Melatonin Treatment for Insomnia in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder
Melatonin Treatment for Insomnia in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder
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DOI：
10.1345/aph.1m365
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发表时间：
2010-01-01
影响因子：
2.9
通讯作者：
Scates, Ann C.
中科院分区：
文献类型：
--
作者：
Bendz, Lisa M.;Scates, Ann C.
目的：评价褪黑激素治疗注意缺陷多动障碍（ADHD）患儿失眠的有效性和安全性。通过MEDLINE检索文献（1948年-2009年8月），EMBASE（1950年-2009年8月）和Scopus（1960- 2009年8月）使用术语褪黑激素、注意力缺陷/多动障碍（ADHD）、儿科、失眠、睡眠障碍和睡眠。研究选择和数据提取：所有英语文章和人类研究进行了识别和评价。对所有确定的随机试验（n = 5）、安全性研究（n = 1）、长期随访研究（n = 1）、事后回顾性分析（n = 1）、荟萃分析（n = 2）、综述文章（n = 9）和信件（n = 1）的结果进行了总结。儿童失眠症在ADHD儿童中很普遍，影响学习成绩，社会功能，整体健康和家庭生活。一线治疗包括排除鉴别诊断，优化ADHD兴奋剂治疗，并开始良好的睡眠卫生和行为治疗。辅助药物治疗是一种选择，褪黑激素通常是处方。褪黑激素调节昼夜节律睡眠障碍，如ADHD儿童的睡眠发作性失眠（SOI）。四项针对ADHD和失眠儿童的研究显示，睡眠开始和睡眠潜伏期有所改善。研究包括6-14岁的儿童，褪黑激素剂量范围为3至6 mg，在预定就寝时间的几小时内给药。在所有研究中，不良事件均为一过性和轻度。现有的褪黑激素的研究是有限的小尺寸和短的持续时间;变量SOI标准，ADHD标准，和治疗评估;和缺乏generalizability.CONCLUSIONS：现有的数据表明，褪黑激素是一种耐受性良好，有效的治疗方案，为儿科患者慢性SOI和ADHD。需要规范的褪黑激素产品和更大规模的精心设计的试验，以建立最佳的剂量方案和长期安全性。
OBJECTIVE: To evaluate the efficacy and safety of melatonin for the treatment of insomnia in pediatric patients with attention-deficit/hyperactivity disorder (ADHD).DATA SOURCES: Literature was accessed through MEDLINE (1948-August 2009), EMBASE (1950-August 2009), and Scopus (1960-August 2009) using the terms melatonin, attention-deficit/hyperactivity disorder (ADHD), pediatric, insomnia, sleep disorder, and sleep. In addition, reference citations from publications identified were reviewed for relevant information.STUDY SELECTION AND DATA EXTRACTION: All English-language articles and human studies were identified and evaluated. Results from all identified randomized trials (n = 5), safety studies (n = 1), long-term follow-up studies (n = 1), post hoc retrospective analyses (n = 1), meta-analyses (n = 2), review articles (n = 9), and letters (n = 1) were summarized.DATA SYNTHESIS: Pediatric insomnia is prevalent in children with ADHD and impacts academic performance, social functioning, overall health, and family life. First-line therapy includes ruling out differential diagnoses, optimizing ADHD stimulant treatment, and initiating good sleep hygiene and behavioral therapy. Adjuvant pharmacotherapy is then an option and melatonin is often prescribed. Melatonin regulates circadian rhythm sleep disorders such as sleep-onset insomnia (SOI) in children with ADHD. Four studies in children with ADHD and insomnia showed improvement in sleep onset and sleep latency. Studies included children 6-14 years old and melatonin doses ranged from 3 to 6 mg administered within a few hours of a scheduled bedtime. In all studies, adverse events were transient and mild. The available melatonin studies are limited by small size and short duration; variable SOI criteria, ADHD criteria, and treatment assessments; and lack of generalizability.CONCLUSIONS: Available data suggest that melatonin is a well-tolerated and efficacious treatment option for pediatric patients with chronic SOI and ADHD. Regulated melatonin products and larger, well-designed trials to establish optimal dosing regimens and long-term safety are needed.