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Andersen NM, Árnadóttir Á, Willadsen TG, Overbeck G. Medical practitioners' experiences and considerations when managing sleep medication for adolescents and young adults. Scand J Prim Health Care 2024:1-11. [PMID: 39345129 DOI: 10.1080/02813432.2024.2407877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2024] [Accepted: 09/18/2024] [Indexed: 10/01/2024] Open
Abstract
INTRODUCTION The prevalence of sleep disorders and use of sleep medication, particularly melatonin, are rising among adolescents and young adults (13-24 years). In Denmark, melatonin is approved for use in children with autism and ADHD up to 18 years of age, with other prescriptions being off-label in these age groups. The perspectives of medical practitioners on prescribing sleep medications to this age group remain largely unexplored. AIM This study aims to investigate the considerations of general practitioners (GPs) and child and adolescent psychiatrists (psychiatrists) when prescribing and deprescribing sleep medications for 13-24-year-olds. METHODS We conducted qualitative semi-structured interviews with 10 GPs and six psychiatrists. Data were analyzed using an inductive approach. RESULTS Psychiatrists typically prescribed melatonin with the expectation that deprescription would occur in general practice. Despite the universal goal of deprescription, it was hindered by various challenges. GPs identified patient motivation and a clear focus on deprescription as facilitative factors and expressed a need for enhanced emphasis on these aspects in general practice. DISCUSSION AND IMPLICATIONS The findings align with existing prescription trends and literature on factors that promote and inhibit deprescription. The study underscores the complexities of deprescribing sleep medications for adolescents and young adults, suggesting the need for expanded guidelines and enhanced continuing education for GPs. CONCLUSIONS The research highlights significant discrepancies among medical practitioners regarding the deprescription process of sleep medications for young individuals, complicated by multiple factors. This underscores the need for better guidelines and further studies.
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Affiliation(s)
- Nanna Maria Andersen
- Department of Public Health, Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Ásthildur Árnadóttir
- Department of Public Health, Center for General Practice, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Region Zealand, Denmark
| | - Tora Grauers Willadsen
- Department of Public Health, Center for General Practice, University of Copenhagen, Copenhagen, Denmark
| | - Gritt Overbeck
- Department of Public Health, Center for General Practice, University of Copenhagen, Copenhagen, Denmark
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Berardelli I, Amerio A, Bartoli F, Cuomo A, Deste G, Orsolini L, Sampogna G, Pompili M. Rethinking the role of trazodone in the different depressive dimensions. Expert Rev Neurother 2024; 24:619-632. [PMID: 38881379 DOI: 10.1080/14737175.2024.2363843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Accepted: 05/31/2024] [Indexed: 06/18/2024]
Abstract
INTRODUCTION The efficacy of trazodone for several psychopathologic dimensions of depression has been shown in the literature. Trazodone has been widely used in some clinical contexts (e.g. for insomnia and depression in the elderly). However, the role of trazodone in several aspects of depression is not well known. AREA COVERED Eight experts from academic and medical centers across Italy met to identify the difficulties and barriers faced in daily clinical practice in the assessment and management of major depressive disorder and how the use of trazodone could address some unmet needs. The objective of the expert meetings and the present document was to increase knowledge of particular areas of treatment with trazodone. EXPERT OPINION Evidence of the role of trazodone in patients affected by major depressive disorder with anxiety symptoms, insomnia, agitation, cognitive deficits, alcohol use disorders, physical comorbidities, and suicide risk has been identified, showing the effectiveness of trazodone in different presentations of major depressive disorder. The main characteristics of patients with depression for whom trazodone seems to be most effective have been identified, providing clinicians with information on possible uses of this drug in such population of patients.
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Affiliation(s)
- Isabella Berardelli
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
| | - Andrea Amerio
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Francesco Bartoli
- School of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - Alessandro Cuomo
- Department of Molecular and Developmental Medicine, University of Siena, Siena, Italy
| | - Giacomo Deste
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
- Department of Mental Health and Addiction Services, ASST Valcamonica, Esine, Italy
| | - Laura Orsolini
- Unit of Clinical Psychiatry, Department of Neurosciences/DIMSC, Polytechnic University of Marche, Ancona, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania 'L. Vanvitelli', Naples, Italy
| | - Maurizio Pompili
- Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Centre, Sant'Andrea Hospital, Sapienza University of Rome, Rome, Italy
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Sesso G, Guccione F, Pisano S, Valente E, Narzisi A, Berloffa S, Fantozzi P, Viglione V, Milone A, Masi G. Emotional Dysregulation and Sleep Problems: A Transdiagnostic Approach in Youth. Clin Pract 2024; 14:934-945. [PMID: 38804406 PMCID: PMC11130951 DOI: 10.3390/clinpract14030074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 04/26/2024] [Accepted: 05/15/2024] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND Sleep is a complex phenomenon that affects several aspects of life, including cognitive functioning, emotional regulation, and overall well-being. Sleep disturbances, especially during adolescence, can negatively impact emotional regulation, making it a critical factor in targeting psychopathology. METHODS This study explores the interplay between emotional dysregulation (ED) and sleep patterns in a sample of 90 adolescent patients by means of self- and parent-rated clinical measures. RESULTS Our findings reveal a bidirectional relationship between ED and sleep problems. Adolescents with higher affective instability experience poorer sleep quality, while those with worse sleep quality exhibit higher internalizing problems. Additionally, emotional reactivity is associated with disrupted circadian rhythms. CONCLUSIONS These results emphasize the significance of addressing sleep problems in the context of psychopathology treatment, potentially leading to improved outcomes. Further research is needed to determine the most effective treatment strategies, including nonpharmacological and pharmacological interventions. Understanding the intricate relationship between sleep problems and emotion regulation offers insights for more targeted and effective treatment approaches for youths struggling with ED.
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Affiliation(s)
- Gianluca Sesso
- Social and Affective Neuroscience Group, Molecular Mind Laboratory, IMT School for Advanced Studies, 55100 Lucca, Italy
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Fulvio Guccione
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Simone Pisano
- Department of Translational Medical Sciences, Child and Adolescent Neuropsychiatry, University of Naples Federico II, 80138 Naples, Italy
| | - Elena Valente
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Antonio Narzisi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Stefano Berloffa
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Pamela Fantozzi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Valentina Viglione
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Annarita Milone
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
| | - Gabriele Masi
- Department of Child and Adolescent Psychiatry and Psychopharmacology, IRCCS Stella Maris Foundation, 56128 Pisa, Italy
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4
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Bushnell G, Ivanenko A, Horton DB, Lunsford-Avery JR, Posner J, Gerhard T, Suarez E, Olfson M. Psychiatric comorbidities and prescribing tendencies of sleep medications and related medications in young people with insomnia: a United States commercial claims-based analysis. Sleep 2024; 47:zsae057. [PMID: 38430553 PMCID: PMC11082474 DOI: 10.1093/sleep/zsae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/05/2024] [Indexed: 03/04/2024] Open
Abstract
STUDY OBJECTIVES To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications. METHODS Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants, hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics "z-drugs," antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities. RESULTS Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists, hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions. CONCLUSIONS Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research.
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Affiliation(s)
- Greta Bushnell
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Anna Ivanenko
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Chicago, IL, USA
| | - Daniel B Horton
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; New Brunswick, NJ, USA
| | - Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University; New Brunswick, NJ, USA
| | - Elizabeth Suarez
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center; New York, NY, USA
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Ekambaram V, Owens J. Medications Used for Pediatric Insomnia. Psychiatr Clin North Am 2024; 47:87-101. [PMID: 38302215 DOI: 10.1016/j.psc.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Pediatric insomnia can affect physical and mental health and cause cognitive deficits, social deficits and decrease quality of life. There are no Food and Drug Administration approved medications approved for pediatric insomnia. Pharmacologic interventions derive mostly from adult data or pediatric case reports. This review focuses on Food and Drug Administration approved prescription drugs (in adults), over-the-counter drugs, and off-label pediatric insomnia drugs. This review helps the clinician learn general principles, practice guidelines, and pharmacologic considerations for medication selection in the pediatric population. Pharmacologic management should be considered in combination with behavior therapy, which is proven to have long-lasting outcomes.
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Affiliation(s)
- Vijayabharathi Ekambaram
- Department of Psychiatry, University of Central Florida, HCA Florida Healthcare Program, 8383 N. Davis Hwy, Pensacola, FL 32514, USA.
| | - Judith Owens
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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6
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Himelfarb M, Shatkin JP. Pediatric Insomnia. Psychiatr Clin North Am 2024; 47:121-134. [PMID: 38302201 DOI: 10.1016/j.psc.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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Affiliation(s)
- Madeline Himelfarb
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA
| | - Jess P Shatkin
- Department of Child & Adolescent Psychiatry, New York University, One Park Avenue, 7th Floor, New York, NY 10016, USA.
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7
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Lyons L. Hypnosis with depressed children and teens: Building skills, creating connection. AMERICAN JOURNAL OF CLINICAL HYPNOSIS 2024; 66:70-82. [PMID: 37205748 DOI: 10.1080/00029157.2023.2208624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/21/2023]
Abstract
Depression in children and teens has been on the rise for several years. Recent increases in anxiety and loneliness, both contributors to the development of depression, are putting more young people at risk for chronic and comorbid mental health struggles. The use of hypnosis with depressed children offers the opportunity to target the identified skills depressed and anxious children need and is a modality clinicians should embrace. This article describes how to create hypnotic interventions focusing on improved emotional and cognitive management, better sleep, and the ability to make positive social connections. Such interventions serve to not only build the resources depressed children need for recovery, but also support a paradigm shift toward prevention in children and families.
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8
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Baweja R, Baweja R, Weidlich H, Nyland JE, Waschbusch DA, Waxmonsky JG. Treatment Utilization Pattern of Preschool Children With Attention-Deficit/Hyperactivity Disorder. J Atten Disord 2024; 28:708-721. [PMID: 38084067 DOI: 10.1177/10870547231215287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
OBJECTIVE The aim of this study was to identify patterns of ADHD care, including factors that guide selection and sequencing of treatments in a large nationwide sample of preschool-aged youth over the past 6 years. METHOD A retrospective cohort study utilizing a large electronic health record (TriNetX) of nearly 24,000 children ages 3 to 6 diagnosed with ADHD. RESULTS One in three preschoolers with ADHD were prescribed psychotropic medication, most commonly methylphenidate and guanfacine. One in 10 had at least one psychotherapy billing code during the entire assessment with most youth starting medication before psychotherapy. Rates of most treatments, including polypharmacy, increased with comorbid psychiatric disorders or sleep problems and over the course of the coronavirus pandemic. CONCLUSION Rates of treatment have increased over time but are still largely inconsistent with published care guidelines that advise therapy before medication. Clinicians appear to prioritize psychiatric comorbidity and sleep problems when selecting treatments.
