Chronobiology International

The Journal of Biological and Medical Rhythm Research

ISSN: 0742-0528 (Print) 1525-6073 (Online) Journal homepage: http://www.tandfonline.com/loi/icbi20

Melatonin ingestion after exhaustive late-evening

exercise improves sleep quality and quantity, and
short-term performances in teenage athletes

Mohamed Cheikh, Omar Hammouda, Nawel Gaamouri, Tarak Driss, Karim

Chamari, Ridha Ben Cheikh, Mohamed Dogui & Nizar Souissi

To cite this article: Mohamed Cheikh, Omar Hammouda, Nawel Gaamouri, Tarak Driss, Karim
Chamari, Ridha Ben Cheikh, Mohamed Dogui & Nizar Souissi (2018): Melatonin ingestion after
exhaustive late-evening exercise improves sleep quality and quantity, and short-term performances
in teenage athletes, Chronobiology International, DOI: 10.1080/07420528.2018.1474891

To link to this article: https://doi.org/10.1080/07420528.2018.1474891

Published online: 30 May 2018.

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CHRONOBIOLOGY INTERNATIONAL
https://doi.org/10.1080/07420528.2018.1474891

Melatonin ingestion after exhaustive late-evening exercise improves sleep

quality and quantity, and short-term performances in teenage athletes
Mohamed Cheikha, Omar Hammouda b,c, Nawel Gaamouria, Tarak Drissb, Karim Chamari d
,
Ridha Ben Cheikhe,f, Mohamed Doguie,f, and Nizar Souissig
a
High Institute of Sport and Physical Education, Manouba University, Manouba, Tunisia; bResearch Center on Sport and Movement (Centre
de Recherches sur le Sport et le Mouvement, CeRSM), UPL, Univ Paris Nanterre, UFR STAPS, Nanterre, France; cFaculty of medicine of Sfax,
Research Unit, Molecular Bases of Human Pathology, UR12ES17, Sfax, Tunisia; dAthlete Health and Performance Research Ctr ASPETAR, Qatar
Orthopaedic and Sports Medicine Hospital, Doha, Qatar; eFunctional Exploration of the Nervous System Service, CHU Sahloul, Sousse,
Tunisia; fFaculty of Medicine, Laboratory of Physiology, Monastir, Tunisia; gNational Observatory of Sport, Tunis, Tunisia

ABSTRACT ARTICLE HISTORY

The present study aimed to explore the effects of a single 10-mg dose of melatonin (MEL) Received 9 November 2017
administration after exhaustive late-evening exercise on sleep quality and quantity, and short- Revised 6 May 2018
term physical and cognitive performances in healthy teenagers. Ten male adolescent athletes Accepted 7 May 2018
(mean ± SD, age = 15.4 ± 0.3 years, body-mass = 60.68 ± 5.7 kg, height = 167.9 ± 6.9 cm and KEYWORDS
BMI = 21.21 ± 2.5) performed two test sessions separated by at least one week. During each Evening exercise;
session, participants completed the Yo-Yo intermittent-recovery-test level-1 (YYIRT-1) at ~20:00 h. adolescence; chronobiology;
Then, sleep polysomnography was recorded from 22:15 min to 07:00 h, after a double blind pineal gland; sleep stages;
randomized order administration of a single 10-mg tablet of MEL (MEL-10 mg) or Placebo (PLA). short-term performance;
The following morning, Hooper wellness index was administered and the participants performed fatigue
the Choice Reaction Time (CRT) test, the Zazzo test and some short-term physical exercises (YYIRT-
1, vertical and horizontal Jumps (VJ; HJ), Hand grip strength (HG), and five-jump test (5-JT)).
Evening total distance covered in the YYIRT-1 did not change during the two conditions (p > 0.05).
Total sleep time (Δ = 24.55 mn; p < 0.001), sleep efficiency (Δ = 4.47%; p < 0.001), stage-3 sleep
(N3 sleep) (Δ = 1.73%; p < 0.05) and rapid-eye-movement sleep (Δ = 2.15%; p < 0.001) were
significantly higher with MEL in comparison with PLA. Moreover, sleep-onset-latency (Δ = –
8.45mn; p < 0.001), total time of nocturnal awakenings after sleep-onset (NA) (Δ = –11 mn;
p < 0.001), stage-1 sleep (N1 sleep) (Δ = –1.7%; p < 0.001) and stage-2 sleep (N2 sleep)
(Δ = −1.9%; p < 0.05) durations were lower with MEL. The Hooper index showed a better
subjective sleep quality, a decrease of the subjective perception of fatigue and a reduced level
of muscle soreness with MEL. Moreover, MEL improved speed and performance but not inaccu-
racy during the Zazzo test. CRT was faster with MEL. Morning YYIRT-1 (Δ = 82 m; p < 0.001) and 5-
JT (Δ = 0.08 m; p < 0.05) performances were significantly higher with MEL in comparison with PLA.
In contrast, HG, VJ and HJ performances did not change during the two conditions (p > 0.05). The
administration of a single dose of MEL-10 mg after strenuous late-evening exercise improved
sleep quality and quantity, selective attention, subjective assessment of the general wellness state,
and some short-term physical performances the following morning in healthy teenagers.

