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Bruni O, Biggio G, Malorgio E, Nobili L. Insomnia in children affected by autism spectrum disorder: The role of melatonin in treatment. Sleep Med 2024; 119:511-517. [PMID: 38805858 DOI: 10.1016/j.sleep.2024.05.046] [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: 03/13/2024] [Revised: 05/08/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
The present article explores the connection between insomnia and Autism Spectrum Disorder (ASD), focusing on the efficacy and safety of melatonin treatments as supported by existing research and current guidelines. In this narrative review a group of Italian experts provide an analysis of the various aspects of managing insomnia in children with ASD, highlighting key points that could enhance the quality of life for both patients and their caregivers. This includes the significance of comprehensively understanding the root causes of a child's sleep difficulties for more effective, long-term management. Insomnia, a condition frequently documented in neurodevelopmental disorders such as ASD, greatly affects the lives of patients and caregivers. Recent data show that melatonin-based formulations are effective and safe for treating ASD-related insomnia both short and long term. In particular, prolonged-release melatonin is poised to be the optimal choice for this patient population. This formulation is approved for the treatment of insomnia in children and adolescents aged 2-18 years suffering from ASD and/or Smith-Magenis syndrome, where sleep hygiene measures and behavioral treatments have not been sufficient. In support, emerging research in pediatric settings indicates long-term efficacy and safety, although further research efforts are still needed. Current guidelines recommend managing insomnia and sleep disturbances in ASD using a combination of behavioral and pharmacological methods, primarily melatonin. Recent concerns about accidental melatonin ingestion highlight the need for high purity standards, such as pharmaceutical-grade prolonged-release formulations. The article also summarizes emerging molecular mechanisms from preclinical research, suggesting future therapeutic approaches.
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Affiliation(s)
- Oliviero Bruni
- Dept of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, 00185, Rome, Italy.
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, 09042, Cagliari, Italy; Institute of Neuroscience, National Research Council (C.N.R.), University Campus, 09042, Cagliari, Italy.
| | - Emanuela Malorgio
- Italian Federation of Primary Care Pediatricians (Federazione Italiana Medici Pediatri, FIMP), Expert on Sleep Disorders AIMS, Torino, Italy.
| | - Lino Nobili
- IRCCS G. Gaslini Institute. Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI) - University of Genova, Italy.
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Giri A, Mehan S, Khan Z, Das Gupta G, Narula AS, Kalfin R. Modulation of neural circuits by melatonin in neurodegenerative and neuropsychiatric disorders. NAUNYN-SCHMIEDEBERG'S ARCHIVES OF PHARMACOLOGY 2024; 397:3867-3895. [PMID: 38225412 DOI: 10.1007/s00210-023-02939-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 12/30/2023] [Indexed: 01/17/2024]
Abstract
Neurodegenerative and neuropsychiatric disorders are two broad categories of neurological disorders characterized by progressive impairments in movement and cognitive functions within the central and peripheral nervous systems, and have emerged as a significant cause of mortality. Oxidative stress, neuroinflammation, and neurotransmitter imbalances are recognized as prominent pathogenic factors contributing to cognitive deficits and neurobehavioral anomalies. Consequently, preventing neurodegenerative and neuropsychiatric diseases has surfaced as a pivotal challenge in contemporary public health. This review explores the investigation of neurodegenerative and neuropsychiatric disorders using both synthetic and natural bioactive compounds. A central focus lies on melatonin, a neuroregulatory hormone secreted by the pineal gland in response to light-dark cycles. Melatonin, an amphiphilic molecule, assumes multifaceted roles, including scavenging free radicals, modulating energy metabolism, and synchronizing circadian rhythms. Noteworthy for its robust antioxidant and antiapoptotic properties, melatonin exhibits diverse neuroprotective effects. The inherent attributes of melatonin position it as a potential key player in the pathophysiology of neurological disorders. Preclinical and clinical studies have demonstrated melatonin's efficacy in alleviating neuropathological symptoms across neurodegenerative and neuropsychiatric conditions (depression, schizophrenia, bipolar disorder, and autism spectrum disorder). The documented neuroprotective prowess of melatonin introduces novel therapeutic avenues for addressing neurodegenerative and psychiatric disorders. This comprehensive review encompasses many of melatonin's applications in treating diverse brain disorders. Despite the strides made, realizing melatonin's full neuroprotective potential necessitates further rigorous clinical investigations. By unravelling the extended neuroprotective benefits of melatonin, future studies promise to deepen our understanding and augment the therapeutic implications against neurological deficits.