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Affiliation(s)
- Raman Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
| | - Ritika Baweja
- Pennsylvania State College of Medicine, Hershey, PA, USA
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9
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Jia XY, Andreou P, Brown C, Constantin E, Godbout R, Hanlon-Dearman A, Ipsiroglu O, Reid G, Shea S, Smith IM, Zwicker JD, Weiss SK, Corkum P. An eHealth Program for Insomnia in Children With Neurodevelopmental Disorders (Better Nights, Better Days): Protocol for an Economic Evaluation of a Randomized Controlled Trial. JMIR Res Protoc 2023; 12:e46735. [PMID: 37698915 PMCID: PMC10523210 DOI: 10.2196/46735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 06/14/2023] [Accepted: 07/19/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Children with neurodevelopmental disorders have a high risk of sleep disturbances, with insomnia being the most common sleep disorder (ie, chronic and frequent difficulties with going and staying asleep). Insomnia adversely affects the well-being of these children and their caregivers. Pediatric sleep experts recommend behavioral interventions as the first-line treatment option for children. Better Nights, Better Days for Children with Neurodevelopmental Disorders (BNBD-NDD) is a 5-session eHealth behavioral intervention delivered to parents to improve outcomes (eg, Pediatric Quality of Life Inventory [PedsQL]) for their children (ages 4-12 years) with insomnia and who have a diagnosis of mild to moderate attention-deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, or fetal alcohol spectrum disorder. If cost-effective, BNBD-NDD can be a scalable intervention that provides value to an underserved population. OBJECTIVE This protocol outlines an economic evaluation conducted alongside the BNBD-NDD randomized controlled trial (RCT) that aims to assess its costs, efficacy, and cost-effectiveness compared to usual care. METHODS The BNBD-NDD RCT evaluates the impacts of the intervention on children's sleep and quality of life, as well as parents' daytime functioning and psychosocial health. Parent participants were randomized to the BNBD-NDD treatment or to usual care. The economic evaluation assesses outcomes at baseline and 8 months later, which include the PedsQL as the primary measure. Quality of life outcomes facilitate the comparison of competing interventions across different populations and medical conditions. Cost items include the BNBD-NDD intervention and parent-reported usage of private and publicly funded resources for their children's insomnia. The economic evaluation involves a reference case cost-effectiveness analysis to examine the incremental cost of BNBD-NDD per units gained in the PedsQL from the family payer perspective and a cost-consequence analysis from a societal perspective. These analyses will be conducted over an 8-month time horizon. RESULTS Research funding was obtained from the Kids Brain Health Network in 2015. Ethics were approved by the IWK Health Research Ethics Board and the University of Calgary Conjoint Health Research Ethics Board in January 2019 and June 2022, respectively. The BNBD-NDD RCT data collection commenced in June 2019 and ended in April 2022. The RCT data are currently being analyzed, and data relevant to the economic analysis will be analyzed concurrently. CONCLUSIONS To our knowledge, this will be the first economic evaluation of an eHealth intervention for insomnia in children with neurodevelopmental disorders. This evaluation's findings can inform users and stakeholders regarding the costs and benefits of BNBD-NDD. TRIAL REGISTRATION ClinicalTrial.gov NCT02694003; https://clinicaltrials.gov/study/NCT02694003. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/46735.
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Affiliation(s)
- Xiao Yang Jia
- The School of Public Policy, University of Calgary, Calgary, AB, Canada
| | - Pantelis Andreou
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | - Cary Brown
- Faculty of Rehabilitation Medicine - Occupational Therapy, University of Alberta, Edmonton, AB, Canada
| | | | - Roger Godbout
- Department of Psychiatry and Addiction, Université de Montréal, Montreal, QC, Canada
| | - Ana Hanlon-Dearman
- Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, MB, Canada
| | - Osman Ipsiroglu
- Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada
| | - Graham Reid
- Departments of Psychology, The University of Western Ontario, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Department of Paediatrics, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, ON, Canada
- Children's Health Research Institute, London, ON, Canada
| | - Sarah Shea
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Isabel M Smith
- Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | | | - Shelly K Weiss
- Department of Pediatrics, Hospital for Sick Children, Toronto, ON, Canada
| | - Penny Corkum
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS, Canada
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10
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Carson M, Moore M, Cicalese O, Dunnewald M, Varker A, Mindell JA, Williamson AA. Variation in Twitter posts referencing pediatric sleep aids. Sleep Health 2023; 9:451-459. [PMID: 37330322 PMCID: PMC10524848 DOI: 10.1016/j.sleh.2023.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 04/25/2023] [Accepted: 04/28/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVES Over 50% of parents who use social media seek parenting advice, however little is known about social media discussions surrounding child sleep aid use. The current study investigated Twitter posts about the use of pediatric sleep aids (melatonin, cannabidiol, weighted blankets, and essential oils), including post frequency, user characteristics, and content. In addition, variation in tweets before and after the onset of the COVID-19 pandemic was examined. METHODS Twitter was searched over a 25-month period using TweetDeck. Tweets were coded for user characteristics (eg, affiliations, gender) and content (eg, tone, states sleep or health outcomes, reference to a neurodevelopmental condition). RESULTS Of the 2754 tweets analyzed, melatonin was referenced most often (60%), followed by essential oils (23%), weighted blankets (14%), and cannabidiol (3%). Most were published by individual users (77%) and were positive (51%) in tone. About 1-third of tweets noted positive sleep or health effects of the sleep aid and only 7% referenced a neurodevelopmental condition. Tweets about pediatric sleep aids increased during the pandemic, primarily those posts about melatonin. CONCLUSIONS Melatonin is the most commonly discussed sleep aid on Twitter, followed by essential oils. Tweets are primarily positive. The number of tweets about sleep aids, specifically melatonin, has increased with time, with significantly more tweets after the start of the pandemic. Clinicians should consider using this outlet to provide empirically-based information regarding the efficacy and benefits or risks of sleep aid use in children.
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Affiliation(s)
| | - Melisa Moore
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Maja Dunnewald
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Abigail Varker
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jodi A Mindell
- Saint Joseph's University, Philadelphia, PA, USA; Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel A Williamson
- Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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11
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Reynolds AM, Spaeth AM, Hale L, Williamson AA, LeBourgeois MK, Wong SD, Hartstein LE, Levenson JC, Kwon M, Hart CN, Greer A, Richardson CE, Gradisar M, Clementi MA, Simon SL, Reuter-Yuill LM, Picchietti DL, Wild S, Tarokh L, Sexton-Radek K, Malow BA, Lenker KP, Calhoun SL, Johnson DA, Lewin D, Carskadon MA. Pediatric sleep: current knowledge, gaps, and opportunities for the future. Sleep 2023; 46:zsad060. [PMID: 36881684 PMCID: PMC10334737 DOI: 10.1093/sleep/zsad060] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 02/19/2023] [Indexed: 03/09/2023] Open
Abstract
This White Paper addresses the current gaps in knowledge, as well as opportunities for future studies in pediatric sleep. The Sleep Research Society's Pipeline Development Committee assembled a panel of experts tasked to provide information to those interested in learning more about the field of pediatric sleep, including trainees. We cover the scope of pediatric sleep, including epidemiological studies and the development of sleep and circadian rhythms in early childhood and adolescence. Additionally, we discuss current knowledge of insufficient sleep and circadian disruption, addressing the neuropsychological impact (affective functioning) and cardiometabolic consequences. A significant portion of this White Paper explores pediatric sleep disorders (including circadian rhythm disorders, insomnia, restless leg and periodic limb movement disorder, narcolepsy, and sleep apnea), as well as sleep and neurodevelopment disorders (e.g. autism and attention deficit hyperactivity disorder). Finally, we end with a discussion on sleep and public health policy. Although we have made strides in our knowledge of pediatric sleep, it is imperative that we address the gaps to the best of our knowledge and the pitfalls of our methodologies. For example, more work needs to be done to assess pediatric sleep using objective methodologies (i.e. actigraphy and polysomnography), to explore sleep disparities, to improve accessibility to evidence-based treatments, and to identify potential risks and protective markers of disorders in children. Expanding trainee exposure to pediatric sleep and elucidating future directions for study will significantly improve the future of the field.
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Affiliation(s)
| | - Andrea M Spaeth
- Department of Kinesiology and Health, Rutgers University, New Brunswick, NJ, USA
| | - Lauren Hale
- Department of Family, Population and Preventive Medicine, Stony Brook University, Stony Brook, NY, USA
| | - Ariel A Williamson
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, PA, USA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Monique K LeBourgeois
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Sachi D Wong
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Lauren E Hartstein
- Department of Integrative Physiology, University of Colorado Boulder, Boulder, CO, USA
| | - Jessica C Levenson
- Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
- Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Misol Kwon
- Division of Sleep Medicine, University of Pennsylvania Perelman School of Medicine, PA, USA
| | - Chantelle N Hart
- The Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
- The Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Ashley Greer
- The Center for Obesity Research and Education, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Cele E Richardson
- School of Psychological Science, University of Western Australia, Perth, WA, Australia
| | | | - Michelle A Clementi
- Clinical Sciences, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Stacey L Simon
- Clinical Sciences, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Lilith M Reuter-Yuill
- Comprehensive Speech and Therapy Center, Western Michigan University, Kalamazoo, MI, USA
| | - Daniel L Picchietti
- University of Illinois School of Medicine, Carle Illinois College of Medicine, Carle Foundation Hospital, and University of Illinois School of Medicine, Urbana, IL, USA
| | - Salome Wild
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | - Leila Tarokh
- Translational Research Center, University Hospital of Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- University Hospital of Child and Adolescent Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
| | | | - Beth A Malow
- Departments of Neurology and Pediatrics, Burry Chair in Cognitive Childhood Development, Vanderbilt University Medical Center, Nashville, TN, USA
- Sleep Disorders Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristina P Lenker
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Susan L Calhoun
- Department of Psychiatry and Behavioral Health, Penn State Health Milton S. Hershey Medical Center, Penn State College of Medicine, Hershey, PA, USA
| | - Dayna A Johnson
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| | - Daniel Lewin
- Department of Pulmonary and Sleep Medicine, Children's National Hospital, Washington, DC, USA
| | - Mary A Carskadon
- Bradley Hospital Sleep Lab, Warren Alpert Medical School, Brown University, Providence, RI, USA
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Mammarella V, Orecchio S, Cameli N, Occhipinti S, Marcucci L, De Meo G, Innocenti A, Ferri R, Bruni O. Using pharmacotherapy to address sleep disturbances in autism spectrum disorders. Expert Rev Neurother 2023; 23:1261-1276. [PMID: 37811652 DOI: 10.1080/14737175.2023.2267761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD), with effects on daytime behavior and functioning, mood and anxiety, and autism core features. In children with ASD, insomnia also has a negative impact on the whole family's quality of life. Therefore, treatment of sleep disturbances should be considered as a primary goal in the management of ASD patients, and it is important to clarify the scientific evidence to inappropriate treatments. AREAS COVERED The authors review the current literature concerning the pharmacological treatment options for the management of sleep-related disorders in patients with ASD (aged 0-18 years) using the PubMed and Cochrane Library databases with the search terms: autism, autistic, autism spectrum disorder, ASD, drug, drug therapy, drug intervention, drug treatment, pharmacotherapy, pharmacological treatment, pharmacological therapy, pharmacological intervention, sleep, sleep disturbance, and sleep disorder. EXPERT OPINION Currently, clinicians tend to select medications for the treatment of sleep disorders in ASD based on the first-hand experience of psychiatrists and pediatricians as well as expert opinion. Nevertheless, at the present time, the only compound for which there is sufficient evidence is melatonin, although antihistamines, trazodone, clonidine, ramelteon, gabapentin, or suvorexant can also be considered for selection.