Introduction fundamental to growth and development as well as

recovering from daily activities (Strasburger and
Adolescence is defined as a vulnerable period char-
Hogan 2013). Moreover, the need for sufficient sleep
acterized by several changes in physiological, socio-
to promote general mental and physical development
cultural and psychological factors that affect health
within adolescent athletes has recently been high-
and behavior (Brand and Kirov 2011). Also, adoles-
lighted by the International Olympic Committee
cence is a critical period for both neural and psycho-
(Bergeron et al. 2015). Nowadays, teenagers are not
logical development, in which sleep plays an
getting enough sleep, and there are many reasons for
important functional role (Colrain and Baker 2011).
this trend. Student athletes are increasingly becoming
Among adolescents, sufficient amount of sleep is
busier and putting more mental and physical

CONTACT Omar Hammouda hammouda.o@u-parisnanterre.fr Research Center on Sport and Movement (Centre de Recherches sur le Sport et le
Mouvement, CeRSM), UPL, Univ Paris Nanterre, UFR STAPS, 200 avenue de la République, 92001, Nanterre, France
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/icbi.
© 2018 Taylor & Francis Group, LLC
2 M. CHEIKH ET AL.

demands on the body. The attempt to balance school, nocturnal awakening and make sleep more difficult
family, friends and sports leaves little free time and (Morin et al. 1999). In the same way, Souissi et al.
keeps their daily schedules full. To meet these (2012) have shown that maximal aerobic exercise
demands, student athletes are often late to bed and performed later in the evening is “worse” than train-
early to rise, sacrificing valuable sleep time in the ing in the afternoon and might result in a markedly
process (Bradford and Fitzgerald 2015). In addition, poor subsequent sleep quality (disturbing and frag-
a plausible explanation for this could be the increased menting sleep) measured with polysomnography
screen time (i.e. televisions, laptops, tablets, smart (PSG). Nevertheless, some previous studies found no
phones, eReaders, etc.) and social media use (Cain impairment in sleep following 1–3 h of vigorous
and Gradisar 2010). In the same way, Harbard et al. exercise ending 30 min before bedtime (O’Connor
(2016) demonstrated that chronotype may exert et al. 1998; Youngstedt et al. 1999). These studies
stronger influences on sleep timing than pre-bedtime have used either actigraphic or subjective methods.
activities. Indeed, most teenagers have internal clock A more recent study using PSG showed that vigorous
mechanisms predisposing them to become “night late-night exercise does not disturb sleep quality but
owls” (Reading 2013). Furthermore, it must be affect cardiac autonomic activity in the first sleep
noted that there is a problem of sleep initiation and hours (Myllymäki et al. 2011). A possible explanation
maintenance in 15–25% of children and adolescents of these discrepancies is that none of the previous
(Shamseer and Vohra 2009). Consequently, many studies examined the inter-individual variability in
teenagers are often in sleep deprivation. Even though, sleep behavior or the athletes’ chronotype (Vitale
adolescents still require 8–10 hours of sleep per night et al. 2017) and sleep assessment methods are
(National Sleep Foundation 2015), the sleep-average different.
time is of 6 h, 6 min (Tavernier et al. 2016). These However, objective and reliable data on this
findings could be attributable to decreased melatonin relationship are scarce, particularly for adolescents
(MEL) secretion – a key hormone of the circadian for whom studying sleep is challenging.
clock which facilitates sleep onset – associated to Still, sleep is required for optimal athletic per-
adolescence (Cavallo 1992). Indeed, the lowest rates formance and recovery, cognitive/academic per-
of plasma MEL are recorded during puberty (i.e. formance and well-being, together with reducing
116.6 ± 43.6 pg/ml against 153.6 ± 72.6 pg/ml before injury and illness risk within athletes, including
puberty) (Cavallo 1992). adolescents (Taylor et al. 2016). Practitioners and
Sleep is a restorative circadian process under- clinicians are thus under increasing pressure to
pinned by numerous interrelated biological processes encourage sufficient sleep in their athletes, since
(Vyazovskiy and Delogu 2014). Sleep has been attrib- inadequate sleep has been reported to reduce var-
uted to having an essential role in human health, vital ious physical performance measures (Thun et al.
for physical and cognitive performance and well- 2015). Specifically, reduced and/or disturbed sleep
being (Simpson et al. 2016). The importance of ade- has been shown to negatively influence aerobic
quate sleep for psychophysiological well-being is (Oliver et al. 2009) and anaerobic performance
emerged when sleep is disturbed (Myllymäki et al. metrics (Souissi et al. 2013).
2011). Even though physical activity is an effective Undeniably, among the few drugs designed to
non-pharmacological approach to improve sleep treat insomnia in adolescent, only MEL is considered
quality (Lang et al. 2013), vigorous late-night exercise safe and effective for use, at least, in short time
is mentioned by the American Academy of Sleep (Babineau et al. 2008) and without any risk of depen-
Medicine (2001) as one possible practice that may dency (Community Pediatrics Committee 2012).
produce increased arousal (reported already by Indeed, Scheer et al. (2012) showed that MEL had
Hauri (1968)) and leads to inadequate sleep hygiene no adverse effects on the athletes’ general health
(Myllymäki et al. 2011). Likewise, it has been demon- complaints as determined through a questionnaire
strated that evening intense physical exercise blunted inquiring about the presence or absence of headache,
MEL secretion due to exercise-induced cortisol insomnia, hyperactivity, irritability, nausea, “sleep-
increase (Monteleone et al. 1992). Most previous stu- ing limbs,” dizziness, constipation, “shaky hands,”
dies have shown that intense exercise may increase stomach cramp, drowsiness, sweating, hunger,
 CHRONOBIOLOGY INTERNATIONAL 3