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Affiliation(s)
- Aditi Giri
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy Moga, Punjab, India
| | - Sidharth Mehan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy Moga, Punjab, India.
- IK Gujral Punjab Technical University, Jalandhar, Punjab, 144603, India.
| | - Zuber Khan
- Division of Neuroscience, Department of Pharmacology, ISF College of Pharmacy Moga, Punjab, India
- IK Gujral Punjab Technical University, Jalandhar, Punjab, 144603, India
| | | | - Acharan S Narula
- Narula Research, LLC, 107 Boulder Bluff, Chapel Hill, NC, 27516, USA
| | - Reni Kalfin
- Institute of Neurobiology, Bulgarian Academy of Sciences, Acad. G. Bonchev St., Block 23, Sofia, 1113, Bulgaria
- Department of Healthcare, South-West University "NeofitRilski", Ivan Mihailov St. 66, Blagoevgrad, 2700, Bulgaria
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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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Horsnell J, Mangar S, Dimitriou D, Halstead EJ. Parental Experiences of Melatonin Administration to Manage Sleep Disturbances in Autistic Children and Adolescent in the UK. Healthcare (Basel) 2023; 11:1780. [PMID: 37372898 DOI: 10.3390/healthcare11121780] [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: 03/15/2023] [Revised: 06/09/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
BACKGROUND Autistic children and adolescents are 40-80% more likely to experience sleep disturbances than their neurotypical peers. In the United Kingdom, melatonin is licensed for short-term usage in adults at age 55 years and above; however, it is often prescribed to autistic children and adolescents to help manage their sleep. The current study sought to understand parental experiences and their motivation of using melatonin to manage sleep disturbances of their autistic children. METHODS The sample included 26 parents who took part in online focus groups answering questions regarding their experiences of using melatonin as a sleep treatment for their children diagnosed with autism between 4 and 18 years old. RESULTS Four main themes were identified: (i) parental perception of melatonin used as 'a naturally produced hormone'; (ii) perceived benefits of using melatonin to improve their child's sleep; (iii) administration of melatonin: dosage amount, timing and pulverising; and (iv) expectation and apprehension over melatonin use. CONCLUSION Some parents reported success with the use of melatonin, and others reported the effects being limited or diminishing in time. Suggestions for healthcare professionals and families regarding melatonin usage in the UK are made with respect to setting clear guidelines for usage, whilst ensuring expectations are set and managed appropriately.
