text Add to dashboard Cite

Patients in an intensive care unit (ICU) may risk disruption of their circadian rhythm. In an intervention research project a cycled lighting system was set up in an ICU room to support patients' circadian rhythm. Part I aimed to compare experiences of the lighting environment in two rooms with different lighting environments by lighting experiences questionnaire. The results indicated differences in advantage for the patients in the intervention room (n=48), in perception of daytime brightness (p=0.004). In nighttime, greater lighting variation (p=0.005) was found in the ordinary room (n=52). Part II aimed to describe experiences of lighting in the room equipped with the cycled lighting environment. Patients (n=19) were interviewed and the results were presented in categories: "A dynamic lighting environment", "Impact of lighting on patients' sleep", "The impact of lighting/lights on circadian rhythm" and "The lighting calms". Most had experiences from sleep disorders and half had nightmares/sights and circadian rhythm disruption. Nearly all were pleased with the cycled lighting environment, which together with daylight supported their circadian rhythm. In night's actual lighting levels helped patients and staff to connect which engendered feelings of calm.

show abstract

Section: Reflections On the Findingsmentioning

confidence: 53%

Section: Critically Illness Light and Circadian Rhythmmentioning

confidence: 95%

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

Engwall

Fridh

Johansson

et al. 2015

Intensive and Critical Care Nursing

109

View full text Add to dashboard Cite

show abstract

“…However, the authors mentioned limitations of their study included not taking into account sedation, delirium, limited light exposure after transferring out of the ICU, and a study cohort with acute brain injury, which may make external stimuli less important. Another study reported that in patients with severe sepsis, outdoor light did not entrain melatonin secretion pattern (51). The authors noted that the environmental light levels were low (maximum of 200 lux).…”

Section: Implications On Treatment Of Sepsismentioning

confidence: 98%

Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer

et al. 2016

View full text Add to dashboard Cite

Physiological and cellular functions operate in a 24-hour cyclical pattern orchestrated by an endogenous process known as the circadian rhythm. Circadian rhythms represent intrinsic oscillations of biological functions that allow for adaptation to cyclic environmental changes. Key clock genes that affect the persistence and periodicity of circadian rhythms include BMAL1/CLOCK, Period 1, Period 2, and Cryptochrome. Remarkable progress has been made in our understanding of circadian rhythms and their role in common medical conditions. A critical review of the literature supports the association between circadian misalignment and adverse health consequences in sepsis, obstructive lung disease, obstructive sleep apnea, and malignancy. Circadian misalignment plays an important role in these disease processes and can affect disease severity, treatment response, and survivorship. Normal inflammatory response to acute infections, airway resistance, upper airway collapsibility, and mitosis regulation follows a robust circadian pattern. Disruption of normal circadian rhythm at the molecular level affects severity of inflammation in sepsis, contributes to inflammatory responses in obstructive lung diseases, affects apnea length in obstructive sleep apnea, and increases risk for cancer. Chronotherapy is an underused practice of delivering therapy at optimal times to maximize efficacy and minimize toxicity. This approach has been shown to be advantageous in asthma and cancer management. In asthma, appropriate timing of medication administration improves treatment effectiveness. Properly timed chemotherapy may reduce treatment toxicities and maximize efficacy. Future research should focus on circadian rhythm disorders, role of circadian rhythm in other diseases, and modalities to restore and prevent circadian disruption.

show abstract

“…With regard to humans, septic patients hospitalized in the ICUs had an altered circadian rhythm of 6-sulfatoxymelatonin (aMT6) urine excretion, with loss of circadian periodicity, diminished phase amplitude, and delayed acrophase [ 112 ], but light exposure in the ICU was not responsible for the impairment in urine aMT6 excretion [ 113 ]. Additionally, nocturnal plasmatic melatonin levels inversely correlate with illness severity in ICU patients with severe sepsis [ 114 ].…”

Section: Melatonin and Sepsismentioning

confidence: 98%

Multiple Facets of Melatonin in Immunity: Clinical Applications

Lardone

Álvarez-Sánchez

Rodríguez-Rodríguez

et al. 2013

Melatonin and Melatonergic Drugs in Clinical Practice

View full text Add to dashboard Cite

Circadian rhythm disruption in severe sepsis: the effect of ambient light on urinary 6-sulfatoxymelatonin secretion

Abstract: Circadian rhythm was disrupted in patients with severe sepsis, as reflected by disordered diurnal variation of urinary 6-SMT excretion. Light levels were low, exhibited limited diurnal variation, and did not entrain circadian rhythms in these patients.

Cited by 65 publications

References 41 publications

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

Lighting, sleep and circadian rhythm: An intervention study in the intensive care unit

Timing Matters: Circadian Rhythm in Sepsis, Obstructive Lung Disease, Obstructive Sleep Apnea, and Cancer

Multiple Facets of Melatonin in Immunity: Clinical Applications

Contact Info

Product

Resources

About