Objective. To assess the influence of administration of β-blockers on melatonin synthesis, sleep quality, and vascular brain damage. Materials and methods. The study group consisted of 114 patients, of whom 103 were men, aged 47-83 years, with cardiovascular disease whose complex therapy included prolonged use of β-blockers. The comparison group consisted of 110 patient with cardiovascular disease, of comparable age and sex, whose complex therapy did not include β-blockers. The daily dynamics of melatonin synthesis were assessed in terms of the excretion of the main melatonin metabolite - 6-sulfatoxymelatonin (6-SOMT) in three portions of urine (day, evening, night). The severity of sleep impairments was assessed by nocturnal polysomnography in all patients. The severity of vascular brain damage was assessed from MRI scans. Results. The analysis results demonstrated a large spread in individual levels of daily 6-SOMT excretion in patients with cardiovascular disease (from 0.9 to 133 μg/day with a median of 16.8 μg/day). A significant reduction in daily 6-SOMT excretion was seen in patients taking β-blockers as compared with patients not taking β-blockers, where levels were 12.8 [6.2; 21.1] and 24.0 [12.5; 41.5] μg/day respectively (p < 0.001). Comparison of subgroups of patients defined by daily 6-SOMT excretion showed that the subgroup of patients with daily 6-SOMT excretion of ≤ 16.8 μg/day displayed a significant increase in sleep latency, a decrease in the duration of REM sleep as a percentage of total sleep duration, and an increase in the number of plaques of gliosis in the white matter of the brain, combined with increases in the leptin level, the leptin/adiponectin ratio, and the glycated hemoglobin level. Conclusions. A low level of daily 6-SOMT excretion is a risk factor for developing impairments to sleep structure and quality and vascular damage to the white matter of the brain, combined with an increased risk of developing metabolic impairments. Prolonged use of β-blockers decreases melatonin synthesis to 50%, increasing the risk of developing insomnia and vascular brain damage, mainly in patients with lower initial levels of daily 6-SOMT excretion.
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Translated from Zhurnal Nevrologii i Psikhiatrii imeni S. S. Korsakova, Vol. 121, No. 8, pp. 7-12, August, 2021.
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Tikhomirova, O.V., Zybina, N.N. & Kozhevnikova, V.V. Effects of Prolonged Use of β-Adrenoblockers on Melatonin Secretion, Sleep Quality, and Vascular Brain Damage. Neurosci Behav Physi 52, 500–504 (2022). https://doi.org/10.1007/s11055-022-01270-y
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DOI: https://doi.org/10.1007/s11055-022-01270-y