Nature and Science of Sleep (Oct 2022)
Melatonin Treatment for Pediatric Patients with Insomnia: Is There a Place for It?
Abstract
Julie Rolling1– 4*, Juliette Rabot1– 3,5,6*, Carmen M Schroder1– 6 1Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France; 2CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France; 3Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France; 4Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France; 5Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France; 6Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France*These authors contributed equally to this workCorrespondence: Carmen M Schroder, Email [email protected]: Sleep is a vital physiological function that is impaired in ranges from 10% in the typically developing pediatric population to over 80% in populations of children with neurodevelopmental disorders and/or psychiatric comorbidities. Pediatric insomnia disorder is an increasing public health concern given its negative impact on synaptic plasticity involved in learning and memory consolidation but also on mood regulation, hormonal development and growth, and its significant impact on quality of life of the child, the adolescent and the family. While first-line treatment of pediatric insomnia should include parental education on sleep as well as sleep hygiene measures and behavioural treatment approaches, pharmacological interventions may be necessary if these strategies fail. Melatonin treatment has been increasingly used off-label in pediatric insomnia, given its benign safety profile. This article aims to identify the possible role of melatonin treatment for pediatric insomnia, considering its physiological role in sleep regulation and the differential effects of immediate release (IR) versus prolonged release (PR) melatonin. For the physician dealing with pediatric insomnia, it is particularly important to be able to distinguish treatment rationales implying different dosages and times of treatment intake. Finally, we discuss the benefit–risk ratio for melatonin treatment in different pediatric populations, ranging from the general pediatric population to children with different types of neurodevelopmental disorders, such as autism spectrum disorder or ADHD.Keywords: melatonin, prolonged release, immediate release, pediatric insomnia, sleep, circadian, autism spectrum disorder, ADHD, delayed sleep phase syndrome