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Affiliation(s)
- Valeria Mammarella
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Silvia Orecchio
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Noemi Cameli
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Sara Occhipinti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Lavinia Marcucci
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giuliano De Meo
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Alice Innocenti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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Edemann-Callesen H, Andersen HK, Ussing A, Virring A, Jennum P, Debes NM, Laursen T, Baandrup L, Gade C, Dettmann J, Holm J, Krogh C, Birkefoss K, Tarp S, Händel MN. Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation. EClinicalMedicine 2023; 61:102048. [PMID: 37457117 PMCID: PMC10339205 DOI: 10.1016/j.eclinm.2023.102048] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background Melatonin prescriptions for children and adolescents have increased substantially during the last decade. Existing clinical recommendations focus on melatonin as a treatment for insomnia related to neurodevelopmental disorders. To help guide clinical decision-making, we aimed to construct a recommendation on the use of melatonin in children and adolescents aged 5-20 years with idiopathic chronic insomnia. Methods A systematic search for guidelines, systematic reviews and randomised controlled trials (RCT) were performed in Medline, Embase, Cochrane Library, PsycInfo, Cinahl, Guidelines International Network, Trip Database, Canadian Agency for Drugs and Technologies in Health, American Academy of Sleep Medicine, European Sleep Research Society and Scandinavian Health Authorities databases. A search for adverse events in otherwise healthy children and adolescents was also performed. The latest search for guidelines, systematic reviews, and adverse events was performed on March 18, 2023. The latest search for RCTs was performed on to February 6, 2023. The language was restricted to English, Danish, Norwegian, and Swedish. Eligible participants were children and adolescents (5-20 years of age) with idiopathic chronic insomnia, in whom sleep hygiene practices have been inadequate and melatonin was tested. There were no restrictions on dosage, duration of treatment, time of consumption, or release formula. Primary outcomes were quality of sleep, daytime functioning and serious adverse events. Secondary outcomes included total sleep time, sleep latency, awakenings, drowsiness, quality of life, all-cause dropouts, and non-serious adverse events. Outcomes were assessed at different time points to assess short-term and long-term effects. Meta-analysis was performed using inverse variance random-effects model and risk of bias was assessed using Cochrane risk of bias tool. If possible, funnel plots would be constructed to investigate publication bias. Heterogeneity was calculated via I2 statistics. A multidisciplinary guideline panel formulated the recommendation according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The certainty of evidence was considered either high, moderate, low or very low depending on the extent of risk of bias, inconsistency, imprecision, indirectness, or publication bias. The evidence-to-decision framework was subsequently used to discuss the feasibility and acceptance of the constructed recommendation alongside the impact on resources and equity. The protocol is registered with the Danish Health Authority. Findings We included eight RCTs with 419 children and adolescents with idiopathic chronic insomnia. Melatonin led to a moderate increase in total sleep time by 30.33 min (95% confidence interval (CI) 18.96-41.70, 4 studies, I2 = 0%) and a moderate reduction in sleep latency by 18.03 min (95% CI -26.61 to -9.44, 3 studies, I2 = 0%), both as assessed by sleep diary. No other beneficial effects were found. None of the studies provided information on serious adverse events, yet the number of participants experiencing non-serious adverse events was increased (Relative risk 3.44, 95% CI 1.25-9.42, 4 studies, I2 = 0%). Funnel plots were not constructed due to the low number of studies. The certainty of evidence was very low on the quality of sleep and low for daytime functioning. Interpretation Evidence of very low certainty shows that benefits are limited and unwanted events are likely when melatonin is used to treat otherwise healthy children and adolescents with chronic insomnia. Melatonin should never be the first choice of treatment for this particular population, yet carefully monitored short-term use may be considered if sleep hygiene practices and non-pharmacological interventions have proven inadequate, and only if daytime function is compromised. Funding The Danish Health Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital supported by the Oak Foundation.
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Affiliation(s)
- Henriette Edemann-Callesen
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Centre for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200, Slagelse, Denmark
| | | | - Anja Ussing
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Anne Virring
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Torben Laursen
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Bispebjerg and Gentofte Departments, Mental Health Centre Copenhagen, Copenhagen University Hospital – the Mental Health Services of the Capital Region in Denmark, Denmark
| | - Christina Gade
- Departments of Clinical Pharmacology and Clinical Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Denmark
| | - Jette Dettmann
- Department of Pediatrics, Copenhagen University Hospital – NOH, Hillerød, Denmark
| | - Jonas Holm
- The Occupational Therapist Association, Denmark
| | - Camilla Krogh
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | | | - Simon Tarp
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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Glass A, Attrill C, Magee C, Blunden S. Factors associated with melatonin use in child sleep disturbance: A survey of Australian parents. Sleep Med 2023; 107:330-337. [PMID: 37295036 DOI: 10.1016/j.sleep.2023.04.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 04/22/2023] [Accepted: 04/26/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Sleep disturbances are prevalent in Australian children and cause a significant amount of stress to both children and their parents. If sleep disturbances are left untreated, they can result in detrimental consequences to both child and parental wellbeing. While behavioural interventions are recognised as the gold standard treatment for paediatric insomnia, there is a growing use of melatonin from both prescription and non-prescription sources in paediatrics. However, empirical research on the efficacy and safety of melatonin for children is sparse, conflicting, and inconsistent. This first Australian study aimed to investigate correlates of melatonin use in a sample of children with sleep disturbance in Australia and assess whether melatonin is being administered to children contrary to Therapeutic Goods Administration Guidelines. METHODS An exploratory online study was undertaken with 318 parents of Australian children with sleep disturbance (95.30% females). Logistic regression, mediation and descriptive analysis were conducted. RESULTS As hypothesised, higher parental stress, older child age, and a diagnosis of ADHD were significantly associated with melatonin use in this sleep disturbed sample. Other potential correlates such as financial stress, number of household dependents, child sleep disturbance, and autism were not significantly associated with melatonin use in adjusted analyses. CONCLUSION Findings show off-label melatonin use in children with sleep disturbance is prevalent. For the first time, this study showed an indirect path linking child sleep disturbances with melatonin use via parental stress. Overall, while the safety of melatonin use remains unknown, there is a clear need to mitigate parental stress to minimise potentially unmonitored and improper use of melatonin in children.
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Affiliation(s)
- Alison Glass
- School of Health, Medical, and Applied Sciences, Central Queensland University, Queensland, Australia
| | - Ceinwyn Attrill
- Centre for Emotional Health, School of Psychological Sciences, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Chris Magee
- NSW government, Cambelltown local government council, Australia
| | - Sarah Blunden
- School of Health, Medical, and Applied Sciences, Central Queensland University, Queensland, Australia.
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Callans K, Carroll DL, McDonough A. Parental experience of hypoglossal nerve stimulator implantation in adolescents with Down Syndrome and obstructive sleep apnea. J Pediatr Nurs 2023; 68:24-29. [PMID: 36328914 DOI: 10.1016/j.pedn.2022.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 08/10/2022] [Accepted: 09/01/2022] [Indexed: 01/26/2023]
Abstract
PURPOSE The purpose of this study is to explore the experience of parents in deciding whether to participate in a clinical trial of the insertion of the Hypoglossal Nerve Stimulator (HNS) to treat their adolescent with Down Syndrome (DS) and Obstructive Sleep Apnea (OSA). DESIGN AND METHODS A qualitative descriptive design with interviews was used to gather parental experiences from those who consented to HNS for their adolescent with DS and OSA. Interviews were conducted, audiotaped, and transcribed. Basic content analysis was followed to interpret the data. Using a process of data debriefing/engagement, codes were generated, and field/reflective notes were used to assure trustworthiness of the data. RESULTS Parents, 13 mothers/2 fathers, participated. Three themes were identified: Parents experience desperation about acceptance of standard of care for their adolescent with DS and OSA. This desperation led parents to seek information/insights from social media and they came to rely on those sites to explore options, ultimately leading them to HNS clinical trial. Finally, parents had a desire to share experience with HNS implantation. CONCLUSIONS Parents described being desperate at acceptance of standards of care for OSA. They shifted reliance on experts and parents by searching social media pages to explore options for treatment of OSA. Parents wished to share experiences with the HNS implantation. PRACTICE IMPLICATIONS Nurses play a role in preparing for the HNS by instructing/educating parents. Nurses can identify supportive social media sites for parents during the HNS decision and suggest ways to measure outcomes of HNS.
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Affiliation(s)
- Kevin Callans
- Case Management, Massachusetts Eye and Ear and Massachusetts General Hospital, Boston, MA, United States of America
| | - Diane L Carroll
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, MA, United States of America.
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16
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Jørgensen CK, Hermann R, Juul S, Faltermeier P, Horowitz M, Moncrieff J, Gluud C, Jakobsen JC. Melatonin for sleep disorders in children with neurodevelopmental disorders: protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. BMJ Open 2022; 12:e065520. [PMID: 36446459 PMCID: PMC9710329 DOI: 10.1136/bmjopen-2022-065520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Accepted: 11/15/2022] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION Neurodevelopmental disorders are a group of disorders thought to be associated with the functioning of the brain and the nervous system. Children with neurodevelopmental disorders often have sleep-related comorbidities that may negatively affect quality of life for both the children and their families. Melatonin is one of the most used interventions in children with neurodevelopmental disorders and sleep disorders. Previous reviews have investigated the effects of melatonin for sleep disorders in children with neurodevelopmental disorders, but these had important limitations, such as inadequate analysis of adverse effects, small sample sizes and short follow-up. METHODS AND ANALYSIS This is a protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials. The protocol is reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. We will search for published and unpublished trials in the Cochrane Central Register of Controlled Trials, MEDLINE Ovid, Embase Ovid, LILACS, Science Citation Index Expanded, Conference Proceedings Citation Index-Science, PsycINFO, ClinicalTrials.gov and the International Clinical Trials Registry Platform. We will search the databases from their inception without language restrictions. We will also request clinical study reports from regulatory authorities and pharmaceutical companies. Review authors working in pairs will screen reports, extract data and conduct risk of bias assessments using the Cochrane Risk of Bias tool. We will include randomised clinical trials comparing melatonin versus placebo or no intervention for sleep disorders in children with neurodevelopmental disorders. Primary outcomes will be total sleep time and adverse effects. Secondary outcomes will be quality of life of the child and caregivers and sleep onset latency. Data will be analysed using random-effects and fixed-effect meta-analyses. Certainty of evidence will be assessed with Grading of Recommendations, Assessment, Development and Evaluation approach. ETHICS AND DISSEMINATION Ethical approval was not required for this protocol. The systematic review will be published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42022337530.
