Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancy-related insomnia

Over-the-counter products for insomnia in adults: A scoping review of randomised controlled trials

BACKGROUND

Insomnia is highly prevalent and poses significant personal and socio-economic challenges. While the National Institute for Health and Care Excellence (NICE) recommendations define possible medical approaches, over-the-counter products are commonly used to self-manage insomnia symptoms. This scoping review aims to determine the size and scope of the evidence-base regarding the effectiveness and safety of over-the-counter products for insomnia symptoms in adults.

METHODS

The electronic databases of CENTRAL, MEDLINE, EMBASE, PsycINFO, and AMED were searched from inception to December 19th, 2022, for all randomised controlled trials evaluating over-the-counter products compared to placebo, in adults aged 18-65 with insomnia symptoms. Results were synthesised descriptively.

RESULTS

51 randomised controlled trials were included, evaluating herbal products (n = 34), dietary supplements (n = 15), herbal-dietary combinations (n = 4), and over-the-counter medicines (n = 2). Sample sizes ranged between 10 and 405 participants. Eleven studies were conducted in participants with co-morbidities. Interventions were most frequently given as monotherapy and compared against placebo. Most studies (n = 41) demonstrated interventions' positive effects on insomnia symptoms. Among the most studied products, valerian and melatonin have substantial evidence to demonstrate their effectiveness and safety. Promising products demonstrating benefits compared with prescription medication alone included: valerian; lemon balm and fennel; and valerian, hops, and passionflower. Intervention-related side effects were mostly mild and transient. No serious adverse events were reported across all studies.

CONCLUSIONS

Over-the-counter products show promising, but inconclusive findings in alleviating insomnia symptoms in adults. Future research should focus on investigating products currently used in real life, consider economic evaluations, and be evaluated in populations with co-morbidities and ethnic minorities, to better guide clinical advice.

Foods for Sleep Improvement: A Review of the Potential and Mechanisms Involved

Insomnia affects one-third of the world's population; the negative effects of insomnia are significant, and traditional insomnia medications have numerous side effects and cause considerable suffering. This has aroused interest in obtaining sleep-improving substances from foods. This study conducted a comprehensive literature review using Web of Science and PubMed with keywords like "sleep", "insomnia", and "food". A subsequent summary of the literature revealed that certain foods, including milk, Ziziphus jujuba, Lactuca sativa, ginseng, Schisandra chinensis, and Juglans regia, etc., are purported to enhance sleep quality by prolonging sleep duration, reducing sleep latency, and alleviating anxiety. The mechanisms of these foods' effects mainly occur via the central nervous system, particularly the gamma-aminobutyric acid (GABA)ergic and 5-hydroxytryptamine (5-HT)ergic systems. Although this review supports the fact that they have potential, further research is needed. There are also issues such as more limited foods, fewer mechanisms, fewer pharmacokinetic studies, and more traditional research models being involved. These need to be addressed in the future to adequately address the problem of insomnia. It is hoped that this study will contribute to research into foods with sleep-improving properties and, in the future, provide an effective natural alternative for those seeking medication.

Therapeutic potential of hypnotic herbal medicines: A comprehensive review

Insomnia affects millions of people worldwide, prompting considerable interest in herbal remedies for its treatment. This review aims to assess the therapeutic potential of such remedies for insomnia by analyzing current scientific evidence. The analysis identified several herbs, including Rosmarinus officinalis, Crocus sativus, Rosa damascena, Curcuma longa, Valeriana officinalis, Lactuca sativa, Portulaca oleracea, Citrus aurantium, Lippia citriodora, and Melissa officinalis, which show promise in improving overall sleep time, reducing sleep latency, and enhancing sleep quality. These plants act on the central nervous system, particularly the serotonergic and gamma-aminobutyric acid (GABA)ergic systems, promoting sedation and relaxation. However, further research is necessary to fully understand their mechanisms of action, optimal dosages, and treatment protocols. Combining herbal medicines with conventional treatments may offer an effective natural alternative for those seeking medication. Nevertheless, individuals should consult their healthcare provider before using herbal remedies for insomnia. While this review provides evidence supporting their use, additional high-quality studies are needed to firmly establish their clinical efficacy.