weakness and sore eyes. Another retrospective study Materials and methods
described the effects of long-term treatment with
Participants
MEL in adolescents (age range: 10–18 years) with
delayed sleep phase syndrome (Szeinberg et al. Ten male adolescent national-level judo competitors
2006). Patients were treated with oral MEL, (age: 15.4 ± 0.3 years; body mass: 60.68 ± 5.7 kg;
3–5 mg/day for an average period of 6 months (per- height: 167.9 ± 6.9 cm; BMI: 21.21 ± 2.5;
iod ranging from 1 to 16 months). No adverse effects mean ± SD) volunteered to take part in the study.
of MEL were noted (Szeinberg et al. 2006). A pediatrician determined all boys as pubertal stage
In some individuals, when used pharmacologi- (at the fifth Tanner stage) using the composite score
cally, the administration of physiologic doses (0.1– of the pubertal stage assessment (Tanner and
0.3 mg) of MEL decreases sleep onset latency Whitehouse 1976) and checked their health status.
(SOL), increases sleep efficiency (SE) and Two criteria were chosen so as to obtain a homo-
improves total sleep time (TST) (Zhdanova and genous group: First, their sleep/wake rhythm as well
Wurtman 1997; Brzezinski 1997). For the treat- as the quality and average amount of their sleep.
ment of the phase delay syndrome, the usual Indeed, the selected participants were either “neither
doses of MEL are 2.5 mg to 3 mg in children and type” (n = 7) or “moderately morning type” (n = 3)
5 mg to 10 mg in adolescents (Owens 2009). according to their answers to the Horne and
Among adolescents, the selected time of MEL Ostberg’s (1976) questionnaire (only neither type
administration should give a sleep time more com- or moderately morning type chronotype partici-
patible with normal school or social life (Dahlitz pants were involved in order to avoid any late
et al. 1991). This clock adjustment allows for nor- sleep onset and/or morning discomfort to wake-up
mal sleep quality and quantity and even a sleep and participate to the experiments). Their average
latency decrease and improved sleep quality and sleep duration evaluated over one month through a
TST (Zhdanova and Wurtman 1997). sleep schedule (Bastuji and Jouvet 1985) was about
Nevertheless, the results from the literature are 7 h (483 min±18.03). Second, their health status:
controversial and this could be explained by the The participants reported that they were non-smo-
different MEL doses used, the nature of supple- kers, not using anti-inflammatory neither antioxi-
mentation (acute or chronic), the time-of-day of dant agents, and did not report any history of
supplementation and/or the protocol setup. In cardiovascular or metabolic disorders. They were
recent years, there has been a great deal of interest currently training ~8 h/week. Participants and
in the possible role of MEL in improving physical their parents/tutors were fully informed of the pro-
performance and exercise-induced oxidative stress cedures and signed a consent form before partici-
and inflammatory responses (Beck et al. 2015). pating. The experimental design of the present study
To the best of the authors’ knowledge, the inter- was approved by the University’s Ethic Committee
action between (1) late-evening strenuous exercises, and met the ethical standards of the Declaration of
(2) nocturnal MEL ingestion, (3) sleep physiology Helsinki.
and (4) cognitive and short-term physical perfor-
mances the following morning in adolescents has
Experimental design
not been studied. Therefore, the purpose of this
study was to explore the effects of a single dose of Participants performed two test sessions. In each
MEL-10 mg ingestion after late-evening intensive session, they completed the Yo-Yo intermittent-
exercise on sleep quality and quantity, cognitive per- recovery-test level-1 (YYIRT-1) at ~20:00 h (time
formance and short-term physical performances the slot: 20:00 h to 20:45 h). The covered distance,
following morning in healthy trained teenagers. We peak heart rate (HRpeak) and rating of perceived
hypothesized that the present study’s findings would exertion (RPE) (Borg 1982) were recorded during
suggest that a single dose of MEL-10 mg ingestion the YYIRT-1. After the post-test shower (warm
after late-evening intensive exercise could promote water shower within 30 min from the end of the
sleep quality and quantity and improve morning exercise), participants took a standard dinner at
short-term performances in teenage athletes. 21:15 min. Then, sleep PSG was recorded from
4 M. CHEIKH ET AL.

