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Published on: September 3, 2020
The role of melatonin to attain electroencephalograms in children in a sub-Saharan African setting
Roland Ibekwe1, Lata Jeaven2, Jo M Wilmshurst1
1Departments of Paediatric Neurology, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa; Departments of Neurophysiology, Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, South Africa.
Insights
Oral melatonin effectively and safely induces sleep for electroencephalograms (EEGs) in South African children, improving data quality. This method is a viable alternative to traditional sedatives like chloral hydrate.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Clinical Neurophysiology
Background:
- Limited access to electroencephalograms (EEGs) in sub-Saharan Africa leads to high patient volumes.
- Sleep state in children improves EEG yield and reduces artifacts.
- Melatonin offers a safe alternative for inducing sleep without airway compromise risks.
Purpose of the Study:
- To evaluate the effectiveness and safety of oral melatonin for inducing sleep in children undergoing EEG in South Africa.
- To compare melatonin's efficacy with chloral hydrate for pediatric EEG sedation.
Main Methods:
- A retrospective study involving 173 children undergoing EEG.
- Oral melatonin (3mg or 6mg) was administered to children unable to cooperate or requiring sleep EEGs.
- A control group received chloral hydrate; outcomes included sleep proportion, data usefulness, latency, duration, artifacts, and abnormalities.
Main Results:
- 87% of children achieved stage 2 sleep with melatonin, with a median sleep latency of 44.5 minutes and duration of 25 minutes.
- No adverse events like irritability or drowsiness were reported.
- Melatonin was less effective in children with developmental/behavioral issues and showed a trend towards higher artifacts (P=0.05).
- EEG abnormality rates (33.5% with melatonin vs. 45.5% historical chloral hydrate) and artifact rates (79% vs. 86%) were comparable.
Conclusions:
- Oral melatonin is an effective and safe option for inducing sleep for EEG recordings in pediatric patients in this setting.
- It presents a viable alternative to chloral hydrate, with comparable results for EEG quality.
- Further research may be needed for children with specific developmental challenges.
Purpose:
Limited access to electroencephalograms (EEGs) in sub-Saharan Africa results in a high patient load attending the few neurophysiology units. The state of sleep in children improves yield and reduces artefact of EEGs. Melatonin induces "natural sleep" without the risk of airway compromise. This study evaluated the effectiveness of oral melatonin to attain electroencephalograms in South African children.
Method:
Children undergoing EEG who were unable to cooperate or required sleep EEG, received oral melatonin (3mg<15kg; 6mg>15kg). A retrospective control group received chloral hydrate. Outcome measures were the proportion of children who slept, useful EEG study data, sleep latency and duration, artefacts and EEG study abnormalities.
Results:
173 children were recruited, 88 (51%) male, median age 4 years 9 months (range 0-14 years). 87% achieved stage 2 sleep. Median sleep latency was 44.5min and duration of sleep was 25min (range 18.5-29min). Children had no post-sedation irritability, persistent drowsiness, nor any other adverse events or deferments for inter-current illnesses. Sedation with melatonin was less successful in children with developmental and behavioural problems (χ2=6.18, P=0.046), with a higher rate of artefacts (χ2=5.83, P=0.05). 33.5% (n=58) had abnormal EEG studies, which was comparable to a historical cohort sedated with chloral hydrate (45.5%) (χ2=1.22, P=1.27). Also for artefacts (79% melatonin group versus 86% chloral hydrate group) (χ2=0.63, P=0.42).
Conclusions:
Melatonin is effective and safe in inducing sleep for EEG recording in our setting.
