Prospective Randomized Study on the Effects of Improved Sleep Quality After Craniotomy on Melatonin Concentrations and Inflammatory Response in Neurosurgical Intensive Care Patients

World Neurosurg. 2020 Aug:140:e253-e259. doi: 10.1016/j.wneu.2020.05.017. Epub 2020 May 16.


Objective: Sleep disorders in intensive care units after a craniotomy can decrease melatonin secretion and increase the inflammatory stress response. The aim of this study was to investigate the influence of improving sleep quality via eye patches and earplugs on melatonin secretion and inflammatory mediator release.

Methods: The study enrolled 41 patients who underwent craniotomy. Patients were randomized into 2 groups. "Group Intervention" received a sleep-promoting intervention with eye patches and earplugs to provide light and noise isolation, while "Group Control" received standard care. Blood levels of C-reactive protein and interleukin 1 and interleukin 6 along with urine levels of 6-sulphatoxymelatonin (aMT6) were measured preoperatively (baseline) and on postoperative days 1 and 3. Sleep quality was assessed with the Richards-Campbell Sleep Questionnaire.

Results: Sleep quality was higher in the intervention group (Richards-Campbell score:80.61 ± 11.96 vs. 33.50 ± 16.32; P < 0.001). Urine aMT6 levels increased significantly in the intervention group in spot urine samples from 10.15 (5.38-14.40) ng/mL at baseline to 14.52 (6.24-29.11) and 11.51 (7.88-29.05) ng/mL on postoperative days 1 and 3. They also increased in 24-hour urine samples from 25.73 (8.24-52.73) ng/mL at baseline to 35.38 (11.48-95.65) and 39.18 (2.36-125.23) ng/mL on postoperative days 1 and 3 (P = 0.001 and P = 0.005, respectively). The aMT6 concentration did not change significantly in the control group. The C-reactive protein concentrations increased postoperatively compared with baseline concentrations in both groups (P = 0.001 and P < 0.001).

Conclusions: Melatonin secretion significantly increased as a result of improving postoperative sleep quality by noise and light isolation in neurosurgical intensive care unit patients after craniotomy.

Keywords: Cranial surgery; Intensive care; Interleukin; Melatonin.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Aged
  • C-Reactive Protein / metabolism
  • Craniotomy*
  • Critical Care*
  • Ear Protective Devices
  • Eye Protective Devices
  • Female
  • Humans
  • Inflammation / etiology
  • Inflammation / metabolism*
  • Intensive Care Units
  • Lighting / adverse effects
  • Male
  • Melatonin / metabolism*
  • Middle Aged
  • Noise / adverse effects
  • Postoperative Period
  • Sleep*


  • C-Reactive Protein
  • Melatonin