Combined Effects of Ziziphus jujuba, Dimocarpus longan, and Lactuca sativa on Sleep-Related Behaviors through GABAergic Signaling

We aimed to analyze the increase in the sleep-promoting effects based on the mixed ratio of botanical extracts, Ziziphus jujuba seeds, Dimocarpus longan fruits, and Lactuca sativa leaves, using animal models. Behavioral analyses, including an analysis of the total sleep time of Drosophila melanogaster, were conducted to select the optimal mixed ratio of the three botanical extracts. The effects were verified in a caffeine-induced sleepless model, specific neurotransmitter receptor antagonists, and ICR mice. In D. melanogaster exposed to 2.0% of each extract, group behavior was significantly reduced, and the mixed extracts of Z. jujuba, D. longan, and L. sativa (4:1:1 and 1:4:1) significantly increased the total sleep time with individual fruit flies. In the caffeine-induced insomnia model, mixed extracts (4:1:1 and 1:4:1) led to the highest increase in total sleep time. An analysis of locomotor ability revealed a significant reduction in the mobility percentage in the mixed extract groups (0:0:1, 1:0:1, 1:1:1, 4:1:1, and 1:4:1). The administration of Z. jujuba extract and mixed extracts (4:1:1) significantly increased the expression of GABAA-R, whereas the administration of the mixed extracts (4:1:1) and (1:4:1) significantly increased the expression of GABAB-R1 and GABAB-R2, respectively. D. longan extract and the mixed ratio (1:4:1) reduced the subjective nighttime movement and increased the total sleep time in the presence of flumazenil. An analysis of ICR mice indicated that the administration of mixed extracts (4:1:1) significantly increased sleep duration in a dose-dependent manner. These results indicated that the mixed ratio of Z. jujuba, D. longan, and L. sativa extracts, particularly the mixed ratio of 4:1:1, may have sleep-enhancing effects in fruit flies and mice. The study also identified changes in gene expression related to GABA receptors, indicating the potential mechanism for the observed sleep-promoting effects.

The effect of orally consumed Lactuca sativa syrup on human milk volume and weight gain in the preterm infant: a randomized controlled clinical trial

Human milk feeding can support premature infants to thrive. Yet those with premature infants can be challenged in human milk production. Considering this, and the use of potentially harmful human milk enhancers, the present study was conducted with the aim of determining the effect of orally consumed Lactuca sativa (L. sativa) syrup (lettuce extract) on human milk volume and subsequent weight gain in the preterm infant. Extracts from lettuce and other plants such as silymarin are already evidenced to be safe for use during lactation and have other therapeutic effects in humans. Yet this is the first study of its kind. This parallel randomized clinical trial included lactating participants with their preterm infants who were born at < 32 weeks' gestation and admitted to an intensive care unit. Convenience sampling was used to recruit participants. Eligible participants were allocated to groups randomly: intervention (n = 47), placebo (n = 46), and control (n = 47). The intervention group received one tablespoon of Lactuca sativa (L. sativa) syrup, and the placebo group received one tablespoon of placebo syrup 3 times a day for 1 week. Those in the control group did not receive any herbal or chemical milk-enhancing compounds. Routine care was provided to all three groups. Participants recorded their milk volume for 7 days in a daily information recorder form. Infant weight was measured prior to the intervention, and on the third, fifth and seventh days of the intervention period. There was a statistically significant difference observed in the adjusted mean volume of milk on the fourth and fifth days between the intervention, placebo, and control groups (P < 0.05). The adjusted mean milk volume of those in the intervention group on the first day was significantly higher than those in the control group and those in the placebo group. On the second day, the adjusted mean milk volume of those in the intervention group was higher than in those from the control group; and on the fourth day it was higher than in those from both the control and placebo groups; on the fifth day it was higher than in those in the placebo group; on the sixth day it was higher than in those in the control group and on the seventh day it was higher than in those in the control group (P < 0.05). There was no statistically significant difference in terms of the mean changes (with or without adjustment) in the weight of preterm infants between any of the groups. Lactuca sativa (L. sativa) syrup increases the volume of human milk production and no specific side effects have been reported in its use. Therefore, Lactuca sativa syrup can be recommended for use as one of the compounds that increase human milk volume.

Efficacy of lettuce seed syrup on insomnia in patients with breast cancer: a pilot double blind randomized placebo controlled clinical trial

OBJECTIVES

Insomnia and sleep disorders are common and can be severe amongst patients with cancer, especially during chemotherapy. The aim of this study was to evaluate the efficacy of lettuce seed syrup in breast cancer patients who suffer from insomnia or disordered sleep.