22:15 min to 07:00 h, after the ingestion (i.e. recorded each 5 s) and only HRpeak was presented
22:00 h) of either a single tablet of MEL-10 mg in the data.
(vegetable source, made by Jamieson lab Toronto,
Montreal, Vancouver, Canada N8W5B5) or a Rating of perceived exertion scale (RPE)
Placebo (PLA) (made from starch and cellulose The RPE scale allows participants to give a sub-
in the laboratory of the local faculty of pharmacy) jective exertion rating for the physical task per-
in a double blind randomized order. Jamieson formed. It consists in a 15-point scale ranging
MEL-10 mg double action sustained release is an from 6 (very, very light) to 20 (very, very hard).
extended-release formula for two-stage sleep aid. The RPE scale is a reliable indicator of physical
The first layer dissolves rapidly to promote sleep, discomfort, has sound psychometric properties
while the second layer releases gradually the addi- and is strongly correlated with several other phy-
tional MEL to assure a complete night of restful siological measures of exertion (Borg 1982).
sleep. Participants were allowed to go to bed (at
22:15 min) in a quiet darkened room and at an Polysomnography
ambient temperature of 23°C. In the following Sleep recording was carried out using a portable
morning, the participants were awakened at polysomnographic machine (Track it MK3 – EEG/
07:00 h by an alarm clock and the PSG electrodes Polygraphy Recorder, USA) (https://www.lifelines
were removed. Upon doing their toilet and just neuro.com/.). PSG is a sleep study. This test
before taking their breakfast (i.e. 07:30 min), they records certain body functions during sleep, or
performed two cognitive tasks: i.e. the Choice attempts to sleep. PSG is used to diagnose sleep
Reaction Time (CRT) followed after 10 min by disorders. To perform the PSG recording, several
the one model Zazzo test, and the Hooper wellness electrodes were placed on the chin, scalp and the
index was collected. Then, participants completed outer edge of the eyelids of the participant (i.e. 8
the YYIRT-1, the Hand grip strength test (HG), electroencephalogram (EEG): for brain electrical
the five-jump test (5-JT) and the vertical and hor- activity; 4 electrooculogram (EOG): for horizontal
izontal Jump tests (VJ; HJ). Finally, the PSG device and vertical movements; 4 electromyogram
was taken to the hospital for blind encryption of (EMG): for chin muscular activity). EEG, EMG
the data by the specialized technician. and EOG were continuously recorded. PSG
recording was analyzed using the Polysmith’ soft-
ware allowing determining TST, Sleep cycles and
Exercises testing
stages composition (N1-, N2-, N3-sleep and rapid-
The Yo-Yo intermittent recovery test level-1 (YYIRT-1) eye-movement-sleep (REM-sleep)), SE (which is
The YYIRT-1 consisted of 20-m shuttle runs per- the ratio of the TST on the total time spent in
formed at increasing velocities with 10 s of active bed (TIB)), SOL and nocturnal awakening after
recovery between runs until exhaustion (Krustrup sleep onset (NA).
et al. 2003). Audio cues of the YYIRT-1 were
recorded on a CD (http://www.teknosport.com, The choice reaction-time test (CRT)
Ancona, Italy) and broadcasted using a calibrated CRT tests general alertness and motor speed. It
portable CD player (Philips, Az1030 CD player, is a 2-CRT test, stimulus and response uncer-
Eindhoven, Holland). The end of the test was tainty are introduced by having two possible
considered when the participant twice failed to stimuli and two possible responses. This is a
reach the front line on time (i.e. objective evalua- test to see how fast you can make a choice.
tion) or he felt unable to complete another shuttle You view a computer screen (15ʺ LCD) showing
at the dictated speed (i.e. subjective evaluation). a white square, a yellow or blue box will appear.
The total distance covered during the YYIRT-1 You must press the correct key on the computer
(including the last incomplete shuttle) was consid- (using the React! V0.9 software) as quickly and
ered as the test score. HR was recorded during the accurately as possible with the index finger when
YYIRT-1, using a Polar heart rate monitor (Polar you see the box. If the box is yellow you press Z,
Electro Oy, T61-coded, Hungary, with values X or C. If the box is blue you press B, N, or M.
 CHRONOBIOLOGY INTERNATIONAL 5

You get 10 attempts in which the visual stimulus separately before testing sessions. Participants
occurred at random intervals of 1–10 s. Once the were asked to rate subjective quality of prior
10 attempts have been completed, the average of night-sleep and fatigue, stress and soreness muscle
the performances performed is displayed on the on a scale of 1–7.
computer screen and will be considered as the
Reaction Time (RT) scores (De Quel et al. 2015; Hand-grip strength (HG)
Bleeker et al. 1987). The maximal hand-grip strength of the dominant
hand was measured with a calibrated hand dynam-
The Zazzo test (1969) ometer (T.K.K. 5401; Takei, Tokyo, Japan). The
The Zazzo test aims at measuring the selective participants stood comfortably with their
attention. The test consisted in identifying a parti- shoulders adducted. The dynamometer was held
cular sign (a small square with a slash down to 45° freely without support and did not touch the par-
on the right), and crossing out as much as possible ticipant’s trunk. The position of the hand
in a limited time (10 min), working line by line, remained constant with a downward direction,
from left to right, leaving aside all the other signs and the palm did not flex on the wrist joint. The
whose orientation of the bar is different (Zazzo participants were required to exert maximal
1969). On each sheet of paper are 1000 signs strength on the dynamometer. They performed
represented and divided into 40 lines and 25 col- two trials, 1 min between each, the better perfor-
umns. Two types of errors can be identified: either mance being used for further analysis.
the participant bars a sign that is not identical to
those displayed on the board (additions: A) or he Five-jump test (5-JT)
forgets to bar (omissions: Om). The number of The 5-JT consists of five consecutive strides with
signs to cross out is 83. The results of the Zazzo joined feet position at the start and end of the
tests were analyzed based on the techniques of jumps to estimate lower body power. From the
computation and reading as described in the starting joined feet position, participants had to
Manual for the Psychological Examination of the directly jump to the front with a leg of their
Child (Zazzo 1969). choice. After the first four strides, i.e. alternating
left and right feet for twice each, they had to per-
● The inaccuracy in crossing out a sign = (Om form the last stride and end the test again with
+ A)/(number of signs to crossing out + A). joined feet. Performance was measured with a tape
● The speed of crossing out a sign. That is to say, measure from the front edge of the participant’s
the number of signs considered at the min- feet at the starting position to the rear edge of the
ute = number of signs considered × 60/time feet at the final position. The reliability of 5-JT
(seconds). performance has previously been assessed
● The performance of crossing out a sign = the (Chamari et al. 2008).
number of signs crossed out correctly in
10 min. Performance = (number of signs Vertical jump (VJ)
found × 10)/time (minutes). The participant must jump on the spot, arms
raised, along a wall. It is placed in the flexed leg
position – Knee joint 90°. Without gaining
The Hooper index momentum – it must not be lowered – it performs
The well-being/wellness Hooper index (Hooper a maximum thrust upward. The height at the jump
and Mackinnon 1995) based on ratings relative is measured by measuring the distance between
to fatigue, stress level, muscle soreness and sleep the start mark (upright arm) and the highest
quality/disorders has been suggested as one of the point reached by the hand. The test is considered
most cost-effective strategies for prevention and correct only when the participant falls to the same
early detection of nonfunctional overreaching. place. The vertical jump corresponds to the differ-
This method is the summation of these four sub- ence between the heights reached without jumping
jective ratings. Each of these ratings was measured and with jumping (Young 1995).
6 M. CHEIKH ET AL.

