A recently published systematic review investigated the benefits and risks of melatonin supplementation for pediatric patients with sleep disturbances.
In order to determine which pediatric patients would benefit from exogenous melatonin supplementation, the study authors utilized PubMed to obtain pertinent randomized controlled trials, crossover studies, and meta-analyses; for each study, they assessed the objectives, outcome measurements, melatonin dosing, results, and author conclusions.
A total of 10 studies were included in the review. “Overall, studies that have evaluated the use of melatonin in pediatrics have shown that exogenous melatonin supplementation is safe and likely effective in select patient populations,” the study authors reported. Evidence revealed that the specific populations of children that benefited from exogenous melatonin in particular included patients with atopic dermatitis, cystic fibrosis, behavioral disorders (ADHD, autism spectrum disorder), epilepsy, and idiopathic insomnia.
The review included 2 trials in patients with ADHD (n=278) and 2 trials in patients with autism (n=124). According to the analysis, overall sleep quality was improved with minimal risk of adverse events in these populations. The study authors recommended that melatonin only be used following optimization of stimulant dosing in patients with ADHD.
“The potential benefits of melatonin supplementation in other pediatric populations are less defined due to a paucity of existing data,” the study authors reported. Although evidence obtained in their review supported melatonin use in pediatric patients with cystic fibrosis, atopic dermatitis, and epilepsy, they recommended exercising caution since limited data was obtained and the “potential impact on the various disease states are still unknown.”
The study authors also reported that various dosing strategies were utilized among the studies analyzed. Despite this, “each study and review showed an improvement in sleep-onset latency, with varying improvement in wakefulness, nighttime awakenings, and REM sleep.” According to the evidence, 3mg was the most common dose administered, however, doses from 0.75mg to 9mg were found to be effective. The study authors recommended utilizing the lowest effective dose in order to improve sleep and decrease the risk of toxicity.
“With further regulation of melatonin supplements, it may be plausible to hold larger, multicenter trials and come to a firm recommendation in the future,” the study authors stated. They added that “At this time, we believe that the benefit of exogenous melatonin supplementation outweighs the risks of adverse events and therefore would recommend its use in aiding patients in improving their sleep.”
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