The effect of bright light therapy on sleep and circadian rhythms in renal transplant recipients: a pilot randomized, multicentre wait-list controlled trial

Abstract

SummaryThis study assessed the effect and feasibility of morning bright light therapy (BLT) on sleep, circadian rhythms, subjective feelings, depressive symptomatology and cognition in renal transplant recipients (RTx) diagnosed with sleep-wake disturbances (SWD). This pilot randomized multicentre wait-list controlled trial included 30 home-dwelling RTx randomly assigned 1:1 to either 3 weeks of BLT or a wait-list control group. Morning BLT (10 000 lux) was individually scheduled for 30 min daily for 3 weeks. Wrist actimetry (measuring sleep and circadian rhythms), validated instruments (subjective feelings and cognition) and melatonin assay (circadian timing) were used. Data were analysed via a random-intercept regression model. Of 30 RTx recipients (aged 58 AE 15, transplanted 15 AE 6 years ago), 26 completed the study. While BLT had no significant effect on circadian and sleep measures, sleep timing improved significantly. The intervention group showed a significant get-up time phase advance from baseline to intervention (+24 min) [(standardized estimates (SE): À0.23 (À0.42; À0.03)] and a small (+14 min) but significant bedtime phase advance from intervention to follow-up (SE: À0.25 (À0.41; À0.09). Improvement in subjective feelings and depressive symptomatology was observed but was not statistically significant. Bright light therapy showed preliminary indications of a beneficial effect in RTx with sleep-wake disturbances. (ClinicalTrials.gov number: NCT01256983)

Melatonin rhythms in renal transplant recipients with sleep–wake disturbances

“…This descriptive analysis was based on the baseline data of a multicentre randomised wait-list controlled design study (Burkhalter et al, 2015). The intervention group completed 3 weeks of baseline measurement, followed by 3 weeks of morning bright light therapy, then a 3-week post-treatment assessment.…”

“…Based on the overview of possible mechanisms of desynchronisation of sleep-wake rhythms, leading to sleep disturbances in dialysis patients (Parker, 2003) and in patients with chronic kidney disease (Russcher et al, 2012), we assume similar mechanisms for RTx recipients. The only significant finding in the intervention group after bright light therapy, applied each morning to regularise nocturnal sleep, was a phase advance in both get-up time and bedtime in the actimetry data (Burkhalter et al, 2015). However, only very few participants had a measureable DLMO, which precluded documenting any parallel advance in DLMO after morning light therapy.…”

“…The purpose of the main study was to evaluate the feasibility of implementing a daily morning bright light therapy intervention in renal transplant (RTx) recipients with sleep disturbances, in the community setting, and to conduct a preliminary exploration of its efficacy for improving sleep characteristics (Burkhalter et al, 2015).…”

Potential benefits of melatonin in organ transplantation: a review

“…These patients experience insomnia, restless legs syndrome (a neurological disorder), and obstructive sleep apnea (Burkhalter et al 2015). It is suggested to be a result of an innate immune response (Kapsimalis et al 2008, Besedovsky et al 2012 or due to the inflammatory effects generated after transplantation (Castanon-Cervantes et al 2010).…”

“…It is suggested to be a result of an innate immune response (Kapsimalis et al 2008, Besedovsky et al 2012 or due to the inflammatory effects generated after transplantation (Castanon-Cervantes et al 2010). A human multicenter study (Burkhalter et al 2015) observed that the daytime bright light therapy improved sleep quality and the disorders derived from it. Decreased levels of melatonin were also observed in all patients, and the authors suggested that the intake of β-blockers and acetylsalicylic acid likely interfered with melatonin secretion, as shown in previous studies (Brismar et al 1988).…”