Horizontal jump (HJ) However, HRpeak during YYIRT-1 displayed no sig-

Participants were in a comfortable starting position; nificant difference between MEL and PLA (Δ = 0.9;
their feet were joined, and their hands were on their p > 0.05; ES = −0.88) (Table 1).
hips. A start line was then marked in front of the toe
where the knee was at an angle of 120°. The partici-
pant’s trunk was in a position similar to their vertical Polysomnographic parameters
squat jump position. Participants were then PSG records showed a higher TST by 24.55 min and
instructed to jump as far forward as possible and SE by 4.47% (p < 0.001), and a lower SOL by
land on two feet. For horizontal jump, the experi- 8.45 min during MEL compared to PLA condition
menter measured the distance from the starting line (Table 2). Moreover, there were lower nocturnal
to the participant’s closest heel (Young 1995). awakenings after sleep onset NA (18.95 min versus
29.95 min; p < 0.001; ES = 1.73), N1-sleep (3.52%
versus 5.3%; p < 0.001; ES = 1.14) and N2-sleep
Statistical analyses
(57.91% versus 59.81%; p < 0.05; ES = 0.60) with
The statistical analysis was performed using MEL compared to PLA. MEL was associated also
Statistica software (StatSoft, Maisons-Alfort, with significantly longer N3-sleep (19.86% versus
France). Values are expressed as mean ± standard 18.3%; p < 0.05; ES = −0.58) and REM-sleep
deviation (mean ± SD). Once the assumption of (18.72% versus 16.57%; p < 0.001; ES = −1.22). The
normality with the Shapiro–Wilk W-test was con- TIB remained unchanged for both sessions (Table 2).
firmed, parametric tests were performed.
Parameters measured in the YYIRT-1, HRpeak,
RPE, polysomnographic recording, CRT, the Zazzo Cognitive performances and Hooper index
test and the Hooper index, VJ, HJ, HG and 5-JT Choice reaction time
performances during the two different test sessions There was a significantly lower CRT score (shorter
(MEL and PLA) were compared using the student RT) during MEL compared with PLA condition
t-test for paired samples. The effect size (ES) of (p < 0.01) (Table 3).
changes in each measured variable is defined as
the difference between the means divided by the The vigilance test (Zazzo)
common standard deviation (Cohen 1992). Data related to the Zazzo test are presented in
Threshold values for the interpretation of ES were Table 3.
0 to <0.20 (trivial), 0.20 to <0.50 (small), 0.50 to Statistical analysis displayed no significant main
<0.80 (medium), ≥0.80 (large). A probability level of effect of MEL ingestion on Inaccuracy (p > 0.05)
0.05 was selected as the criterion for statistical sig-
nificance. A 95% confidence interval was used to set
confidence margins to the results.

Results
RPE, HRpeak and the YYIRT-1 performance
YYIRT-1 test performed in the evening displayed no
significant difference between MEL and PLA
(p > 0.05) (Figure 1). Morning performances’ statis-
tical analysis showed a significantly higher YYIRT-1
performance with MEL compared to PLA (Δ = 82 m; Figure 1. Mean values ± ES of the distance (m) covered in the
p < 0.001; ES = −0.59) (Figure 1). Moreover, RPE YYIRT-1 recorded in the late-evening (20:00 h) and in the
morning (08:00 h) after nighttime either MEL-10 mg or PLA
scores after the YYIRT-1 test has indicated a signifi-
ingestion. ***: significant difference between MEL and PLA at
cant decrease in the MEL condition in comparison level p < 0.001. +++: significant difference between morning
with PLA one (Δ = −2.7; p < 0.001; ES = 2.55). and late-evening sessions at level p < 0.001.
 CHRONOBIOLOGY INTERNATIONAL 7

Table 1. HRpeak during the YYIRT-1 test and RPE scores recorded in the late-evening (20:00 h) and in the morning (08:00 h) for PLA
and MEL conditions.
PLA MEL t value p value Δ value IC 95% ES
Late -Evening HRpeak (beats min−1) 193.60 ± 2.50 193.90 ± 2.30 −0.75 p > 0.05 0.30 [−0.38 to 1.25] −0.12
RPE (AU) 15.60 ± 0.80 15.70 ± 1.10 −0.36 p > 0.05 0.10 [−0.526 to 0.72] −0.10
Morning HRpeak (beats min−1) 190.40 ± 2.75 191.30 ± 1.34 −1.33 p > 0.05 0.9 [−0.62 to 2.42] −0.88
RPE (AU) 17.8 ± 0.92 15.1 ± 1.20 12.65 p < 0.001 −2.7 [−3.18 to 2.22] 2.55
PLA: placebo; MEL: melatonin; IC 95%: Confidence interval; ES: effect size; Δ = value MEL session–value PLA session; HRpeak: peak heart rate; RPE:
Rating of perceived exertion; AU: Arbitrary units.

