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Pharmacologic Treatments for Sleep Disorders in Children: A Systematic Review

Marian S McDonagh1, Rebecca Holmes1, Frances Hsu1

  • 11 Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA.

Journal of Child Neurology
|January 25, 2019
PubMed

Insights

Melatonin effectively improves sleep in children with neurodevelopmental disorders, offering short-term benefits for sleep latency and duration. Other medications show limited efficacy for pediatric sleep issues.

Area of Science:

  • Pediatric Sleep Medicine
  • Neurodevelopmental Disorders Pharmacology
  • Clinical Trial Analysis

Background:

  • Sleep problems are prevalent in children, particularly those with neurodevelopmental disorders, impacting behavior and quality of life.
  • Pharmacologic interventions are often considered for pediatric sleep disorders, necessitating evidence-based efficacy and safety data.

Purpose of the Study:

  • To systematically review the efficacy and harms of pharmacologic treatments for sleep disorders in children and adolescents.
  • To evaluate specific medications including zolpidem, eszopiclone, diphenhydramine, and melatonin.

Main Methods:

  • Systematic review of 22 placebo-controlled randomized controlled trials (RCTs) published through June 2018.
  • Searches conducted in MEDLINE, Cochrane Library, and PsycINFO databases.
  • Included 1758 children and adolescents (mean age 8.2 years) across trials ranging from 1 to 13 weeks.

Main Results:

  • Zolpidem and eszopiclone showed no sleep improvement in children with attention-deficit/hyperactivity disorder (ADHD), though zolpidem improved Clinical Global Impression scores.
  • Diphenhydramine demonstrated minor improvements in sleep latency and duration (8-10 minutes) in a small RCT.
  • Melatonin significantly improved sleep latency (median 28 min) and duration (median 33 min) in 19 RCTs, particularly in children with autism spectrum disorder (ASD) and neurodevelopmental disorders.
  • Adverse events were infrequent with melatonin but more common with eszopiclone and zolpidem.

Conclusions:

  • Melatonin is a useful short-term treatment for specific sleep outcomes in children, especially those with comorbid ASD and neurodevelopmental disorders.
  • Current evidence for zolpidem, eszopiclone, and diphenhydramine in pediatric sleep disorders is limited or shows minimal benefit.
  • Further research is needed to adequately study other pharmacologic interventions and long-term outcomes for pediatric sleep disorders.

Keywords:
autisminsomniamelatoninneurodevelopmental disorderssleep disorderssystematic review

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