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Affiliation(s)
- Caroline Kamp Jørgensen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Rikke Hermann
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Centre for Children, Youth, and Families, Glostrup, Denmark
| | - Sophie Juul
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Pascal Faltermeier
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- MSH Medical School Hamburg, University of Applied Sciences and Medical University, Hamburg, Germany
| | - Mark Horowitz
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, UK
| | - Joanna Moncrieff
- Research and Development Department, North East London NHS Foundation Trust (NELFT), London, UK
- Division of Psychiatry, University College London, London, UK
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
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Bushnell GA, Gerhard T, Keyes K, Hasin D, Cerdá M, Olfson M. Association of Benzodiazepine Treatment for Sleep Disorders With Drug Overdose Risk Among Young People. JAMA Netw Open 2022; 5:e2243215. [PMID: 36413369 PMCID: PMC9682430 DOI: 10.1001/jamanetworkopen.2022.43215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IMPORTANCE Benzodiazepines are prescribed for the treatment of adolescent sleep disorders; however, benzodiazepine overdoses occur, often in combination with opioids. OBJECTIVE To evaluate whether benzodiazepine treatment for sleep disorders, compared with alternative pharmacologic treatments (trazodone, hydroxyzine, zolpidem, zaleplon, and eszopiclone), is associated with increased risk of drug overdose for young people. DESIGN, SETTING, AND PARTICIPANTS This cohort study included privately insured people 10 to 29 years of age identified from a US commercial claims database (MarketScan), from January 1, 2009, to December 31, 2018. Young people with a sleep disorder diagnosis initiating benzodiazepine (n = 23 084) or comparator pharmacologic treatments (n = 66 706) were included in the study. Statistical analysis was performed from November 1, 2021, to May 16, 2022. EXPOSURES New use of benzodiazepine treatment or comparator pharmacologic treatments (defined as ≥1 year without a prescription for benzodiazepine or comparator medications). MAIN OUTCOMES AND MEASURES Incident diagnosed drug overdoses were identified from inpatient and emergency department records within 6 months of treatment initiation. The propensity score-adjusted cumulative incidence of overdose and hazard ratios (HRs) were estimated with intention-to-treat (analyzed based on initial treatment) and as-treated analyses (added censoring at treatment discontinuation). Results were stratified by prior prescription opioid fill. RESULTS The cohort included 23 084 young people initiating benzodiazepine treatment (14 444 female participants [62.6%]; mean [SD] age, 23 [4.1] years) and 66 706 initiating a comparator treatment (38 446 female participants [57.6%]; mean [SD] age, 22 [4.4] years). Six months after treatment initiation, 9.7% (95% CI, 9.3%-10.1%) of benzodiazepine users and 12.3% (95% CI, 12.1%-12.6%) of the comparator group were still receiving treatment. The crude incidence of drug overdose at 6 months was 0.9% for benzodiazepine initiators and 0.8% for comparator treatment initiators. In adjusted analyses, an increased risk of drug overdose was associated with benzodiazepines vs comparator treatments (intention-to-treat analysis: HR, 1.25 [95% CI, 1.03-1.51]; as-treated analysis: HR, 1.44 [95% CI, 1.14-1.80]). This association was stronger among young people with a recent prescription opioid fill vs those without a recent prescription opioid fill (as-treated analysis: adjusted HR, 2.01 [95% CI, 1.24-3.25] vs adjusted HR, 1.31 [95% CI, 1.00-1.70]). CONCLUSIONS AND RELEVANCE The findings of this study suggest that benzodiazepines, compared with alternative pharmacologic treatments for common sleep disorders, were associated with an increased risk of drug overdose among young people during the following 6-month period, especially among those with a recent opioid prescription. Drug overdose is an important safety consideration when treating young people with benzodiazepines.
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Affiliation(s)
- Greta A. Bushnell
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Biostatistics and Epidemiology, Rutgers University School of Public Health, Piscataway, New Jersey
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Sciences, Rutgers Institute for Health, Health Care Policy and Aging Research, New Brunswick, New Jersey
- Department of Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University, Piscataway, New Jersey
| | - Katherine Keyes
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
| | - Deborah Hasin
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
| | - Magdalena Cerdá
- Center for Opioid Epidemiology and Policy, Department of Population Health, New York University School of Medicine, New York, New York
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York
- Department of Psychiatry, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, New York
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Iwamoto BK, Decker KM, Byars KC, Van Dyk TR. Impact of Exogenous Melatonin on Sleep and Daytime Functioning in Healthy, Typically Developing Adolescents. CURRENT SLEEP MEDICINE REPORTS 2022. [DOI: 10.1007/s40675-022-00235-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Alfano CA, Valentine M, Nogales JM, Kim J, Kim JS, Rigos P, McGlinchey EL, Ripple CH, Wolfson AR. How Are the Sleep Problems of Children in the US Foster Care System Addressed? J Dev Behav Pediatr 2022; 43:e525-e532. [PMID: 35507424 DOI: 10.1097/dbp.0000000000001090] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 03/11/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE Evidence of poor sleep health among children in foster care continues to mount, but information about whether and how sleep problems are addressed is unavailable. The goal of this study was to begin to fill these significant knowledge gaps. METHODS Four hundred eighty-five foster caregivers from across the United States completed a survey focused on the sleep health of one child, 4 to 11 years ( M = 6.4; SD = 2.2) currently in their care. Caregivers provided quantitative and qualitative responses to questions regarding training, information, and services received in relation to their child's sleep. Caregivers also reported on the factors and strategies they perceived as most important for helping children in their care sleep well. RESULTS Only 13% of caregivers reported receiving any information/education about sleep from agencies or case workers, whereas 55% had sought help from a health provider related to their child's sleep. Nearly half of all caregivers (46%) reported giving their child melatonin. Caregivers reported that a bedtime routine/consistency, reassurance of safety/love, and a calming environment were most important for helping their child sleep well. A recurrent theme in qualitative responses was a need to mitigate child fear/anxiety at night. CONCLUSION Children in foster care face a range of risk factors that increase the likelihood of poor/insufficient sleep, but these findings suggest this critical aspect of health requires greater clinical and research attention. As these data were collected during the initial months of the COVID-19 pandemic, replication studies are necessary.
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Affiliation(s)
| | | | | | - Jinu Kim
- Department of Psychology, University of Houston, Houston, TX
| | - Josephine S Kim
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ; and
| | - Priscilla Rigos
- Department of Psychology, Fairleigh Dickinson University, Teaneck, NJ; and
| | | | | | - Amy R Wolfson
- Department of Psychology, Loyola University Maryland, Baltimore, MD
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Jang YJ, Choi H, Han TS, Sung D, Woo JY, Kim TH, Park MH. Effectiveness of Clonidine in Child and Adolescent Sleep Disorders. Psychiatry Investig 2022; 19:738-747. [PMID: 36202109 PMCID: PMC9536883 DOI: 10.30773/pi.2022.0117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/20/2022] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We aimed to investigate the improvement in sleep quantity and quality when clonidine was used in children and adolescents with insomnia. We also examined how sociodemographic characteristics such as age, sex, underlying psychological problems, and levels of depression and anxiety affected the effect of clonidine. METHODS We retrospectively reviewed outpatients aged 6 to 24 who took clonidine due to insomnia from September 2019 to September 2021 at the Department of Psychiatry at Eunpyeong St. Mary's Hospital of Catholic University. We used the Pittsburgh Sleep Quality Index (PSQI), Children's Depression Inventory (CDI), and State-Trait Anxiety Inventory (STAI) for our study. RESULTS A total of 62 participants were included in our study (34 females, mean age 13.94±4.94 years). After using clonidine, there was a significant decrease in PSQI components 1, 2, and 5, especially PSQI component 2. There was a greater decrease in sleep latency when clonidine was used in females, those aged between 13 and 24, those with mood/anxiety disorder or attention-deficit/hyperactivity disorder, those whose sleep latency exceeded 60 minutes at baseline, and those who used clonidine for more than 14 days. Those with higher STAI-Trait scores and CDI scores at baseline showed less improvement in total PSQI scores. CONCLUSION Considering that there are currently no Food and Drug Administration-approved sleep drugs for children and adolescents and no apparent difference in efficacy and safety among sleep drugs, we demonstrated that treatment with clonidine might be a good approach to improve sleep quality and quantity for children and adolescents.
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Affiliation(s)
- Young-Jin Jang
- Department of Psychiatry, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Haemi Choi
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Tae Sun Han
- Department of Psychiatry, Wonju Severance Christian Hospital, Wonju, Republic of Korea
| | - Dajung Sung
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jae Yeon Woo
- Department of Psychiatry, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Tae-Hyeong Kim
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Min-Hyeon Park
- Department of Psychiatry, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Economou NT, Ferini-Strambi L, Steiropoulos P. Sleep-Related Drug Therapy in Special Conditions: Children. Sleep Med Clin 2022; 17:531-542. [PMID: 36150812 DOI: 10.1016/j.jsmc.2022.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Pharmacologic treatment of the most common pediatric sleep disorders lacks evidence, and alternative methods, which have been proved to alleviate the symptoms, are preferred in most cases. The implementation of specific guidelines is of great importance because sleep disorders in children are not rare and they can negatively affect children's development and their cognitive and social skills. This article summarizes the current therapeutic management of sleep disorders in children, bearing in mind the absence of evidence-based guidelines on this topic.
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Affiliation(s)
- Nicholas-Tiberio Economou
- Sleep Unit, Department of Psychiatry, University of Athens, 74 Vas Sofias Avenue, Athens 11528, Greece; Enypnion Sleep-Epilepsy Center, Bioclinic Hospital Athens, 15 M. Geroulanou Street, Athens 11524, Greece
| | - Luigi Ferini-Strambi
- Division of Neuroscience, University Vita-Salute San Raffaele, Via Stamira d'Ancona 20, Milan 20127, Italy
| | - Paschalis Steiropoulos
- Department of Pulmonology, Medical School, Democritus University of Thrace, University Campus, Dragana, Alexandroupolis 68100, Greece.