Table 2. Sleep polysomnographic parameters (mean ± SD) (n = 10) recorded after nocturnal MEL or PLA ingestion.
Parameters PLA MEL Δ value IC 95% Δ% value t value p value ES
TIB (min) 518.0 ± 3.77 519.5 ± 4.03 1.50 [−0.38 to 3.38] 0.29 t = 1.80 p > 0.05 −0.38
TST (min) 463.0 ± 6.49 487.55 ± 6.98 24.55 [20.41 to 28.68] 5.30 t = 13.43 p < 0.001 −3.64
SE (%) 89.38 ± 1.07 93.85 ± 1.17 4.47 [3.75 to 5.18] 4.99 t = 14.07 p < 0.001 −3.99
SOL (min) 22.05 ± 4.17 13.60 ± 3.25 −8.45 [−11.2 to −5.65] −38.32 t = 6.81 p < 0.001 2.27
NA (min) 29.95 ± 7.58 18.95 ± 5.03 −11.00 [−14.18 to −7.82] −36.73 t = 7.82 p < 0.001 1.73
N1 sleep (%) 5.30 ± 1.38 3.52 ± 1.74 −1.78 [−2.33 to −1.23] −33.63 t = 7.38 p < 0.001 1.14
N2 sleep (%) 59.81 ± 3.55 57.91 ± 2.39 −1.90 [−3.68 to −0.12] −3.18 t = 2.42 p < 0.05 0.60
N3 sleep (%) 18.30 ± 3.04 19.86 ± 2.30 1.73 [0.18 to 3.27] 9.53 t = 2.53 p < 0.05 −0.58
REM sleep (%) 16.57 ± 1.95 18.72 ± 1.55 2.15 [1.12 to 3.18] 13.00 t = 4.72 p < 0.001 −1.22
TIB : time in bed; TST : total sleep time; SE : sleep-efficiency; SOL : sleep onset-latency; NA : total time of nocturnal awakenings after sleep onset; N1-
sleep : stage 1 sleep; N2-sleep : stage 2 sleep; N3-sleep : stage 3 sleep; REM-sleep : rapid-eye-movement-sleep; Δ = value MEL session–value PLA
session; Δ% = (Δ/value PLA session)×100; IC 95%: Confidence interval; ES: effect size; PLA: placebo; MEL: melatonin.

Table 3. Mean ± SD values for the cognitive performances and Hooper index (n = 10) measured the following morning after
nocturnal MEL or PLA ingestion.
Items PLA MEL Δ value IC 95% Δ% value t value p value ES
CRT (S) 0.42 ± 0.07 0.37 ± 0.06 −0.057 [−0.09 to −0.02] −13.47 3.63 p < 0.01 0.70
Zazzo Test Inaccuracy (AU) 0.05 ± 0.03 0.04 ± 0.04 −0.01 [−0.015 to 0.04] −21.82 1.03 p > 0.05 0.20
Speed (AU) 210.32 ± 51.35 265.95 ± 42.69 55.62 [0.22 to 111.03] 26.45 2.27 p < 0.05 −1.17
Performance (AU) 166.80 ± 43.50 208.31 ± 20.30 41.51 [11.31 to 71.71] 24.88 3.11 p < 0.05 −1.30
Hooper wellness index Sleep (AU) 3.60 ± 0.96 2.30 ± 0.94 −1.30 [−2.47 to −0.13] −36.11 2.51 p < 0.05 1.36
Fatigue (AU) 3.30 ± 0.94 2.30 ± 0.82 −1.00 [−1.75 to −0.24] −30.30 3.00 p < 0.05 1.09
Muscles soreness (AU) 3.30 ± 1.60 2.00 ± 0.94 −1.30 [−2.19 to 0.40] −39.39 3.28 p < 0.01 0.51
Stress (AU) 2.00 ± 0.94 1.90 ± 0.99 −0.10 [−1.14 to 0.94] −5.00 0.22 p > 0.05 0.10
CRT: Choice reaction time; Δ = MEL session value–PLA session value; Δ% = (Δ/PLA session value)×100. IC 95%: confidence interval; ES: Effect size;
PLA: Placebo; MEL: Melatonin; AU: Arbitrary units.

but it displayed a significant main positive effect of during MEL condition (p < 0.05). In contrast,
MEL ingestion on Speed (p < 0.05) and stress level was unchanged when comparing both
Performance (p < 0.05). Nevertheless, results conditions (p > 0.05).
showed reduced selective attention with PLA com-
pared to MEL.
Short-term physical performances
The Hooper index Data related to the short-term physical perfor-
Data related to the Hooper index are presented in mances are presented in Table 4. There was no
Table 3. Statistical analysis of data collected from significant difference between PLA and MEL con-
the four subjective ratings demonstrated that the ditions in HG performance (p > 0.05). Statistical
feeling of fatigue and muscle soreness were lower analysis revealed significant increase in 5-JT per-
the morning after MEL ingestion compared with formance with MEL when compared to PLA
PLA (p < 0.05 and p < 0.01, respectively). Likewise, (p < 0.05) (Figure 2). The performance during
a significant effect of MEL was observed for the the HJ and VJ displayed no significant difference
subjective perception of sleep with a better quality between MEL and PLA conditions (p > 0.05).
8 M. CHEIKH ET AL.

Table 4. Mean ± SD values for short-term physical performances (n = 10) measured the following morning after nocturnal MEL or
PLA ingestion.
PLA MEL t value p value Δ value IC 95% ES
5-JT (m) 10.48 ± 0.68 10.56 ± 0.71 −3.18 p < 0.05 0.08 [−0.02 to 0.13] −0.11
HG (kg) 42.87 ± 5.86 43.65 ± 6.11 −0.78 p > 0.05 0.78 [−3.04 to 1.48] −0.13
HJ (cm) 217 ± 22,52 225 ± 14,14 −1.87 p > 0.05 8 [−1.61 to 17] −0.42
VJ (cm) 44.00 ± 7.36 44.3 ± 7.04 −0.58 p > 0.05 0.30 [−1.47 to 0.87] −0.41
PLA: placebo; MEL: melatonin; IC 95%: Confidence interval; ES: effect size; Δ = value MEL session–value PLA session; 5-JT: Five-jump test; HG: Hand-
grip strength; HJ: Horizontal jump; VJ: Vertical jump.

