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Systematic review of melatonin treatment in children with neurodevelopmental disabilities and sleep impairment
Louise Phillips1, Richard E Appleton
1Department of Neurology, Royal Liverpool Children's NHS Trust, Liverpool L12 2AP, UK.
Insights
Melatonin may help reduce sleep onset time in children with neurodevelopmental disabilities. However, evidence is limited, with no significant effects found on total sleep time or awakenings.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Pharmacology
Background:
- Sleep disturbances are prevalent in children with neurodevelopmental disabilities.
- Conventional treatments for these sleep issues are often ineffective.
Purpose of the Study:
- To systematically review randomized clinical trials on melatonin for sleep disturbances in children with neurodevelopmental disabilities.
- To assess melatonin's effect on sleep latency, total sleep time, and awakenings.
Main Methods:
- Systematic review of randomized clinical trials comparing oral melatonin with placebo.
- Inclusion criteria: children with neurodevelopmental disabilities and sleep disturbance.
- Data extraction focused on sleep latency, total sleep time, awakenings, and parental reports.
Main Results:
- Only three studies with 35 children met the inclusion criteria.
- Melatonin significantly decreased sleep onset time compared to placebo (p<0.05).
- No significant effects were observed for total sleep time, night-time awakenings, or parental opinions.
Conclusions:
- Limited randomized clinical trial data suggest melatonin may reduce sleep onset latency in this population.
- Further research is needed due to the scarcity of high-quality evidence.
- Melatonin remains a common prescription despite limited robust data.
Abstract:
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.