METHODS

This pilot study was a double-blinded randomized controlled clinical trial conducted in Shoha-e-Tajrish Hospital (Tehran, Iran) from September 2018 to June 2019. 50 adult patients with breast cancer with insomnia or sleep disorders were enrolled. Participants were randomly allocated to lettuce seed syrup (5 mL twice daily), or placebo syrup at the same dose for four weeks. The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate sleep quality before and after the intervention.

RESULTS

Compared to placebo, the mean of the total PSQI score decreased significantly in participants who received lettuce seed syrup (p=0.014). In addition, there were statistically significant reductions in the mean scores of subject quality sleep (p=0.002), sleep duration (p=0.038), habitual sleep efficacy (p=0.029) and sleep disturbance (p=0.032) in patients who received lettuce seed syrup.

CONCLUSIONS

Lettuce seed syrup may improve self-reported sleep quality in participants with breast cancer. Larger trials are indicated in diverse samples of participants with caner to learn if these finds are generalizable.

Evaluation of the Effectiveness of Fermented Soybean-Lettuce Powder for Improving Menopausal Symptoms

Menopause syndrome causes a decline in the quality of life of postmenopausal women. Hormone therapy is recommended for the treatment of menopausal syndromes. However, it has several side effects. Soybean has been safely used to relieve the symptoms of menopause. Lettuce has antidiabetic and anti-inflammatory effects and improves sleep quality. Natural nitric oxide metabolites are produced through fermentation, which increases the effectiveness of the functional substances. This study assessed the alleviation of menopausal syndrome symptoms by natural nitric oxide-containing soybean lettuce extract using the Kupperman index. This study included adult women with menopausal syndrome and a Kupperman index of ≥15. After a four-week study with 40 participants, the final analysis included 39 participants in the experimental group (n = 19) and the placebo group (n = 20). Body mass index, waist circumference, and the total cholesterol, low-density and high-density lipoprotein cholesterol, and triglyceride levels were not altered before and after treatment in both groups. There was a significant decrease in the Kupperman index after treatment in the experimental group, but no significant change was observed in the placebo group. Soybean lettuce extract alleviates menopause syndrome without any special side effects.

Non-pharmacological Interventions for Improving Sleep Quality During Pregnancy: A Systematic Review and Meta-Analysis

OBJECTIVE

 To investigate the effect of non-pharmacological interventions to improve sleep quality during pregnancy.

DATA SOURCES

 A search was made in the NCBI/PubMed, ClinicalTrials.gov, Embase, BVS, and Web of Science databases. There were no limitations regarding language, sample size, and type of non-pharmacological intervention. We have included prospective clinical trials between July 2014 and July 2019.

SELECTION OF STUDIES

 This study was registered in the Prospective International Registration of Systematic Reviews (PROSPERO) database was performed. Publication bias was also assessed with funnel plots. the primary outcome was the total score in the Pittsburgh Sleep Quality Index (PSQI) before and after intervention. Risk of bias and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) criteria were used for assessing methodological quality. From the 28 retrieved studies, we have selected 8 for qualitative analysis and 6 for meta-analysis.

DATA COLLECTION

 Two independent reviewers performed the study selection. In the case of disagreement, a third senior reviewer was consulted. The study was initially assessed based on the title, followed by abstract. Lastly, the full text was assessed to be included.

DATA SYNTHESIS

 A significant improvement on the sleep quality (PSQI score) was observed when all interventions were grouped (MD = -3.03, 95%CI -4.15 to -1.92, n = 623, i² = 84%, p < 0.001). Analysis by subgroup (music listening: MD = -1.96, 95% CI -3.27 to -0.65, n = 207, i² = 67%, p = 0.003 and other interventions: MD = -3.66, 95% CI -4.93 to -2.40, n = 416, i2 = 80%, p < 0.001) showed an improvement, with high heterogeneity. Risk of bias has shown performance and detection bias for almost studies, and GRADE evidence was very low for all analyzed variables.

CONCLUSION

 Non-pharmacological interventions-listening to music, physical exercise, relaxation exercises, lettuce seed, sleep hygiene, and acupressure-are effective for improving sleep quality during pregnancy.