were represented and extreme M-type and moder-

ately E-type were lacking. In contrast, eight ado-
lescents were E-type, which explains the absence of
the moderately E-type and the few number of the
moderately M-type participants (n = 3) and con-
sequently the sample size was quite small.
To accomplish the purpose of our study, we have
specifically selected the YYIRT-1 because it is an
exhaustive exercise that affects sleep when carried
out late in the evening and several studies that have
studied the effect of the evening exercise on sleep
Figure 2. Mean values ± ES of the distance (m) jumped in the
5J-T recorded in the morning (08:00 h) after nighttime either quality and quantity (objective assessments: actigra-
MEL-10 mg or PLA ingestion. *: significant difference between phy, PSG) have used the YYIRT-1 (Vitale et al. 2017;
MEL and PLA at level p < 0.05. Souissi et al. 2012). Also, during this study the YYIRT-
1 was the only test repeated both in the evening and in
Discussion the morning because the short-term physical exercises
chosen in this present study (5-JT, HG, VJ and HJ)
Methodological considerations
were not too exhaustive to influence sleep. Therefore,
In the present study, participants were selected we have found it useless to repeat these short-term
according to their score on the self-assessment physical exercises both in the evening and in the
questionnaire of Horne and Ostberg (1976). morning. Even comparing the differences between
According to Vitale et al. (2017), chronotype had evening and morning short-term physical perfor-
a significant effect on sleep parameters in response mances could have been good for the present study.
to the evening high intensity interval exercise: The choice of an exhaustive exercise (i.e. The
sleep quality was poorer in the M-type subjects, YYIRT-1) has been well studied and with reference
whereas no changes in sleep behavior were noted to previous studies. Dworak et al. (2008) demonstrated
in the E-type individuals. Indeed, actigraphy-based that alterations in sleep architecture and sleep conti-
sleep parameters were negatively affected only in nuity after preceding exercise depend on exercise
the M-type subjects after the evening exercise. intensity. However, regular moderate physical activity
Furthermore, it seems that E-type needs more can have beneficial effects on sleep (Roveda et al.
time to get physically ready for a sport activity 2011). In this way, previous studies concerning late-
after waking up than M-type (Vitale and evening exercise and sleep have demonstrated that no
Weydahl 2017). For these reasons, we eliminated effects on sleep were seen after moderate late-evening
the extreme types (M-type and E-type). Since teen- exercise (Dworak et al. 2008; Driver and Taylor 2000;
agers have a natural tendency predisposing them Youngstedt et al. 1997; Youngstedt et al. 2000), but
to become E-type (Reading 2013), we found pro- also have reported increased slow-wave sleep (SWS).
blems in the selection of the participants. Moreover, shortened SOL has been reported after
However, following the responses of 18 teenagers moderate late-night exercise when compared with
(members in a judo team) to the Morningness– exercise in the morning and early evening
Eveningness questionnaire, not all chronotypes (Kobayashi et al. 1999).
 CHRONOBIOLOGY INTERNATIONAL 9

By referring to these studies, it seems of good awakening after sleep onset (NA) in healthy teen-
sense to admit that there was no negative impact agers (−36.73% compared with PLA). Accordingly,
of moderate late-evening exercise on sleep quality. Garfinkel et al. (1995) demonstrated that treatment
It seems, yet, to promote sleep. Therefore, we with 2 mg controlled release MEL for 3-weeks in
cannot evoke sleep problems following late-eve- MEL-deficient subjects significantly decreased the
ning moderate exercise. amount of awakening time after sleep onset.
According to Youngstedt (2005), sleep is dis- Similarly, Nave et al. (1995) found that MEL-5 mg
turbed if the exercise is performed in the four supplementation for a period of 4-weeks decreases
hours before sleep time. Likewise, exercise can NA in youngsters (6–17 years) with Autism
negatively affect the sleep quality when it was Spectrum Disorders.
performed close to bedtime (Stepanski and Wyatt Few studies have investigated the possible
2003). In this sense, Souissi et al. (2012) showed effects of exogenous MEL on sleep architecture.
that intense late-evening (at 20:00 h) exercise (i.e. The present study findings showed that MEL
YYIRT-1) disturbs sleep quality and quantity but decreased N1- and N2-sleep durations.
has no effect on sleep when performed in the Nonetheless, Wurtman and Zhdanova (1995) and
afternoon (at 14:00 h). Indeed, since we realized Monti et al. (1999) have found that the latter sleep
the present study in the perspectives of the study stages durations remained unchanged after admin-
of Souissi et al. (2012) done in the same laboratory istration of 2 or 3 mg of immediate-release MEL,
while keeping the same exhaustive exercise, our respectively.
first test session was performed late in the evening Regarding stage N3-sleep and REM-sleep, noctur-
(at ~20:00 h) namely ~2 hours before bed time. nal MEL-10 mg administration resulted in higher
sleep stages durations by 9.5 and 13.0%, respectively,
compared with PLA. These findings are in accor-
Results and discussion
dance with the results of Lewis (1999), showing that
The aim of this study was to investigate the effects a single dose of MEL-10 mg sharply increased both
of a single dose of MEL-10 mg ingestion after N3- and REM-sleep durations resulting in a restful,
exhaustive late-evening exercise on sleep quality regenerator and detoxifying sleep in healthy
and quantity, psycho-cognitive and short-term humans. In contrast, Hughes and Badia (1997)
physical performances the following morning in showed that sleep following a single dose of MEL-
young athletes. 10 mg administration among healthy young male
A major finding of this study was that nocturnal contained significantly more stage N2-sleep and
(i.e. 22:00 h) MEL ingestion significantly increased less N3-sleep, while stage N1-sleep and REM-sleep
TST and SE and lowered SOL. These results are were unaffected. However, previous study has shown
consistent with those of Smits et al. (2001) who that MEL had no effect on N2- and N3-sleep
showed that chronic (4-week 5 mg/day) MEL sup- (Almeida Montes et al. 2003). This discrepancy
plementation in adolescents improved SE, between the studies could be mainly explained by
increased TST and decreased SOL. Likewise, the divergences of the experimental protocols (i.e.
MEL was also successful in promoting TST and level of sleep deterioration, chronotype, age and sex
SE even when used as a treatment of sleep disorder of the participants and essentially the nature of MEL
in a particular population (children with neurolo- (double action, prolonged or immediate release cap-
gical disabilities, neuropsychiatric and develop- sules), the MEL dose and the time of MEL adminis-
ment including blindness, deaf-blindness, mental tration: daytime or nighttime administration). The
retardation and autism) (Jan and O’Donnell 1996) pooled data from various studies were highly hetero-
or in a pathological population (hypertensive geneous, possibly due to the fact that the MEL pre-
patients (Scheer et al. 2012), patients with chronic parations used in these individual studies varied in
primary insomnia (Monti et al. 1999)). dose used and probably also in quality, excipients
In the present study, nocturnal MEL-10 mg and purity as well (in this study, the MEL dose was
ingestion after intensive late-evening exercise characterized by a double action sustained release).
resulted in a significantly reduced nocturnal Thereby, when summarizing the effect of exogenous
10 M. CHEIKH ET AL.

