Elsevier

Phytomedicine

Volume 21, Issue 5, 15 April 2014, Pages 753-757
Phytomedicine

Sleep quality in pregnancy during treatment with Bryophyllum pinnatum: An observational study

https://doi.org/10.1016/j.phymed.2013.11.003Get rights and content

Abstract

Introduction

Poor sleep quality in pregnancy is frequent. A treatment with sedatives is problematic due to possible adverse effects for mother and embryo/foetus. In the present study, we investigated the sedative effect of Bryophyllum pinnatum, a phytotherapeutic medication used in anthroposophic medicine. In previous clinical studies on its tocolytic effect, B. pinnatum showed a good risk/benefit ratio for mother and child. A recent analysis of the prescribing pattern for B. pinnatum in a network of anthroposophic physicians revealed sleep disorders as one of the most frequent diagnoses for which these preparations are prescribed.

Materials and methods

In this prospective, multi-centre, observational study, pregnant women suffering from sleep problems were treated with B. pinnatum (350 mg tablets, 50% leaf press juice, Weleda AG, Arlesheim, dosage at physician's consideration). Sleep quality, daily sleepiness and fatigue were assessed with the aid of standardised questionnaires, at the beginning of the treatment and after 2 weeks. Possible adverse drug reactions perceived by the patients during the treatment were recorded.

Results

The number of wake-ups, as well as the subjective quality of sleep was significantly improved at the end of the treatment with B. pinnatum. The Epworth Sleeping Scale decreased, indicating a decrease of the tiredness during the day. There was, however, no evidence for prolongation of the sleep duration, reduction in the time to fall asleep, as well as change in the Fatigue Severity Scale after B. pinnatum. No serious adverse drug reactions were detected.

Conclusion

B. pinnatum is a suitable treatment of sleep problems in pregnancy. The data of this study encourage further clinical investigations on the use of B. pinnatum in sleep disorders.

Introduction

Bryophyllum (B.) pinnatum (Lamarck) Oken [syn.: Kalanchoe pinnata (Lamarck) Persoon, syn.: Bryophyllum calycinum Salisbury] is a plant of the family Crassulaceae. It is originally from Madagascar but meanwhile grows widely across tropical Africa, tropical America, India, China and Australia (Kamboj and Saluja, 2009). The plant is known under different common names, such as life plant, air plant, love plant, Cathedral bells and Goethe plant. Leave extracts from B. pinnatum have been used in traditional medicine of the regions where it grows, and is suggested to have the following properties: sedative, central nervous system (CNS) depressant, analgesic, anti-pyretic, muscle relaxant, gastroprotective, anti-inflammatory, anti-septic, anti-allergic, anti-anaphylactic, anti-leishmanial, anti-ulcer, immunomodulating, wound healing and anti-cancer (Ojewole, 2005, Kamgang et al., 2008, Kamboj and Saluja, 2009, El Abdellaoui et al., 2010, Nayak et al., 2010, Mahata et al., 2012).

In Europe, Rudolf Steiner introduced B. pinnatum in 1921 as an anthroposophical treatment of “hysteria” (Daems, 1982). In 1970, B. pinnatum was introduced in obstetrics at the anthroposophic Herdecke Community Hospital (Germany) for the treatment of premature labour (Hassauer et al., 1985). Since then, several empirical and clinical studies about the tocolytic effect were published (Daub, 1989, Vilaghy, 2002, Plangger et al., 2006). All studies documented a favourable tolerability of B. pinnatum. The relaxant effect of aqueous extract and press juice of B. pinnatum leaves on uterine contractions could be corroborated with experiments performed with myometrium strips (Gwehenberger et al., 2004, Wächter et al., 2011), and with myometrium cell lines (Simões-Wüst et al., 2010). Recent studies also showed a relaxant effect of B. pinnatum leaf press juice on the porcine detrusor (Schuler et al., 2012). A characterisation of the prescribing pattern of B. pinnatum preparations in a network of anthroposophic physicians revealed sleep disorders as one of the most frequent diagnoses for which these preparations are prescribed (Simões-Wüst et al., 2012).

For various reasons some pregnant women have a poorer sleep quality than non-pregnant women (Brunner et al., 1994). During pregnancy, treatment with sedatives is problematic due to possible undesirable effects for mother and embryo/foetus. In earlier studies on tocolysis with B. pinnatum, these products had shown a good risk/benefit ratio for mother and child. Therefore, we investigated in this observational study the treatment of pregnancy-related sleep problems with B. pinnatum.

Section snippets

Study design

The prospective, multi-centre observational study was authorised by the ethical committee of canton Zurich. Written informed consent was obtained from all women participating in the study. Pregnant women to be treated for at least 14 days with B. pinnatum (chewable tablets 350 mg, dosage depended on physician's prescription) for newly diagnosed sleep disorders related to the ongoing pregnancy (associated with, e.g. hard stomach, general agitation and anxiety) were included in the study if

Study patients

From April 2009 until May 2011, 78 pregnant women were recruited from three different outpatient clinics in Switzerland. From these 78 patients, 28 patients did not finish the study. The reasons for study dropout are depicted in Table 1. Of the 50 participants who finished the study, one was excluded because the treatment with B. pinnatum lasted only 9 instead of 14 days (therapy stop due to nausea). Hence, data from 49 patients could be evaluated. They included 24 out of 41 patients recruited

Discussion

This observational study shows that some parameters of the sleep quality improved significantly under treatment with B. pinnatum and that the preparation was well tolerated. The subjective sleep quality increased, while the sleep problems and the mean number of wake-ups during the night diminished during treatment. The time to fall asleep, and the ability of uninterrupted sleep were, however, not significantly changed. These improvements are particularly interesting, since sleep quality may

Conflict of interest

APSW and UvM received during the last five years occasional research funds from the Weleda AG, the producer of B. pinnatum preparations.

Acknowledgments

We express our gratitude to the participating patients. Thanks are also due to the medical personnel who assisted in recruiting the patients, in particular Alexandra Dolder, and to Burkart Seifert for the statistical analysis. We thank the three outpatient clinics (Paracelsus-Hospital Richterswil, Bülach Hospital, and Zurich University Hospital) for the possibility to perform this study. Financial support by Weleda AG (Arlesheim, Switzerland) and the Supporting Association Paracelsus-Hospital

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