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Low Doses of Melatonin to Improve Sleep in Children with ADHD: An Open-Label Trial
Ana Checa-Ros1,2, Antonio Muñoz-Hoyos3, Antonio Molina-Carballo3
1Grupo de Investigación en Enfermedades Cardiorrenales y Metabólicas, Departamento de Medicina y Cirugía, Facultad de Ciencias de la Salud, Universidad Cardenal Herrera-CEU, CEU Universities, Calle Santiago Ramón y Cajal s/n, Alfara del Patriarca, 46115 Valencia, Spain.
Insights
Low-dose melatonin (1 mg) significantly increased total sleep time in pediatric patients with ADHD on methylphenidate. This treatment showed a good safety profile, suggesting potential benefits for sleep in this population.
Area of Science:
- Pediatric Sleep Medicine
- Neurodevelopmental Disorders
- Pharmacology
Background:
- Limited research exists on low-dose melatonin's sleep effects in children, especially those with ADHD.
- Previous studies primarily focused on adult populations.
Purpose of the Study:
- To investigate the impact of 1 mg melatonin (aMT) on the sleep patterns of pediatric patients diagnosed with ADHD and undergoing methylphenidate (MPH) treatment.
- To assess changes in sleep duration, sleep onset latency, and sleep efficiency.
Main Methods:
- A cohort of children and adolescents (7-15 years) with ADHD on extended-release MPH was enrolled.
- Sleep diaries were collected over seven weeks, followed by a four-week treatment with 1 mg of aMT before bedtime.
- Actigraphy was used for seven-day sleep assessments before and after the intervention.
Main Results:
- Twenty-seven pediatric patients completed the study.
- A statistically significant increase in total sleep time (TST) was observed after one month of aMT treatment (from 463 to 485 minutes; p < 0.040).
- No significant improvements were noted in sleep onset latency (SOL) or sleep efficiency, with minor adverse effects reported.
Conclusions:
- One milligram of melatonin effectively increases total sleep time in children and adolescents with ADHD receiving psychostimulant therapy.
- The treatment demonstrated a favorable tolerability profile.
- Further placebo-controlled studies are recommended to optimize aMT administration timing for potentially reducing SOL in this patient group.
Objective:
Only a few studies assessing the sleep effects of low doses of melatonin (aMT) have been performed in the past, most of them in adults, and only one in subjects with attention-deficit/hyperactivity disorder (ADHD). The aim of this study was to provide evidence of the changes induced by aMT doses as low as 1 mg in the sleep pattern of pediatric patients with ADHD under treatment with methylphenidate (MPH).
Methods:
Children and adolescents (7-15 years) with ADHD who were receiving extended-release MPH were recruited. A seven-week sleep diary was collected prior to starting a four-week treatment with 1 mg of aMT (30 min before bedtime). Seven-day actigraphic assessments of sleep were performed before and after treatment.
Results:
Twenty-seven patients (17 males, 62.96%) participated in the study, who had been receiving MPH for 1.57 (1.11) months. A significant increase in sleep duration (TST) was observed after one month of treatment (463 (49) min to 485 (41) min; p < 0.040), with nonsignificant improvements in sleep-onset latency (SOL), nocturnal awakenings, or sleep efficiency. Only minor adverse effects were reported.
Conclusion:
Low doses of melatonin (1 mg) are able to increase TST in children and adolescents with ADHD receiving treatment with psychostimulants, with an adequate tolerability profile. Further placebo-controlled trials adjusting the time of aMT administration to the individual circadian profile should explore the effects of low doses of this hormone to shorten SOL in this population of patients.
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