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22
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Real-World Characteristics and Treatment Patterns of Patients With Insomnia Prescribed Trazodone in the United States. Clin Ther 2022; 44:1093-1105. [PMID: 36041931 DOI: 10.1016/j.clinthera.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 07/13/2022] [Accepted: 07/13/2022] [Indexed: 11/20/2022]
Abstract
PURPOSE This study sought to describe patient characteristics and treatment patterns among patients with insomnia prescribed trazodone in the United States. METHODS This real-world, retrospective, descriptive cohort study used US commercial insurance claims from July 1, 2009, through June 30, 2019. The index date was the first prescription for trazodone between January 1, 2010, and December 31, 2018, with 6 months for the preindex period and ≥6 months for the postindex period. FINDINGS Among 5.8 million patients with insomnia, 17.7% were prescribed trazodone, and 357,380 adults (6.2%) and 7564 children (0.1%) met the study eligibility criteria. The mean (SD) age was 48.8 (15.8) years for adults and 14.8 (2.7) years for pediatrics. Most patients were female (229,280 adults [64.2%] and 4481 children [59.2%]). Insomnia due to mental disorder was the most common specific diagnosis. The most common (>25%) comorbid conditions were anxiety, depression, and hypertensive disease, and 1 of 10 had a history of substance abuse. Zolpidem was previously prescribed (73,342 adults [20.5%] and 233 children [3.1%]) and continued to be prescribed. Concomitant antidepressants were most common (216,893 adults [60.7%] and 5414 children [71.6%]), but benzodiazepines (132,740 adults [37.1%] and 1188 children [15.7%]), antiepileptics (115,064 adults [32.2%] and 2103 children [27.8%]), nonbenzodiazepines (90,946 adults [25.4%] and 542 children [7.2%]), and antipsychotics (40,490 adults [11.3%] and 2063 children [27.3%]) were also prescribed. IMPLICATIONS This study provides current evidence that trazodone use is widespread among patients with insomnia and is often associated with other specific comorbidities, such as psychiatric conditions. A deeper knowledge of the real-world management of patients with insomnia may facilitate steps toward improving sleep quality, daytime functioning, and clinical outcomes for patients.
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23
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Tedroff K, von Euler M, Dahlén E. Melatonin usage in children and young adults, a registry-based cohort study. Eur J Paediatr Neurol 2022; 39:30-34. [PMID: 35636101 DOI: 10.1016/j.ejpn.2022.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022]
Abstract
Sleep disorder is common in children and adolescents, particularly in those with attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). While non-pharmacological treatment is first line, occasionally an add-on of an oral drug is needed. The endogenous hormone melatonin is increasingly used for sleep disorders in children and adolescents. In this registry-based cohort study we follow dispensation of melatonin in young individuals, 0-25 years of age, in Stockholm, Sweden during 2016-2019. In all 9980 individuals, were dispensed melatonin in 2016 and followed for 3 years. Child psychiatrist was the most common prescribing specialty, 55% of all prescriptions. Only 20% had a recorded diagnosis of sleep disorder. The majority, 65% had a neuro psychiatric diagnose. Half of the individuals had at least 4 prescribed drugs dispensed during the follow-up. Almost half of our cohort were dispensed melatonin during the entire study period and doses and volumes of drug dispensed increased by 50 and 100%, respectively. Continuous medication was most common among children 6-12 years, where 7 out of 10 individuals were still adherent after three years. As long-term safety data is lacking, we find this concerning, and this illustrates the need of long-term follow-up of melatonin use in children and young individuals.
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Affiliation(s)
- K Tedroff
- Department of Women's and Children's Health, Karolinska Institutet, SE, 171 76, Stockholm, Sweden; Region Stockholm, Health and Medical Care Administration, Box 6909, SE, 102 39, Stockholm, Sweden; Centre for Psychiatry Research, Stockholm Health Care Services, Region Stockholm, 113 30, Stockholm, Sweden
| | - M von Euler
- Department of Neurology, Faculty of Medicine and Health, Örebro University, SE, 70182, Örebro, Sweden
| | - E Dahlén
- Region Stockholm, Health and Medical Care Administration, Box 6909, SE, 102 39, Stockholm, Sweden; Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, SE-118 83 Stockholm, Sweden.
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24
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Gradisar M, Kahn M, Micic G, Short M, Reynolds C, Orchard F, Bauducco S, Bartel K, Richardson C. Sleep's role in the development and resolution of adolescent depression. NATURE REVIEWS PSYCHOLOGY 2022; 1:512-523. [PMID: 35754789 PMCID: PMC9208261 DOI: 10.1038/s44159-022-00074-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 12/03/2022]
Abstract
Two adolescent mental health fields - sleep and depression - have advanced largely in parallel until about four years ago. Although sleep problems have been thought to be a symptom of adolescent depression, emerging evidence suggests that sleep difficulties arise before depression does. In this Review, we describe how the combination of adolescent sleep biology and psychology uniquely predispose adolescents to develop depression. We describe multiple pathways and contributors, including a delayed circadian rhythm, restricted sleep duration and greater opportunity for repetitive negative thinking while waiting for sleep. We match each contributor with evidence-based sleep interventions, including bright light therapy, exogenous melatonin and cognitive-behaviour therapy techniques. Such treatments improve sleep and alleviate depression symptoms, highlighting the utility of sleep treatment for comorbid disorders experienced by adolescents.
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Affiliation(s)
- Michael Gradisar
- WINK Sleep Pty Ltd, Adelaide, Australia
- Sleep Cycle AB, Gothenburg, Sweden
| | - Michal Kahn
- School of Psychology, Flinders University, Adelaide, Australia
- School of Psychological Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Gorica Micic
- School of Psychology, Flinders University, Adelaide, Australia
| | - Michelle Short
- School of Psychology, Flinders University, Adelaide, Australia
| | | | - Faith Orchard
- School of Psychology, University of East Sussex, Brighton, United Kingdom
| | - Serena Bauducco
- School of Psychology, Flinders University, Adelaide, Australia
- School of Law, Psychology and Social Work, Örebro University, Örebro, Sweden
| | - Kate Bartel
- School of Psychology, Flinders University, Adelaide, Australia
| | - Cele Richardson
- School of Psychological Science, University of Western Australia, Perth, Australia
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25
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Pavkovic IM, Kothare SV. Pharmacologic Approaches to Insomnia and Other Sleep Disorders in Children. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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26
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Law EF, Kim A, Ickmans K, Palermo TM. Sleep Health Assessment and Treatment in Children and Adolescents with Chronic Pain: State of the Art and Future Directions. J Clin Med 2022; 11:jcm11061491. [PMID: 35329817 PMCID: PMC8954024 DOI: 10.3390/jcm11061491] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/01/2022] [Accepted: 03/04/2022] [Indexed: 12/29/2022] Open
Abstract
Sleep is interrelated with the experience of chronic pain and represents a modifiable lifestyle factor that may play an important role in the treatment of children and adolescents with chronic pain. This is a topical review of assessment and treatment approaches to promote sleep health in children and adolescents with chronic pain, which summarizes: relevant and recent systematic reviews, meta-analyses, and methodologically sound prospective studies and clinical trials. Recommendations are provided for best practices in the clinical assessment and treatment of sleep health in youth with chronic pain. This overview can also provide researchers with foundational knowledge to build upon the best evidence for future prospective studies, assessment and intervention development, and novel clinical trials.
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Affiliation(s)
- Emily F. Law
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
- Correspondence:
| | - Agnes Kim
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
- Medical College of Georgia, Augusta University & University of Georgia Medical Partnership Campus, Augusta, GA 30912, USA
| | - Kelly Ickmans
- Pain in Motion Research Group (PAIN), Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium;
- Movement & Nutrition for Health & Performance Research Group (MOVE), Department of Movement and Sport Sciences, Faculty of Physical Education and Physiotherapy, Vrije Universiteit Brussel, Pleinlaan 2, 1050 Brussels, Belgium
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Tonya M. Palermo
- Department of Anesthesiology & Pain Medicine, University of Washington School of Medicine, Seattle, WA 98195, USA;
- Center for Child Health, Behavior & Development, Seattle Children’s Research Institute, Seattle, WA 98121, USA;
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27
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Chan NY, Au CT, Li SX, Wing YK. Sleep Complaints Among School Children. Sleep Med Clin 2022; 17:53-65. [PMID: 35216761 DOI: 10.1016/j.jsmc.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Sleep complaints are common among children. These include both night-time and daytime symptoms, such as trouble falling asleep, problems in maintaining sleep, snoring, and unusual events during sleep and daytime functioning impairment. However, sleep complaints in children are often overlooked and undertreated in clinical practice. Untreated sleep problems may further impact on children's development and will persist into adulthood in some cases. This review summarizes the common sleep complaints and disorders in school children, and provides an overview of the epidemiology, clinical features, consequences, and treatment of the sleep problems.
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Affiliation(s)
- Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Chun Ting Au
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China; The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China.
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China.
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28
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Klein TA, Graves JM, Panther S. Trazodone Prescribing for Children With Attention Deficit Hyperactivity Disorder on Medicaid in Oregon. J Pediatr Pharmacol Ther 2022; 27:132-140. [DOI: 10.5863/1551-6776-27.2.132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Accepted: 06/09/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE
To examine trazodone prescribing to Medicaid-insured children with a diagnosis of attention deficit hyperactivity disorder (ADHD) from 2012 to 2016 for patient-level factors, including coexisting diagnoses associated with trazodone prescriptions.
METHODS
A retrospective cohort study used de-identified claims data from the Oregon Health Authority to analyze associations, frequency, and likelihood of new trazodone fills.
RESULTS
A total of 16,547 trazodone prescriptions were identified, representing 8.4% (n = 2,705) of 32,134 children. Most were filled for children ages 10 years and older. Children with ADHD were predominantly male (70.7%); however, more female children had a filled trazodone prescription compared with males (10.1% vs 7.7%). Female and male children with a filled trazodone prescription shared common diagnoses in the top 10 rank, although episodic mood disorders, such as bipolar disorder (International Classification of Diseases, Ninth Revision, Clinical Modification, diagnosis code 296) were only noted for female children. Female children were significantly older at the time of the first filled trazodone prescription (12.5 years; 95% CI, 12.3–12.7) compared with male children (12.0 years; 95% CI, 11.8–12.1). Modified Poisson regression models found children with ADHD and a filled trazodone prescription were 3 times more likely to have a sleep-related diagnosis as their most common diagnosis (excluding ADHD), compared with those of the same age and sex without a trazodone prescription (RR, 2.94; 95% CI, 2.44–3.54).
CONCLUSIONS
Children with ADHD are prescribed trazodone off label and for conditions with no national guidelines or clinical evidence of efficacy. Female children on Medicaid may be prescribed trazodone for concurrent mental health conditions, and further research is warranted regarding potential correlates.
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Affiliation(s)
- Tracy A. Klein
- College of Nursing, Washington State University Vancouver, WA (TAK)
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29
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Michaels NL, Spiller HA, Badeti J, Sheftall AH, Funk AR, Smith GA. Benzodiazepine exposures among women of reproductive age in the US, 2004-2018. Hum Exp Toxicol 2021; 40:1807-1816. [PMID: 33906473 PMCID: PMC9757131 DOI: 10.1177/09603271211013431] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Benzodiazepines, often used to treat anxiety, insomnia, and other conditions, are prescribed more frequently to women than men, and emergency department visits and overdose deaths involving benzodiazepines have increased significantly among women in recent years. This study describes characteristics and trends associated with benzodiazepine exposures among women of reproductive age (15-49 years old) that were reported to United States poison control centers from 2004 through 2018. The National Poison Data System recorded 258,370 first-ranked benzodiazepine exposures among women 15-49 years old during the study period. More than one-half (56.9%) of exposures involved a single-substance and one-third (34.0%) occurred among women 20-29 years old. The majority were categorized as "intentional, suspected suicide" (73.2%) or "intentional" (12.9%). Exposures frequently resulted in admission to a psychiatric facility (20.6%), critical care unit (18.1%), or non-critical care unit (9.3%). Twenty percent of cases resulted in a serious medical outcome, including 205 deaths. The substantial percentage of benzodiazepine exposures among women of reproductive age that were intentional and associated with suicide attempts or suicide deaths indicate that increased prevention efforts are needed to address this issue.
