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Efficacy of Melatonin for Sleep Disturbance in Children with Persistent Post-Concussion Symptoms: Secondary Analysis
Karen Maria Barlow1,2, Valerie Kirk2, Brian Brooks3
1Child Health Research Centre, University of Queensland Faculty of Medicine and Biomedical Sciences, South Brisbane, Queensland, Australia.
Insights
Melatonin treatment effectively reduced sleep disturbances in youth with persistent post-concussion symptoms (PPCS) following mild traumatic brain injury (mTBI). The 3mg dose also showed a significant reduction in depressive symptoms.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Traumatology
Background:
- Sleep disturbances are prevalent in children experiencing persistent post-concussion symptoms (PPCS).
- Melatonin is frequently recommended for these sleep issues, but robust evidence is limited.
- Mild traumatic brain injury (mTBI) can lead to prolonged recovery periods involving sleep disruption.
Purpose of the Study:
- To assess the efficacy of melatonin in treating sleep disturbances in adolescents with PPCS after mTBI.
- To compare the effects of different melatonin dosages (3mg and 10mg) against a placebo.
- To investigate secondary outcomes including sleep parameters and behavioral changes.
Main Methods:
- A secondary analysis of a clinical trial involving youth aged 8-18 with PPCS and sleep-related problems (SRPs).
- Participants were randomized to receive placebo, 3mg melatonin, or 10mg melatonin for 2 weeks.
- Primary outcome: change in SRPs (Post-Concussion Symptom Inventory); Secondary outcomes: actigraphy data (sleep efficiency, duration, latency) and behavior assessments.
Main Results:
- Sleep-related problems (SRPs) decreased in all groups, with a notable reduction in the 3mg melatonin group compared to placebo and the 10mg group.
- Melatonin (both 3mg and 10mg) significantly increased sleep duration compared to placebo.
- The 10mg melatonin group showed improved sleep efficiency (per protocol analysis), and the 3mg group demonstrated a significant decrease in depressive symptoms.
Conclusions:
- Short-term melatonin administration is well-tolerated and effective for managing sleep disturbances in youth with PPCS post-mTBI.
- Melatonin, particularly at a 3mg dose, may offer additional benefits by reducing depressive symptoms in this population.
- Further research can explore optimal dosing and long-term effects of melatonin for pediatric concussion recovery.
Abstract:
Sleep disturbances are commonly reported in children with persistent post-concussion symptoms (PPCS). Melatonin treatment is often recommended, yet supporting evidence is scarce. We aimed to evaluate the efficacy of treatment with melatonin for sleep disturbance in youth with PPCS following mild traumatic brain injury (mTBI). This article is a secondary analysis of a clinical trial of melatonin compared with placebo to treat PPCS. Youth (8-18 years of age) with PPCS and significant sleep-related problems (SRPs) at 4-6 weeks post-injury were eligible. Exclusion criteria: significant medical/psychiatric history; previous concussion/mTBI within 3 months. Treatment groups were: placebo, melatonin 3 mg, or melatonin 10 mg. Primary outcome was change in SRPs measured using the Post-Concussion Symptom Inventory (PCSI) after 2 weeks of treatment. Secondary outcomes included change in actigraphy sleep efficiency, duration, onset latency, and wake-after-sleep-onset. Behavior was measured using Behaviour Assessment for Children (2nd edition). Seventy-two participants (mean age 14.0, standard deviation [SD] = 2.6) years; 60% female) with PPCS and significant sleep disturbance were included in the secondary analysis: placebo (n = 22); melatonin 3 mg (n = 25); melatonin 10 mg (n = 25). Sixty-four participants had actigraphy data. SRPs decreased across all groups over time with a significant effect of melatonin 3 mg (3.7; 95% confidence interval [CI]: 2.1, 5.4) compared with placebo (7.4; 95% CI: 4.2, 10.6) and melatonin 10 mg (6.4; 95% CI: 3.6, 9.2). Sleep duration increased in the melatonin 3 mg (43 min; 95% CI: 6, 93) and melatonin 10 mg groups (55 min; 95% CI: 5, 104) compared with placebo. A per protocol analysis demonstrated improved sleep efficiency in the melatonin 10 mg group (p = 0.029). No serious adverse events were reported. Depressive symptoms significantly decreased with melatonin 3 mg (-4.7; 95% CI: -9.2, -.2) but not with melatonin 10 mg (-1.4, 95% CI: -5.9, 3.2) treatment compared with placebo. Changes in cognition or behavior were otherwise not significantly different between treatment groups. Short-term melatonin is a well-tolerated treatment for sleep disturbance in youth with PPCS following mTBI. In this context, it may also be associated with a reduction in depressive symptoms.
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