MEL on sleep, it becomes apparent that nocturnal addition, the purpose of this study can respond to
administration of MEL improves sleep quality and the suggestion of Chase et al. (2017) who called for
quantity. Indeed, previous studies have shown that the search of strategies to improve the conse-
MEL is closely related to the beginning as well as the quences of sleep loss on performances the follow-
maintenance of sleep without altering its architec- ing morning which are shown to be impaired. In
ture (Gilbert et al. 1999). the present study and despite the same late-eve-
Concerning psycho-cognitive performances, the ning effort performed, MEL ingestion induced
present study’s findings showed that nocturnal several positive effects on sleep and short-term
MEL ingestion improved CRT and Vigilance physical and cognitive performances the following
(Zazzo Test) performances in the following morn- morning in comparison with PLA condition. The
ing. In fact, Zazzo test results indicated that noc- present findings showed that, whilst vertical and
turnal MEL-10 mg administration improved the horizontal jumps (VJ; HJ), Hand-grip strength
following day Speed and Performance of crossing (HG) and HRpeak did not change significantly
out a sign (Δ% = 26.5% and Δ% = 24.9%, respec- with nighttime MEL-10 mg ingestion, 5-JT,
tively) but had no effect on Inaccuracy, reflecting a YYIRT-1 and RPE were improved with MEL
better selective attention with MEL compared to dose quoted above. These findings are partially in
PLA. From a wellness prospective, the Hooper agreement with those of Atkinson et al. (2001)
index showed better scores of subjective sleep which concluded that MEL-5 mg ingested before
quality, fatigue and muscle soreness (with an aver- nocturnal sleep did not affect morning short-term
age change of 1.30; 1 and 1.30, respectively) the performances (i.e. HG; 4 km cycling) and RPE
morning after MEL ingestion compared with PLA. scores. There are obviously two differences
These findings are in accordance with those of between this study and the present work; the
Peck et al. (2004) concluding that MEL adminis- MEL dose used and the protocol setup (i.e.
tration at a dose of 1 mg nightly may be effective Atkinson et al.’s study was conducted without
in improving certain aspects of cognitive function- sleep disturbance). It seems, therefore, that 5 mg
ing and subjective reports of sleep quality in of MEL ingested before nocturnal exercise is not
healthy elderly subjects. Contrarily, Atkinson enough to exert a significant effect upon physical
et al. (2001) have shown that nocturnal (i.e. performance (Ghattassi et al. 2014). In addition,
23:00 h) MEL-5 mg administration had no effect Ghattassi et al. (2014) found a dose–response rela-
on subjective sleep quality and intra oral tempera- tionship between MEL and the effects on short-
ture in the following morning. Certainly, prolon- term evening physical performances. They showed
gation of sleep duration is also an indication of that although MEL-8 mg ingestion has an adverse
improved SE and continuity. Such improvements effect on physical capacities and 5-mg of MEL
are associated with better achievements in various ingestion does not affect short-term performances,
performance tests (such as attention, fine motor the measurement of the dependent variables was
activity and RT scores) and the sensation of before nocturnal sleep, and the latency between
improved well-being during the following day MEL administration and performance measures
(Satoh and Mishima 2001). Also, positive subjec- was shorter comparatively to the present study.
tive assessment of the levels of fatigue and muscles In addition, the present study was conducted
soreness could be explained by biochemical expla- during both exhaustive late-evening exercise con-
nations since MEL has many anti-inflammatory, dition and situation in which sleep is disturbed,
anti-oxidant, analgesic and nociceptive effects contrarily of the other studies that were released
(Escames et al. 2012). either before nocturnal sleep or in normal sleep
One of the reasons to conduct the present inves- situation.
tigation was the fact that the reliable data on the Finally, one of the strength of the present study
relationship between nighttime MEL ingestion is the use of PSG to evaluate and study sleep
after a late-evening exhaustive exercise and the among adolescent athletes. However, some limita-
following morning short-term physical perfor- tions inherent to the experimental protocol of this
mances are scarce particularly for adolescents. In study warrant mention. First, the sample size is
 CHRONOBIOLOGY INTERNATIONAL 11

very small. Second, an experimental session with American Academy of Sleep Medicine. 2001. International
only MEL ingestion to dissociate the effect of the classification of sleep disorders, revised: diagnostic and
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55:372–79.
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Karim Chamari http://orcid.org/0000-0001-9178-7678 heavy exercise impairs 3-km cycling time trial performance
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