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.
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.
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.
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.
Funding source: Shiraz University of Medical Sciences
Award Identifier / Grant number: 1396-01-64-15514
The authors would like to thank the Traditional Medicine and Materia Medica Research Center, school of traditional medicine, Shahid Beheshti University of Medical Sciences, and the office of the Vice-chancellor for Research of Shiraz University of Medical Sciences.
Research Funding: Shiraz University of Medical Sciences was supporting this research project through grant No. 1396-01-64-15514.
Author contributions: SHM, HRM and GH designed the research project; SHM, BM, RG, MMP, GH, and MP conducted the research project, including recruitment, intervention and biochemical analysis; MP and GH performed statistical analysis and together with MMP and RB., drafted the manuscript. All authors provided critical comments, read and approved the final version.
Competing interests: There was no conflict of interest to declare.
1. Sateia, M, Doghramji, K, Hauri, P, Morin, C. Evaluation of chronic insomnia. An American academy of sleep medicine review. Sleep 2000;23:243–308. https://doi.org/10.1093/sleep/23.2.1l.Search in Google Scholar
2. Moline, ML, Broch, L, Zak, R, Gross, V. Sleep in women across the life cycle from adulthood through menopause. Sleep Med Rev 2003;7:155–77. https://doi.org/10.1053/smrv.2001.0228.Search in Google Scholar
3. Yennurajalingam, S, Carmack, C, Balachandran, D, Eng, C, Lim, B, Delgado, M, et al.. Sleep disturbance in patients with cancer: a feasibility study of multimodal therapy. BMJ Support Palliat Care 2020. https://doi.org/10.1136/bmjspcare-2019-001877.Search in Google Scholar
4. Luskin, M, Zhou, E, Zhang, Z, DeAngelo, DJ, Stone, R, Wadleigh, M, et al.. Sleep Disturbance Among Patients with Myelodysplastic Syndromes and Acute Leukemia. DC: Am Soc Hematol Washington; 2019.10.1182/blood-2019-125147Search in Google Scholar
5. Hinds, PS, Hockenberry, M, Rai, SN, Zhang, L, Razzouk, BI, McCarthy, K, et al.. editors. Nocturnal awakenings, sleep environment interruptions, and fatigue in hospitalized children with cancer. Oncol Nurs Forum; 2007.10.1188/07.ONF.393-402Search in Google Scholar
6. Linder, LA, Christian, BJ, editors Nighttime sleep disruptions, the hospital care environment, and symptoms in elementary school-age children with cancer. Oncol Nurs Forum; 2012. NIH Public Access.10.1188/12.ONF.553-561Search in Google Scholar
9. Leproult, R, Copinschi, G, Buxton, O, Van Cauter, E. Sleep loss results in an elevation of cortisol levels the next evening. Sleep 1997;20:865–70. https://doi.org/10.1093/sleep/20.10.865.Search in Google Scholar
10. Avidan, AY, Palmer, LA, Doan, JF, Baran, RW. Insomnia medication use and the probability of an accidental event in an older adult population. Drug Healthc Patient Saf 2010;2:225. https://doi.org/10.2147/dhps.s14955.Search in Google Scholar PubMed PubMed Central
13. Jezdic, Z, Vulinac, SO, Racz, A, Kovacevic, I, Sedic, B, Jadranka, P. Influence of aromatherapy on alleviation of insomnia symptoms. Complement Alter Med 2018;2018:1–5.Search in Google Scholar
15. Pearson, NJ, Johnson, LL, Nahin, RL. Insomnia, trouble sleeping, and complementary and alternative medicine: analysis of the 2002 national health interview survey data. Arch Intern Med 2006;166:1775–82. https://doi.org/10.1001/archinte.166.16.1775.Search in Google Scholar PubMed
16. Heydarirad, G, Keyhanmehr, AS, Mofid, B, Nikfarjad, H, Mosavat, SH. Efficacy of aromatherapy with Rosa damascena in the improvement of sleep quality of cancer patients: a randomized controlled clinical trial. Compl Ther Clin Pract 2019;35:57. https://doi.org/10.1016/j.ctcp.2019.01.017.Search in Google Scholar PubMed
17. Arzani, MA. Teb-e-akbari. Qom, Iran: Jalaledin Publication; 2008.Search in Google Scholar
18. SE, J. Zakhireh kharazmshahi. Qom: Ehyae tebe tabiei; 2012.Search in Google Scholar
19. AM, K. Eksir-e-Azam (The great elixir) Tehran. Iran: Institute of medicine historical studies, Islamic and complementary medicine; 2007.Search in Google Scholar
21. Yakoot, M, Helmy, S, Fawal, K. Pilot study of the efficacy and safety of lettuce seed oil in patients with sleep disorders. Int J Gen Med 2011;4:451. https://doi.org/10.2147/ijgm.s21529.Search in Google Scholar PubMed PubMed Central