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Affiliation(s)
- Jade Horsnell
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
| | - Stephen Mangar
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, 25 Woburn Square, London WC1H 0AA, UK
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
| | - Elizabeth J Halstead
- Psychology and Human Development, UCL Institute of Education, London WC1H 0AA, UK
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Kim SH, Jung JH, Chang MC, Park D. The effect of intensive rehabilitation treatment on sleep disorder in children with motor delays. BMC Pediatr 2023; 23:291. [PMID: 37322423 PMCID: PMC10268337 DOI: 10.1186/s12887-023-04067-1] [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: 10/29/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND Although the importance of sleep problems has been increasingly emphasized due to the effects on children's development and children's and families' daytime behaviors, physical health, and quality of life, they have been overlooked in clinical practice. However, there have been few studies on the effects of rehabilitation on sleep problems. Therefore, in this study, we investigated the effects of an intensive rehabilitation program on sleep problems in children with developmental delays (DD). METHODS We included 36 children with DD (30 outpatients, 6 inpatients) and their caregivers who completed all items on the Sleep Disturbance Scale for Children. Of the children with DD, 19 (59.3%) had cerebral palsy (CP) and 13 (40.7%) had DD of non-CP origins, of which 6 (18.8%) had prematurity, 4 (12.5%) had genetic causes, and 3 (9.4%) had an unknown origin. Changes in sleep problems after the intensive rehabilitation program were evaluated using a paired or unpaired t-test, depending on the distribution of the continuous variables. RESULTS After the intensive rehabilitation program, in 36 children with DD, there was a significant improvement in the difficulty in initiating and maintaining sleep (DIMS) sub-score (p < 0.05). However, there was no significant improvement in the total score or other sub-scores, such as those for sleep breathing disorders (SBD), disorders of arousal (DA), sleep-wake transition disorders (SWTD), disorders of excessive somnolence (DOES), and sleep hyperhidrosis (SH). In the subgroup analysis according to the cause of DD, children with CP had a significant improvement in DIMS and DOES sub-scores (p < 0.05). CONCLUSION The intensive rehabilitation program, consisting of more than two sessions per day, effectively alleviated sleep problems in children with DD, especially in those with CP. Among the sleep problems, the intensive rehabilitative program was most effective at improving the DIMS. However, further prospective studies with a larger number of patients with DD and a more standardized protocol are necessary to generalize this effect.
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Affiliation(s)
- Sung Hyun Kim
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Gyeonggi-Do, Republic of Korea
| | - Jin Hee Jung
- Department of Rehabilitation Medicine, Bundang Jesaeng Hospital, Gyeonggi-Do, Republic of Korea
| | - Min Cheol Chang
- Department of Rehabilitation Medicine, Yeungnam University Hospital, Daegu, 42415, Republic of Korea.
| | - Donghwi Park
- Department of Rehabilitation Medicine, Daegu Fatima Hospital, Ayang-ro 99 gil, Dong-gu,, Daegu, 44033, Republic of Korea.
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Yao S, Liu Y, Liu X, Liu G. Effects of SNPs in AANAT and ASMT Genes on Milk and Peripheral Blood Melatonin Concentrations in Holstein Cows ( Bos taurus). Genes (Basel) 2022; 13:genes13071196. [PMID: 35885979 PMCID: PMC9322776 DOI: 10.3390/genes13071196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 06/27/2022] [Accepted: 06/28/2022] [Indexed: 02/01/2023] Open
Abstract
Aralkylamine N-acetyltransferase (AANAT) and acetylserotonin O-methyltransferase (ASMT), the two rate-limiting enzymes for melatonin synthesis, regulate melatonin production in mammals. Through analysis of the milk melatonin level and dairy herd improvement (DHI) index, it was found that the melatonin concentration in milk was significantly negatively correlated with the 305 day milk yield (305M) and peak milk yield (PeakM) (p < 0.05), while it was significantly positively correlated with the serum melatonin concentration (p < 0.05). The full-length of AANAT and ASMT were sequenced and genotyped in 122 cows. Three SNPs in AANAT and four SNPs in ASMT were significantly related to MT levels in the milk and serum (p < 0.05). The SNPs in AANAT were temporarily denoted as N-SNP1 (g.55290169 T>C), N-SNP2 (g.55289357 T>C), and N-SNP3 (g.55289409 C>T). The SNPs in ASMT were temporarily denoted as M-SNP1 (g.158407305 G>A), M-SNP2 (g.158407477 A>G), M-SNP3 (g.158407874 G>A), and M-SNP4 (g.158415342 T>C). The M-SNP1, M-SNP2, and M-SNP3 conformed to the Hardy−Weinberg equilibrium (p > 0.05), while other SNPs deviated from the Hardy−Weinberg equilibrium (p < 0.05). The potential association of MT production and each SNP was statistically analyzed using the method of linkage disequilibrium (LD). The results showed that N-SNP2 and N-SNP3 had some degree of LD (D′ = 0.27), but M-SNP1 and M-SNP2 had a strong LD (D′ = 0.98). Thus, the DHI index could serve as a prediction of the milk MT level. The SNPs in AANAT and ASMT could be used as potential molecular markers for screening cows to produce high melatonin milk.
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