Cognitive Behavioral Therapy for Insomnia in School-Aged Children and Adolescents

Melatonin use in the pediatric population: an evolving global concern

BACKGROUND

The impact of melatonin on pediatric populations has not yet been widely researched. This narrative review is intended to summarize the current literature regarding the efficacy and safety of melatonin for children and potential pitfalls in its clinical use, in order to assist pediatric practitioners in making evidence-based recommendations that serve the best interests of their patients and families.

DATA SOURCES

A literature review of melatonin in the pediatric population was conducted using PubMed search terms: melatonin, pediatrics, child/adolescent.

RESULTS

Melatonin use in the pediatric population world-wide has increased significantly over the past several decades. While a number of studies, largely in children with neurodevelopmental disorders with insomnia, have suggested that melatonin is generally safe and well-tolerated, a similar body of evidence is overall lacking for typically developing children and prospective studies regarding long-term adverse events are lacking. In addition, recent studies have raised concerns regarding the variable content of melatonin in over-the-counter products, as well as safety issues relating to accidental ingestions.

CONCLUSIONS

Due to a number of concerns regarding inappropriate use, lack of efficacy and safety data across pediatric populations and variability in actual content, melatonin should be used with caution in children and only under medical supervision.

[Insomnia in children]

Healthy sleep is essential for a child's full growth and development. To assess the quality of sleep, it is necessary to be clearly guided by the dynamics of its standards depending on age. Insomnia in children has a number of features compared to adults. Clinical variants of acute and chronic insomnia are associated with stress, childhood somatic pathology, and hyperactivation of the central nervous system. Children with concomitant neuropsychiatric pathology are prone to severe insomnia. The presence of negative associations of falling asleep in the first year of life contributes to the formation of insomnia in young children. In adolescents, insomnia is associated with sleep hygiene disorders and has a psychophysiological character. Treatment of insomnia in children includes normalization of sleep hygiene, the use of behavioral therapy methods, and prescribing pharmaceutical drugs with age restrictions. The safety profile plays a fundamental role in the drug therapy of childhood insomnia.

Morbidity among Adolescent Hypnotic Drug Users in Norway: An Observational Population-Based Study

We have previously shown that the use of hypnotic drugs increased among young Scandinavians during 2012-2018. This study aimed to explore psychiatric and somatic morbidity among adolescent hypnotic drug users in a cohort study of 13-17-year-old individuals during 2008-2018 in Norway. Data sources were (i) prescription data from the Norwegian Prescription Database linked to specialist health care diagnoses from the Norwegian Patient Registry and (ii) sleep disorder diagnoses from the Primary Health Care Database. Hypnotic drugs were defined as the sedative antihistamine alimemazine and the ATC group "Hypnotics and Sedatives" (N05C), excluding midazolam. In 2017, 2519 girls (16.5/1000) and 1718 boys (10.7/1000) were incident (new) users of hypnotic drugs. Most of these new users (82% of girls, 77% of boys) were referred to secondary health care, where the most frequent diagnoses were mental and behavioral disorders (51.8% of girls, 46.2% of boys), while only 3.2% received a specific sleep disorder diagnosis. The most common mental and behavioral disorders were "Neurotic stress-related disorders" among girls (27.4%) and "Behavioral and emotional disorders" among boys (23.6%). In conclusion, the trend of increasing hypnotic drug use among adolescents reflects the initiation of hypnotic drugs in a subgroup of the population with a higher disease burden, mainly due to psychiatric disorders, than the general population.

Effect of Cognitive Behavioural Therapy in Improving Sleep and Health Status in Patients with Cardiometabolic Syndrome: a Meta-Analysis

The aim of this study was to assess the effect of cognitive behavioural therapy intervention on sleep and health improvement in patients with cardiometabolic syndrome and sleep problems. This study also aimed to assess the effect of different study designs to explain the overall intervention effect through subgroup analysis. Relevant randomized controlled trial studies were searched through six online databases. The PEDro scale was used to assess the quality of the included studies. The random effects model was used to assess the mean difference, effect size, and standard deviation of the outcome variables. The heterogeneity of the included studies was assessed using I2 and Q tests. Publication bias was assessed by the Egger test. Cognitive behavioural therapy intervention provided a significant effect in improving the Pittsburgh Sleep Quality Index, Insomnia Severity Index, total sleep time, sleep efficiency, depression, fatigue, and HbA1c. The effect of cognitive behavioural therapy is more significant when relaxation training and education components are included. Cognitive behavioural therapy is suitable for the treatment of sleep problems in patients with cardiometabolic syndrome. Cognitive behavioural therapy is also effective on depression and fatigue but has a limited effect on blood pressure and biomedical indicators related to cardiometabolic syndrome.