22. Pour, ZS, Hosseinkhani, A, Asadi, N, Shahraki, HR, Vafaei, H, Kasraeian, M, et al.. Double-blind randomized placebo-controlled trial on efficacy and safety of Lactuca sativa L. seeds on pregnancy-related insomnia. J Ethnopharmacol 2018;227:176–80. https://doi.org/10.1016/j.jep.2018.08.001.Search in Google Scholar PubMed
23. Ghorbani, A, Rakhshandeh, H, Sadeghnia, HR. Potentiating effects of Lactuca sativa on pentobarbital-induced sleep. Iran J Pharm Res 2013;12:401.Search in Google Scholar
24. Sateia, MJ. International classification of sleep disorders-third edition: highlights and modifications. Chest 2014;146:1387–94. https://doi.org/10.1378/chest.14-0970.Search in Google Scholar PubMed
25. Nazifi, M, Mokarami, H, Akbaritabar, A, Kalte, HO, Rahi, A. Psychometric properties of the Persian translation of Pittsburgh sleep quality index. Health Scope 2014;3:e15547. https://doi.org/10.17795/jhealthscope-15547.Search in Google Scholar
26. Ranjbar, M, Afsharypuor, S, Shakibaei, F. Effect of topical lettuce (Lactuca sativa L.) seed oil on childhood sleep disorders: a randomized double-blind controlled trial. Res J Pharmacogn 2020;7:47–54.Search in Google Scholar
27. Kim, H-W, Suh, HJ, Choi, H-S, Hong, K-B, Jo, K. Effectiveness of the sleep enhancement by green romaine lettuce (Lactuca sativa) in a rodent model. Biol Pharmaceut Bull 2019;42:1726–32. https://doi.org/10.1248/bpb.b19-00454.Search in Google Scholar PubMed
28. Murillo-Rodríguez, E, Arias-Carrión, O, Zavala-García, A, Sarro-Ramírez, A, Huitrón-Reséndiz, S, Arankowsky-Sandoval, G. Basic sleep mechanisms: an integrative review. Cent Nerv Syst Agents Med Chem 2012;12:38–54. https://doi.org/10.2174/187152412800229107.Search in Google Scholar PubMed
29. Salmannezhad, H, Mojahedi, M, Ebadi, A, Montazeri, A, Mozaffarpur, SA, Saghebi, R, et al.. An assessment of the correlation between happiness and Mizaj (temperament) of university students in Persian medicine. Iran Red Crescent Med J 2017;19. https://doi.org/10.5812/ircmj.55627.Search in Google Scholar
30. Nimrouzi, M, Daneshfard, B, Tafazoli, V, Akrami, R. Insomnia in traditional Persian medicine. Acta Med His Adriatica 2019;17:45–54. https://doi.org/10.31952/amha.17.1.2.Search in Google Scholar PubMed
31. Zare, R, Shams, M, Heydari, M, Najarzadeh, A, Zarshenas, M. Analysis of the efficacy of cinnamon for patients with diabetes mellitus type II based on traditional Persian medicine syndrome differentiation: a randomized controlled trial. Shiraz E-Med J 2020;21. https://doi.org/10.5812/semj.95609.Search in Google Scholar
32. Ameri, A, Heydarirad, G, Mahdavi Jafari, J, Ghobadi, A, Rezaeizadeh, H, Choopani, R. Medicinal plants contain mucilage used in traditional Persian medicine (TPM). Pharmaceut Biol 2015;53:615–23. https://doi.org/10.3109/13880209.2014.928330.Search in Google Scholar PubMed
33. MH, AAK. Makhzan al-Advieh. Tehran: Tehran University of Medical Sciences; 2009:328 p.Search in Google Scholar
34. Avicenna. The canon of medicine. Great Books of the Islamic World; 1999.Search in Google Scholar
36. García-Macías, P, Ordidge, M, Vysini, E, Waroonphan, S, Battey, NH, Gordon, MH, et al.. Changes in the flavonoid and phenolic acid contents and antioxidant activity of red leaf lettuce (Lollo Rosso) due to cultivation under plastic films varying in ultraviolet transparency. J Agric Food Chem 2007;55:10168–72. https://doi.org/10.1021/jf071570m.Search in Google Scholar PubMed
37. Silva, CKC, da Silva, KB, de Miranda, PRB, Gomes, TCA, da Silva Júnior, JM, Souza, MA, et al.. Fertilizer source influence on antioxidant activity of lettuce. Afr J Agric Res 2018;13:2855–61.Search in Google Scholar
38. Razi, MZ. Al-Havi Fi Al-Tibb (Arabic). Beirut: Dar Al Kotob Al-islmiyah; 2000.Search in Google Scholar
39. Whirl‐Carrillo, M, McDonagh, EM, Hebert, J, Gong, L, Sangkuhl, K, Thorn, C, et al.. Pharmacogenomics knowledge for personalized medicine. Clin Pharmacol Therapeut 2012;92:414–7. https://doi.org/10.1038/clpt.2012.96.Search in Google Scholar PubMed PubMed Central
40. Espie, CA, Barrie, LM, Forgan, GS. Comparative investigation of the psychophysiologic and idiopathic insomnia disorder phenotypes: psychologic characteristics, patients’ perspectives, and implications for clinical management. Sleep 2012;35:385–93. https://doi.org/10.5665/sleep.1702.Search in Google Scholar PubMed PubMed Central
© 2021 Walter de Gruyter GmbH, Berlin/Boston