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Affiliation(s)
- NL Michaels
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - HA Spiller
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Central Ohio Poison Center, Columbus, OH, USA
| | - J Badeti
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children’s Hospital, Columbus, OH, USA
| | - AH Sheftall
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
- Center for Innovation in Pediatric Practice at the Abigail Wexner Research Institute of Nationwide Children’s Hospital, Columbus, OH, USA
| | - AR Funk
- Central Ohio Poison Center, Columbus, OH, USA
| | - GA Smith
- Center for Injury Research and Policy, The Abigail Wexner Research Institute of Nationwide Children’s Hospital, Columbus, OH, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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30
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Henneberry E, Lamy M, Dominick KC, Erickson CA. Decades of Progress in the Psychopharmacology of Autism Spectrum Disorder. J Autism Dev Disord 2021; 51:4370-4394. [PMID: 34491511 DOI: 10.1007/s10803-021-05237-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/07/2021] [Indexed: 12/14/2022]
Abstract
Recent decades have been marked by a wave drug treatment research in autism spectrum disorder (ASD). This work has resulted in improved ability to treat commonly occurring behavioral challenges associated with ASD including most prominently irritability marked by aggression, self-injurious behavior, and severe tantrums. While treatment of interfering behavior has progressed in our field, there remain several areas of unmet medical need including most prominently a lack of any approved drug therapies for the core, defining symptoms of autism. We outline the progress to date in the field of autism drug treatment while taking a future look forward into how decades of work can inform better future steps in this field.
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Affiliation(s)
- Erin Henneberry
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4002, Cincinnati, OH, 45229, USA
| | - Martine Lamy
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Kelli C Dominick
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4002, Cincinnati, OH, 45229, USA.,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, USA
| | - Craig A Erickson
- Division of Child and Adolescent Psychiatry, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 4002, Cincinnati, OH, 45229, USA. .,Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati School of Medicine, Cincinnati, USA.
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31
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Simard V, Morin AS, Godin S, Boothman L, Lavoie AJ. Children’s separation anxiety and nightmare frequency, distress, and separation-related content. CURRENT PSYCHOLOGY 2021. [DOI: 10.1007/s12144-021-02272-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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32
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Kimland EE, Bardage C, Collin J, Järleborg A, Ljung R, Iliadou AN. Pediatric use of prescribed melatonin in Sweden 2006-2017: a register based study. Eur Child Adolesc Psychiatry 2021; 30:1339-1350. [PMID: 32699990 PMCID: PMC8440257 DOI: 10.1007/s00787-020-01598-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 07/06/2020] [Indexed: 11/26/2022]
Abstract
Sleep disturbances are common in the pediatric population and should primarily be treated non-pharmacologically. Most medicines for sleep disturbances are not approved for pediatric use and data on long-term safety is scarce. In Sweden, melatonin is classified as a prescription medicine. The aim of the present study was to characterize the prevalence and incidence of dispensed melatonin prescriptions, long-term treatment, concomitant dispensation of psychotropic medication, and psychiatric comorbidity, in children and adolescents aged 0-17 years living in Sweden during 2006-2017. Data was retrieved by linking the national population-based registers, the Swedish Prescribed Drug register and the National Patient register. In 2017, nearly 2% of the pediatric population 0-17 years was dispensed at least one prescription of melatonin, which was more than a 15-fold increase for girls and a 20-fold increase for boys, when compared to 2006. Among the children in the age group 5-9 who initiated a melatonin treatment in 2009, 15% of girls and 17% of boys were found to be continuously prescribed melatonin 8 years later. Nearly 80% of all children with dispensed melatonin had concomitant dispensations of psychotropic medications. The most common combination was melatonin together with centrally acting sympathomimetic medicines (23% of girls and 43% of boys). About half of the children (47% of girls and 50% of boys) had at least one registered diagnosis of mental or behavioral disorders. The most common diagnosis was attention deficit hyperactive disorder, across all age groups and genders. The continuous increase of use of melatonin in children, often concomitant with other psychotropic medications, together with a high proportion of younger children with prescriptions of melatonin on a long-term basis, suggests the need for further structured follow up studies, in particular of long-term use.
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Affiliation(s)
- Elin E Kimland
- Swedish Medical Products Agency, Dag Hammarskjölds väg 42, Box 26, 751 03, Uppsala, Sweden.
| | - Carola Bardage
- Swedish Medical Products Agency, Dag Hammarskjölds väg 42, Box 26, 751 03, Uppsala, Sweden
| | - Julius Collin
- National Board of Health and Welfare, Rålambsvägen 3, 116 30, Stockholm, Sweden
| | - Anders Järleborg
- National Board of Health and Welfare, Rålambsvägen 3, 116 30, Stockholm, Sweden
| | - Rickard Ljung
- Swedish Medical Products Agency, Dag Hammarskjölds väg 42, Box 26, 751 03, Uppsala, Sweden
| | - Anastasia N Iliadou
- National Board of Health and Welfare, Rålambsvägen 3, 116 30, Stockholm, Sweden
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33
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Arango C, Pina-Camacho L. Trends in utilisation of hypnotics among Scandinavian young people. Acta Psychiatr Scand 2021; 144:97-99. [PMID: 34287821 DOI: 10.1111/acps.13341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 06/15/2021] [Accepted: 06/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Celso Arango
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain
| | - Laura Pina-Camacho
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón, CIBERSAM, IiSGM, School of Medicine, Universidad Complutense, Madrid, Spain.,Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
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34
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McLay LK, Schluter PJ, Eggleston MJF, Woodford EC, Bowden N. Melatonin dispensing among New Zealand children aged 0-18 years with autism: a nationwide cross-sectional study. Sleep Med 2021; 80:184-192. [PMID: 33601231 DOI: 10.1016/j.sleep.2021.01.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/14/2021] [Accepted: 01/18/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE/BACKGROUND Sleep problems in children on the autism spectrum are prevalent and persistent. Such problems are the result of a combination of biopsychosocial factors, including abnormal melatonin secretion. Exogenous melatonin is an empirically supported and popular treatment for sleep problems. However, we know little about rates of melatonin dispensing and associated variables. This study investigated rates of melatonin dispensing and the sociodemographic and child characteristics associated with its use in New Zealand. METHODS This nationwide cross-sectional study used linked administrative health data obtained via the Integrated Data Infrastructure (IDI). Data were obtained for 11,202, 0-18 year old children on the autism spectrum. Descriptive data, and adjusted and unadjusted risk ratios, were calculated for sociodemographic and child characteristics. RESULTS Melatonin is accessed by almost one quarter of children on the autism spectrum in New Zealand, with higher observed rates among females and those aged between 5 and 11 years, of European ethnicity, and presenting with co-occurring mental health conditions. CONCLUSIONS Findings are largely consistent with research investigating both sleep disturbances and psychotropic drug use among children on the autism spectrum. High rates of melatonin use, age- and sex-related differences in its use, and the complexity associated with the presence of co-occurring conditions necessitates development of practice guidelines for melatonin dispensing. Further investigation into the duration of melatonin use and the interaction between child characteristics, co-occurring conditions, sociodemographic variables and melatonin dispensing is warranted.
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Affiliation(s)
- L K McLay
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand.
| | - P J Schluter
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand; School of Clinical Medicine, Primary Care Clinical Unit, The University of Queensland, Brisbane, Australia.
| | - M J F Eggleston
- Mental Health Division, Canterbury District Health Board, New Zealand.
| | - E C Woodford
- School of Health Sciences, University of Canterbury - Te Whare Wānanga o Waitaha, Christchurch, New Zealand
| | - N Bowden
- A Better Start National Science Challenge, New Zealand; Department of Women's and Children's Health, University of Otago, New Zealand.
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35
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Abstract
Insomnia is the most common sleep disorder among all ages; unfortunately, however, child and adolescent insomnia is infrequently addressed. Given the importance of adequate sleep for proper brain development, pediatric populations are particularly vulnerable to the negative effects of insomnia. Therefore, proper clinical assessment and treatment of pediatric insomnia is crucial. This article is the result of a comprehensive literature review and serves as a guide to the disorder and how it presents differently across child development.
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Abstract
Pediatric insomnia can affect physical and mental health and cause cognitive deficits, social deficits and decrease quality of life. There are no Food and Drug Administration approved medications approved for pediatric insomnia. Pharmacologic interventions derive mostly from adult data or pediatric case reports. This review focuses on Food and Drug Administration approved prescription drugs (in adults), over-the-counter drugs, and off-label pediatric insomnia drugs. This review helps the clinician learn general principles, practice guidelines, and pharmacologic considerations for medication selection in the pediatric population. Pharmacologic management should be considered in combination with behavior therapy, which is proven to have long-lasting outcomes.
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Affiliation(s)
- Vijayabharathi Ekambaram
- Department of Psychiatry, Touro University, Touro University Medical Group, 1805 North California Street, Suite 201, Stockton, CA 95204, USA.
| | - Judith Owens
- Department of Neurology, Boston Children's Hospital, Harvard Medical School, Boston, MA 02115, USA
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37
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Recent Advances in the Pharmacological Management of Behavioral Disturbances Associated with Autism Spectrum Disorder in Children and Adolescents. Paediatr Drugs 2020; 22:473-483. [PMID: 32686015 DOI: 10.1007/s40272-020-00408-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Autism spectrum disorder (ASD) is a heterogeneous neuropsychiatric condition affecting an estimated one in 36 children. Youth with ASD may have severe behavioral disturbances including irritability, aggression, and hyperactivity. Currently, there are only two medications (risperidone and aripiprazole) approved by the US Food and Drug Administration (FDA) for the treatment of irritability associated with ASD. Pharmacologic treatments are commonly used to target ASD-associated symptoms including irritability, mood lability, anxiety, and hyperactivity. However, evidence for the efficacy of many commonly used treatments is limited by the lack of large placebo-controlled trials of these medications in this population. Research into the pathophysiology of ASD has led to new targets for pharmacologic therapy including the neuroimmune system, the endocannabinoid system, and the glutamatergic neurotransmitter system. The goal of this review is to provide an overview of the current evidence base for commonly used treatments, as well as emerging treatment options for common behavioral disturbances seen in youth with ASD.
