Ten-year trends in pediatric hypnotic prescribing before and during the COVID-19 pandemic in Japan

Sleep problems, particularly insomnia, are common among children and adolescents, and may have been exacerbated during the COVID-19 pandemic. However, long-term trends in pediatric hypnotic prescribing and changes associated with the pandemic remain poorly characterized. Using the JMDC Claims Database, we conducted an observational study of children and adolescents aged 2-18 years in Japan between January 2014 and December 2023 to examine hypnotic prescribing by age, sex, and pharmacological class and changes following the April 2020 COVID-19-related state of emergency. The proportion of children and adolescents prescribed hypnotics increased from 0.4% (2800 of 673,141) in 2014 to 1.0% (23,977 of 2,401,028) in 2023, with larger increases among adolescents and females. Prescribing of benzodiazepines and benzodiazepine receptor agonists decreased, whereas prescribing of melatonin receptor agonists and orexin receptor antagonists increased. Interrupted time-series analysis showed a significant increase in the slope after April 2020, whereas the immediate level change was not statistically significant. The post-state-of-emergency slope change was 3.64 (95% CI, 2.69 to 4.58; P < 0.001) prescriptions per 100,000 population per month. In sensitivity analyses excluding melatonin, post-state-of-emergency increases were attenuated overall and persisted mainly among adolescents. Pediatric hypnotic prescribing in Japan increased over the past decade, with distinct age-, sex-, and pharmacological class-specific patterns. Although prescription rates accelerated after April 2020, increases were already evident before the COVID-19 pandemic. Continued increases suggest that pre-existing trends and newly available pharmacological options, in addition to pandemic-related changes, may have contributed to the upward trend, particularly among adolescents and females.