Systematic review of melatonin treatment in children with neurodevelopmental disabilities and sleep impairment
Child; Humans; Wakefulness/physiology; Brain/physiopathology; Melatonin/therapeutic use; Antioxidants/therapeutic use; Developmental Disabilities/drug therapy/epidemiology/physiopathology; Sleep Wake Disorders/epidemiology; sleep disturbance/disorders; Rett syndrome; pharmacologic intervention; melatonin
Sleep disturbances in children with neurodevelopmental disabilities are common and frequently difficult to treat with conventional pharmacological and behavioural methods. Melatonin is a pineal hormone known to be important in the regulation of the circadian rhythm, including the sleep-wake cycle. This systematic review of available evidence from randomized clinical trials assesses whether melatonin plays a beneficial role in these children and, in particular, its effect on total sleep time, time to sleep onset (sleep latency), and number of awakenings. We also looked at a parental view of the effect. Randomized clinical trials were identified where oral melatonin was compared with a placebo in children with any type of neurodevelopmental disability and associated sleep disturbance. Only three studies, reporting a total of 35 children, fulfilled the criteria for inclusion. The two studies that reported time to sleep onset showed a significant decrease (p<0.05) in this specific outcome where melatonin was compared with a placebo. There was no significant effect of melatonin compared with a placebo on the other outcome measures of total sleep time, night-time awakenings, and parental opinions. Despite the extremely limited randomized clinical trial data, melatonin appears to remain a commonly prescribed drug for disturbed sleep in children with neurodevelopmental abnormalities.
Phillips L; Appleton R E
Developmental Medicine and Child Neurology
2004
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
<a href="http://doi.org/10.1017/s001216220400132x" target="_blank" rel="noreferrer noopener">10.1017/s001216220400132x</a>
Understanding sleep-wake behavior and sleep disorders in children: the value of a model
Child; Humans; Age Factors; Sleep Disorders; Time Factors; Crying; Predictive Value of Tests; adolescent; Preschool; infant; Models; Homeostasis; Behavior/physiology; Sleep Disorders/physiopathology; Biological; Adolescent Behavior/physiology; Child Behavior/physiology; Circadian Rhythm/physiopathology; Comprehension/physiology; Infant Behavior/physiology; Sleep/physiology; Wakefulness/physiology
PURPOSE OF REVIEW: Sleep-wake problems such as night wakings, excessive crying, or difficulties in falling asleep are frequent behavioral issues during childhood. Maturational changes in sleep and circadian regulation likely contribute to the development and maintenance of such problems. This review highlights the recent research examining bioregulatory sleep mechanisms during development and provides a model for predicting sleep-wake behavior in young humans. RECENT FINDINGS: Findings demonstrate that circadian and sleep homeostatic processes exhibit maturational changes during the first two decades of life. The developing interaction of both processes may be a key determinant of sleep-wake and crying behavior in infancy. Evidence shows that the dynamics of sleep homeostatic processes slow down in the course of childhood (i.e., sleep pressure accumulates more slowly with increasing age) enabling children to be awake for consolidated periods during the day. Another current topic is the adolescent sleep phase delay, which appears to be driven primarily by maturational changes in sleep homeostatic and circadian processes. SUMMARY: The two-process model of sleep regulation is a valuable framework for understanding and predicting sleep-wake behavior in young humans. Such knowledge is important for improving anticipatory guidance, parental education, and patient care, as well as for developing appropriate social policies.
2006
Jenni OG; LeBourgeois MK
Current Opinion In Psychiatry
2006
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1097/01.yco.0000218599.32969.03" target="_blank" rel="noreferrer">10.1097/01.yco.0000218599.32969.03</a>