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Esposito D, Belli A, Ferri R, Bruni O. Sleeping without Prescription: Management of Sleep Disorders in Children with Autism with Non-Pharmacological Interventions and Over-the-Counter Treatments. Brain Sci 2020; 10:brainsci10070441. [PMID: 32664572 PMCID: PMC7407189 DOI: 10.3390/brainsci10070441] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/07/2020] [Accepted: 07/09/2020] [Indexed: 12/18/2022] Open
Abstract
Autism Spectrum Disorders (ASD) are lifelong neurodevelopmental conditions characterized by abnormal social interaction, communication, and behavior. Sleep disturbances represent a common comorbidity in children and adolescents with ASD, with prevalence ranging from 50 to 80%. It has been proved that sleep disruption worsens the symptoms of autism and results in challenging behaviors. Improving sleep should therefore be a primary therapeutic goal. Treatment options range from lifestyle modifications to pharmacological therapy. Several reviews have been written on pharmacological treatments, but very few on the beneficial effects of non-pharmacological interventions, over-the-counter drugs, and nutritional supplements. This study consists of a narrative review of the literature, presenting the available evidence on the following treatments: sleep education, behavioral interventions, complementary and alternative medicine (special mattresses and blankets, massage, aromatherapy, yoga, physical activity), and commonly used over-the-counter medications and supplements (antihistamines, melatonin, tryptophan, carnosine, iron, vitamins, and herbal remedies). For some treatments—such as melatonin and behavioral interventions—effectiveness in ASD is well established in the literature, while other interventions appear of benefit in clinical practice, even if specific studies in children and adolescents with ASD are lacking. Conversely, other treatments only seem to show anecdotal evidence supporting their use.
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Affiliation(s)
- Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (D.E.); (A.B.)
| | - Arianna Belli
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University of Rome, 00185 Rome, Italy; (D.E.); (A.B.)
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute–IRCCS, 94018 Troina, Italy;
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, 00185 Rome, Italy
- Correspondence:
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Oerbeck B, Overgaard KR, Hjellvik V, Bramness JG, Hansen BH, Lien L. The Use of Sleep Medication in Youth Residential Care. J Child Adolesc Psychopharmacol 2020; 30:335-341. [PMID: 31976753 PMCID: PMC7310223 DOI: 10.1089/cap.2019.0172] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0-20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ≥ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5-2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3-1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylum seekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.
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Affiliation(s)
- Beate Oerbeck
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.,Address correspondence to: Beate Oerbeck, PhD, Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424 Oslo, Norway
| | | | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen G. Bramness
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Berit Hjelde Hansen
- Department of Rare Disorders and Disabilities, Oslo University Hospital, Oslo, Norway
| | - Lars Lien
- Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.,Faculty of Health and Social Science, Inland University College of Applied Science, Elverum, Norway
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Hartman AG, Terhorst L, Little N, Bendixen RM. Uncovering sleep in young males with Duchenne muscular dystrophy. Eur J Paediatr Neurol 2020; 26:20-28. [PMID: 32165079 DOI: 10.1016/j.ejpn.2020.02.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 02/24/2020] [Accepted: 02/26/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVES Sleep health in rare disease is often overlooked due to the complex nature of the disease. For males with Duchenne muscular dystrophy, sleep assessment is typically focused on pulmonary function and identification of sleep disordered breathing. Unfortunately for young boys with Duchenne muscular dystrophy, sleep assessment is often neglected, resulting in a dearth of knowledge on sleep health in this population. This study describes sleep quantity and quality in both younger (4-9 years) and older (10-17 years) males with Duchenne muscular dystrophy (n = 19) and compares these characteristics with sleep characteristics of unaffected peers (n = 17). METHODS This study was a longitudinal, observational study. Sleep measures were collected using the parent-proxy Children's Sleep Habits Questionnaire-Abbreviated version and objective sleep measures from actigraphy (sleep efficiency, awakenings, and awakening duration) over 30 days for all participants. Means and standard deviations were examined, and effect sizes were computed to quantify the magnitude of difference between the Duchenne muscular dystrophy and unaffected groups. RESULTS Overall, boys with Duchenne muscular dystrophy were found to experience worse sleep than their unaffected peers as measured by parent report and actigraphy. Effect sizes of both measures demonstrated moderate to large magnitudes of difference in many of the sleep variables. Parents of boys with Duchenne muscular dystrophy reported higher scores (indicating worse sleep) in all subsections and total score of the Children's Sleep Habits Questionnaire - Abbreviated version. Actigraphy data indicated that the Duchenne muscular dystrophy group had lower percent sleep efficiency, more night awakenings and longer duration of night awakenings than their unaffected peers. CONCLUSION Our findings offer a novel look into sleep in young boys with Duchenne muscular dystrophy. Both parent-report and actigraphy data indicate poor sleep health in this population compared with age-matched unaffected peers. Actigraphy was found to align with parent-report of sleep in this population, supporting the use of these two different ways to measure sleep in Duchenne muscular dystrophy. Results from this study should encourage clinicians and researchers alike to further explore sleep and its impact on disease in young boys with Duchenne muscular dystrophy.
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Affiliation(s)
- Amy G Hartman
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States.
| | - Lauren Terhorst
- University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
| | - Natalie Little
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
| | - Roxanna M Bendixen
- Pediatric Research Laboratory, University of Pittsburgh, Department of Occupational Therapy, Pennsylvania, PA, United States
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Hanzlik E, Klinger SA, Carson R, Duis J. Mirtazapine for sleep disturbances in Angelman syndrome: a retrospective chart review of 8 pediatric cases. J Clin Sleep Med 2020; 16:591-595. [PMID: 32022663 DOI: 10.5664/jcsm.8284] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY OBJECTIVES Angelman syndrome (AS) is a rare neurodevelopmental disorder that is characterized by developmental delay, intellectual disability, seizures, a characteristic happy personality, gait ataxia, tremulousness of the limbs, microcephaly, and anxiety. Severe sleep disturbances with the diminished need for sleep and abnormal sleep-wake cycles are seen in up to 90% of patients with AS. AS is caused by absent maternal expression of the gene UBE3A located in the 15q11.2-q13 locus. We hypothesized that selective antagonism of 5-HT₂ and 5-HT₃ serotonin receptors with mirtazapine would benefit sleep disturbances in patients with AS. METHODS Institutional Review Board approval was obtained at Vanderbilt University Medical Center. Medical records of individuals seen in the Comprehensive Angelman Syndrome clinic were retrospectively reviewed to determine the use of mirtazapine for disordered sleep. Parents were asked to respond to a survey to assess the phenotypic features of sleep and behavioral disturbances in AS. They were asked about the use of medications for sleep, focusing on the benefits and risks of mirtazapine. RESULTS A cohort of 8 individuals with AS, ranging in age from 3 to 16 years old with histories of sleep challenges, were treated with 3.75 to 30 mg of mirtazapine at bedtime for 0 to 36 weeks. Nocturnal awakenings were the most common sleep challenge reported. Seven of eight patients reported benefits from mirtazapine, including increased total sleep time, decreased nocturnal awakenings, and decreased time to fall asleep. The most significant side effects of mirtazapine were hyperphagia and weight gain. CONCLUSIONS Individuals with AS have abnormal sleep-wake cycles and a high unmet medical need. Mirtazapine helped with sleep onset and nighttime awakenings in 7 of 8 patients, with 2 patients reporting a positive benefit with respect to behavior. These data suggest that mirtazapine may be considered for the treatment of sleep difficulties in patients with AS who remain refractory to more conventional therapies. Weight gain was a common side-effect and led to discontinuation of treatment in 1 patient.
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Affiliation(s)
- Emily Hanzlik
- Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sarah A Klinger
- Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert Carson
- Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jessica Duis
- Medical Genetics & Genomic Medicine, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Boafo A, Greenham S, Sullivan M, Bazaid K, Suntharalingam S, Silbernagel L, Magner K, Robillard R. Medications for sleep disturbance in children and adolescents with depression: a survey of Canadian child and adolescent psychiatrists. Child Adolesc Psychiatry Ment Health 2020; 14:10. [PMID: 32175006 PMCID: PMC7063733 DOI: 10.1186/s13034-020-00316-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 02/20/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Primary care physicians and child and adolescent psychiatrists often treat sleep disturbances in children and adolescents with mood disorders using medications off-label, in the absence of clear evidence for efficacy, tolerability and short or long-term safety. This study is the first to report Canadian data about prescribing preferences and perceived effectiveness reported by child and adolescent psychiatrists regarding medications used to manage sleep disturbances in children and adolescents with depression. METHODS Canadian child and adolescent psychiatrists were surveyed on their perception of effectiveness of a range of medications commonly prescribed for sleep disturbances, their ranked preferences for these medications, reasons for avoiding certain medications, and perceived side effects. RESULTS Sixty-seven active child and adolescent psychiatrists completed the survey. Respondents reported noting significant sleep issues in 40% of all their patients. Melatonin and trazodone were identified as the first treatment of choice by 83% and 10% of respondents respectively, and trazodone was identified as the second treatment of choice by 56% of respondents for treating sleep disturbances in children and adolescents with depression. Melatonin (97%), trazodone (81%), and quetiapine (73%) were rated by a majority of respondents as effective. Doxepin, zaleplon, tricyclic antidepressants, zolpidem, or lorazepam were rarely prescribed due to lack of evidence and/or concerns about adverse effects, long-term safety, suitability for youth, suicidality, and dependence/tolerance. CONCLUSIONS Melatonin and certain off-label psychotropic drugs are perceived as being more effective and appropriate to address sleep disturbances in children and adolescents with depression. More empirical evidence on the efficacy, tolerability and indications for using these medications and newer group of sleep medications in this population is needed.
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Affiliation(s)
- Addo Boafo
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada ,Sleep Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, ON Canada
| | - Stephanie Greenham
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255School of Psychology, University of Ottawa, Ottawa, ON Canada
| | - Marla Sullivan
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada
| | - Khalid Bazaid
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Sinthuja Suntharalingam
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada ,grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Lana Silbernagel
- grid.28046.380000 0001 2182 2255Department of Psychiatry, University of Ottawa, Ottawa, ON Canada
| | - Katherine Magner
- grid.414148.c0000 0000 9402 6172Mental Health Program, Children’s Hospital of Eastern Ontario, 401 Smyth Road, Ottawa, ON KH 8L1 Canada
| | - Rébecca Robillard
- Sleep Research Unit, The Royal’s Institute of Mental Health Research, Ottawa, ON Canada ,grid.28046.380000 0001 2182 2255School of Psychology, University of Ottawa, Ottawa, ON Canada
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Bushnell GA, Crystal S, Olfson M. Prescription Benzodiazepine Use in Privately Insured U.S. Children and Adolescents. Am J Prev Med 2019; 57:775-785. [PMID: 31753258 PMCID: PMC6935869 DOI: 10.1016/j.amepre.2019.07.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 07/14/2019] [Accepted: 07/15/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Benzodiazepines are commonly prescribed in the U.S. but entail safety concerns, including dependency. In pediatrics, many indications lack trial data. Authors aimed to describe youth initiating prescription benzodiazepine treatment, identify potential indications and prescribing concerns, estimate the duration of treatment by potential indication, and identify factors that predict long-term use. METHODS The study cohort included children (aged 3-12 years) and adolescents (aged 13-17 years) initiating prescription benzodiazepine treatment (≥3 days' supply) from January 2010 to September 2015 in a U.S. commercial claims database. Potential indications included selected ICD-9-CM diagnoses (≤30 days prior). Long-term (≥6 months) benzodiazepine treatment was estimated with Kaplan-Meier estimation and modified Poisson regression identified independent predictors of long-term benzodiazepine treatment (analysis completed in 2018). RESULTS Of 24,504 children and 61,046 adolescents initiating benzodiazepines, 62% of the children and 68% of the adolescents had a potential indication. Anxiety disorders were the most common indication, with mental health indications more common among adolescents (45%) than children (23%) and epilepsy and movement disorders higher in children. Recent opioid prescriptions were common before benzodiazepine initiation (children, 22%; adolescents, 21%). Six percent of the initiators became long-term benzodiazepine users. Potential indication, provider contact, psychotropic medication, and chronic conditions independently predicted long-term benzodiazepine treatment in adolescents and children. CONCLUSIONS U.S. children and adolescents are prescribed benzodiazepines for various mental health and other medical conditions, many lacking evidence of pediatric efficacy. Long-term benzodiazepine treatment, concurrent opioid prescriptions, psychotropic use, and prior substance use disorder diagnoses suggest safety risks among some youth prescribed benzodiazepines.
