Melatonin is an important hormone concerned with the sleep-wake cycle in human beings. And, children with neuro-developmental ailments show higher prevalence of sleep disturbances as compared to their peers without these problems.
Paul Gringras and his colleagues conducted a randomized placebo controlled trial to examine the efficacy of melatonin in treating sleep disorders in kids with neuro-developmental problems. The study was published in BMJ 2012.
AdvertisementThe researchers enrolled 146 children from 19 hospitals across Wales and England, ranging in age from 3 years to 15 years 8 months, and having neurological and developmental problems. The children also had deranged sleep patterns.
Sleep problem was defined in the study as 'the child not falling asleep within one hour of lights out or having less than six hours of continuous sleep'.
Just 45 minutes before retiring to bed, the children were given immediate-release melatonin or matching placebo capsules for 12 weeks. The dose was started with 0.5mg and was subsequently increase to 2mg, 6mg and 12mg depending upon the response. The parents were asked to maintain a record of their children's sleep. The child's sleep pattern was reviewed at four weekly intervals and the dose was increased to the next dose increment if the child -
• fulfilled the sleep disorder eligibility criteria;
• had received at least 5 of the possible 7 doses in the preceding week; and
• had no serious adverse events.
The scientists observed the factors such as sleep onset latency, family functioning, adverse effects and assessment of child behavior. Nature and duration of sleep was assessed from parent's record diaries and actigraphy. Actigraphy is a 'non-invasive method of monitoring human rest / activity cycles'.
It was found that melatonin increased total sleep time and decreased sleep onset latency. Melatonin was very effective in children with long sleep latency.
The researchers observed that melatonin induced little extra sleep in children. They fell asleep faster and woke up earlier. However the family functioning outcomes and child behavior did not show significant improvement. The scientists were of the opinion that further comparisons with melatonin analogues or slow-release melatonin were needed.
Anant Dave, child psychiatrist from West Midlands, while commending the study however feels that 'the frequency with which Melatonin is prescribed is quite high when one considers its modest effect on sleep as described in this study'. He suggested that the care-givers of children with neuro-developmental disorders should be given better support as well as 'more specific non-pharmacological approaches towards sleep problems, using a range of therapeutic modalities'.
Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial; Gringras et al; BMJ 2012