Alternative Extraction Methods of Essential Oil From the Flowers of Citrus aurantium L. Var Daidai Tanaka: Evaluation of Oil Quality and Sedative-Hypnotic Activity

The aim of this study was to analyze the content of hypnotic components in the essential oil from Citrus aurantium flowers (EDD), extracted by different methods, and to characterize its sedative-hypnotic effects. The sedative-hypnotic capacity of EDD was evaluated using pentobarbital-induced sleeping assays, locomotor activity tests and GABAA receptor antagonists. The results showed that EDD extracted by steam and water distillation (SWD), hydrodistillation (HD), and ultrasound-assisted hydrodistillation (UHD) had as their main components linalool, linalyl acetate, and limonene, comprising more than 55% of the total peak area. Compared with EDD extracted by HD and UHD, the total content of linalool and linalyl acetate in EDD obtained by SWD was highest, whereas the content of limonene in EDD extracted by the 3 different methods was not different. Oral and intraperitoneal administration of EDD resulted in reduced sleep latency and increased sleep duration of mice, as well as reduced locomotor activity, which was proven by decreases in the total distance travelled, average velocity, number of activities, and central distance. Interestingly, intraperitoneal injection of EDD had better sedative and hypnotic effects than oral ingestion. In vitro assays using SH-SY5Y cells showed that EDD dose-dependently increased Cl− influx, which could be blocked by the GABAA receptor antagonists, picrotoxin, bicuculline, and flumazenil, suggesting that EDD promoted sedative-hypnotic activity by potentiating GABAA receptor-mediated Cl− current responses. Altogether, these results suggest that the important hypnotic-sedative activity of EDD appears to be due to the effects of limonene, and particularly the high contents of linalool and linalyl acetate, which were effectively extracted by SWD.

Sleep quality and gestational diabetes in pregnant women: a systematic review and meta-analysis

Poor sleep quality is very common among pregnant women. Gestational diabetes mellitus (GDM) has been related to various adverse maternal and neonatal outcomes. The aim of this systematic review was to examine the association between poor sleep quality and gestational diabetes risk. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic search was conducted in five electronic databases from inception to February 2019. Studies that examined the relationship between sleep quality and glucose in pregnant women were screened for eligibility. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated from aggregate data using a fixed-effect model. Thirteen non-experimental studies (n = 21,194 women) were eligible for inclusion. Poor sleep quality was measured using subjective questionnaires in nine studies and objective methods (actigraphy or polysomnography) in four studies. GDM was typically diagnosed following standard guidelines. Eight studies were included in the meta-analysis for GDM. Overall, self-reported poor sleep quality was a significant risk factor for GDM (pooled OR = 1.43, 95%CI: 1.16,1.77, p = 0.001). Three studies examined the association between objective sleep quality and GDM, but no significant relationship was observed. Subjective poor sleep quality was related to an increased risk for GDM, while objectively measured sleep quality was not. This review was limited by the assessment of sleep quality. Future larger studies are warranted to examine the effects of sleep quality on glucose metabolism in pregnancy. Ideally, these studies should measure sleep quality using both validated questionnaires and objective methods. These will provide further directions for improving sleep during pregnancy and exploring its effects on glucose metabolism.

Interventions for sleep problems during pregnancy: A systematic review

Sleep problems during pregnancy are prevalent and could be linked to negative outcomes during pregnancy or post-partum. However, these complaints are often underdiagnosed and undertreated. This review aimed to systematically assess the effectiveness of different interventions to ameliorate poor sleep quality and insomnia during pregnancy. Pubmed, PsycINFO and Medline databases were systematically searched without publication period restriction until 3rd May 2019. Eligible studies had to: include pregnant women of any age and gestational age; use clinical intervention designs targeted at improving sleep outcome; report pre- and post-treatment data for one or more sleep-related outcomes; be published in English, Italian, German, Spanish, or French. Sixteen studies were selected including 1252 expecting mothers. Studies evaluated the efficacy of various interventions: cognitive behavioral interventions for insomnia (4); pharmacotherapy (1); acupuncture (1); mindfulness and yoga (3); relaxation (5) and herbal medication (2). Only six were randomized controlled trials, and only four evaluated longitudinal outcomes. Preliminary support was found for all interventions, but our knowledge is still too limited by lack of evidence. There is an utmost urgency to perform high-quality randomized controlled trials for insomnia interventions during pregnancy and to implement effective programs in standard gynecological care.