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Affiliation(s)
- Greta A Bushnell
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York.
| | - Stephen Crystal
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, New Jersey
| | - Mark Olfson
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, New York; Department of Psychiatry, Columbia University Irving Medical Center, New York, New York
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Bruni O, Angriman M, Melegari MG, Ferri R. Pharmacotherapeutic management of sleep disorders in children with neurodevelopmental disorders. Expert Opin Pharmacother 2019; 20:2257-2271. [DOI: 10.1080/14656566.2019.1674283] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Central Hospital of Bolzano, Bolzano, Italy
| | | | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Pharmacologic Treatment of Insomnia in Children and Adolescents with Chronic Pain Conditions. CURRENT ANESTHESIOLOGY REPORTS 2019. [DOI: 10.1007/s40140-019-00316-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Klein T, Woo TM, Panther S, Odom-Maryon T, Daratha K. Somnolence-Producing Agents: A 5-Year Study of Prescribing for Medicaid-Insured Children With Attention Deficit Hyperactivity Disorder. J Pediatr Health Care 2019; 33:e1-e8. [PMID: 30630642 DOI: 10.1016/j.pedhc.2018.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 10/08/2018] [Accepted: 10/12/2018] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Researchers evaluated the prescribing of medications that induce somnolence to children with attention deficit hyperactivity disorder (ADHD) insured by Medicaid. METHOD An observational study of prescription claims for children ages 3-18 with ADHD-associated ICD 9 diagnoses filled between January 1, 2012 and December 31, 2016 in Oregon. RESULTS There were 14,567 prescriptions written for a 30-day supply of sleep medication for 2,518 children. Most were written for males (66.3%) and to those ages 12-18 (63.8%). Trazodone, hydroxyzine, quetiapine, clonazepam, and amitriptyline were frequently prescribed. There were few prescriptions for zaleplon and zolpidem. DISCUSSION Trazodone, hydroxyzine, and amitriptyline are commonly prescribed without clinical efficacy or guidance for children with ADHD. Quetiapine is prescribed off label in sub-therapeutic doses for its somnolence effect. Mental health drugs, which have voluntary formulary guidance in Oregon, and antihistamines on formulary, are more frequently prescribed for children with ADHD than drugs with FDA approval for insomnia.
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Badawy SM, Law EF, Palermo TM. The Interrelationship between Sleep and Chronic Pain in Adolescents. CURRENT OPINION IN PHYSIOLOGY 2019; 11:25-28. [PMID: 31815208 DOI: 10.1016/j.cophys.2019.04.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Over half of youth with chronic pain report sleep deficiency including difficulties falling asleep, maintaining sleep, feeling unrested, and experiencing short sleep duration. Sleep deficiency has been shown to play a causal role in the development or worsening of chronic pain, and is associated with a variety of negative consequences for youth with chronic pain. The purpose of this review is to provide a summary of the literature on the interrelationship of sleep and chronic pain in adolescents. We review the impact and prevalence of sleep disturbances, conceptual models of the interrelationship of sleep and pain, biobehavioral mechanisms and risk factors, sleep assessment, and treatment of sleep deficiency and chronic pain in adolescents. Our recommendations for future research include understanding biobehavioral mechanisms that underlie the link between chronic pain and sleep deficiency to help guide development and testing of treatments for co-occurring pain and sleep disturbance in adolescents.
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Affiliation(s)
- Sherif M Badawy
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Division of Hematology, Oncology and Stem Cell Transplant, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Emily F Law
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA
| | - Tonya M Palermo
- Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA
- Center for Child Health, Behavior & Development, Seattle Children's Research Institute, Seattle, WA
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McDonagh MS, Holmes R, Hsu F. Pharmacologic Treatments for Sleep Disorders in Children: A Systematic Review. J Child Neurol 2019; 34:237-247. [PMID: 30674203 DOI: 10.1177/0883073818821030] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Sleep problems are common in children, especially those with neurodevelopmental disorders, and can lead to consequences in behavior, functioning, and quality of life. We systematically reviewed the efficacy and harms of pharmacologic treatments for sleep disorders in children and adolescents. We searched MEDLINE, Cochrane library databases, and PsycINFO through June 2018. We included 22 placebo-controlled randomized controlled trials (1-13 weeks' duration), involving 1758 children (mean age 8.2 years). Single randomized controlled trials of zolpidem and eszopiclone in children with attention-deficit/hyperactivity disorder (ADHD) showed no improvement in sleep or ADHD ratings. Clinical Global Impression Improvement/Severity scores significantly improved with zolpidem ( P = .03 and P = .006, respectively). A single, small randomized controlled trial of diphenhydramine reported small improvements in sleep outcomes (8-10 minutes' better sleep latency and duration) after 1 week. In 19 randomized controlled trials, melatonin significantly improved sleep latency (median 28 minutes; range 11-51 minutes), sleep duration (median 33 minutes; range 14-68 minutes), and wake time after sleep onset (range 12-43 minutes), but not number of awakenings per night (range 0-2.7). Function and behavior improvement varied. Improvement in sleep was greatest in children with autism or other neurodevelopmental disorders, and smaller in adolescents and children with chronic delayed sleep onset. Adverse events were infrequent with melatonin, but more frequent than placebo in children taking eszopiclone or zolpidem. These findings show that melatonin was useful in improving some sleep outcomes in the short term, particularly those with comorbid ASD and neurodevelopmental disorders. Other drugs and outcomes are inadequately studied.
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Affiliation(s)
- Marian S McDonagh
- 1 Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA
| | - Rebecca Holmes
- 1 Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA
| | - Frances Hsu
- 1 Department of Medical Informatics and Clinical Epidemiology, Pacific Northwest Evidence-based Practice Center, Oregon Health & Science University, Portland, OR, USA
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Conroy DA, Czopp AM, Dore-Stites DM, Dopp RR, Armitage R, Hoban TF, Arnedt JT. Modified Cognitive Behavioral Therapy for Insomnia in Depressed Adolescents: A Pilot Study. Behav Sleep Med 2019; 17:99-111. [PMID: 28332858 DOI: 10.1080/15402002.2017.1299737] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Objective/Background: The purpose of the study was to pilot a five-week insomnia treatment in adolescents with major depressive disorder (MDD) and insomnia. This was an open-label trial of a modified-group cognitive behavioral therapy for insomnia (CBTI). Participants: Adolescents with MDD (n = 16; mean age = 17.3 +/- 1.7), characterized by the Children's Depression Rating Scale-Revised T-score ≥ 55 and insomnia, characterized by > 30 min to fall or return to sleep and an Insomnia Severity Index (ISI) score of ≥ 7 participated. Methods: Sleep diaries, actigraphy, weekly ISI, Quick Inventory of Depressive Symptomatology (QIDS), and Multidimensional Fatigue Inventory (MFI) were completed. Results: Paired t-tests comparing pre- and posttreatment revealed a decrease in sleep onset latency from 41 min +/- 14 min to 18 min +/- 8.9 min (t = 5.9, p = .004). Linear mixed modeling across sessions revealed that ISI (B = 11.0, SE = 0.94, p < .001), QIDS (B = 11.3, SE = 0.96, p < .001), and MFI (B = 30.0, SE = 4.4, p < .001) improved across treatment. Daily sleep diaries showed decreased wake during the night (B = 22.8, SE = 7.19, p = .008), increased sleep time (B = 382.4, SE = 71.89, p < .001), and increased quality of sleep (B = 3.7, SE = 0.37, p < .001). When asked whether group members would recommend this group, 27% responded "yes" and 73% responded "definitely yes." Conclusions: Additional controlled studies utilizing sleep-focused therapy in depressed adolescents with insomnia are warranted.
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Affiliation(s)
- Deirdre A Conroy
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Alison M Czopp
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Dawn M Dore-Stites
- Pediatric Behavioral Development, University of Michigan, Ann Arbor, Michigan
| | - Richard R Dopp
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Roseanne Armitage
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
| | - Timothy F Hoban
- Pediatric Sleep Medicine and Clinical Neurophysiology, University of Michigan, Ann Arbor, Michigan
| | - J Todd Arnedt
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan
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Sleep Problem Detection and Documentation in Children With Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder by Developmental-Behavioral Pediatricians: A DBPNet Study. J Dev Behav Pediatr 2019; 40:20-31. [PMID: 30589766 DOI: 10.1097/dbp.0000000000000624] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the percentage of children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and combined ASD + ADHD who had sleep problems documented by developmental-behavioral pediatricians at diagnostic and follow-up visits at 12 US academic medical centers comprising the Developmental-Behavioral Pediatrics Research Network (DBPNet) and to identify the predictors of sleep problem documentation. METHODS Developmental-behavioral pediatricians completed encounter forms that covered sociodemographic, medical, clinician, and visit factors. There was 1 dependent variable, sleep problem documentation, for which 4 definitions were developed (Model 1 = Sleep Disorder coded; Model 2 = Sleep Disorder or polysomnogram coded; Model 3 = Sleep Disorder, polysomnogram, or sleep medication coded; and Model 4 = Sleep Disorder, polysomnogram, sleep medication, or clonidine coded). RESULTS Sleep problem documentation was 14.1% for Model 1, 15.2% for Model 2, 17.3% for Model 3, and 19.7% for Model 4. All values were lower (p < 0.001) than the reported prevalence of sleep problems in these conditions. For Model 4, predictors of sleep problem documentation were age group, ethnicity, medical insurance type, and DBPNet site. CONCLUSION Developmental-behavioral pediatricians in DBPNet under-reported sleep problems in children with ASD and ADHD. Variation among sites was substantial. Care plans for children with ASD and ADHD should specify which treating clinician(s) monitors sleep issues.
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