Dados do Trabalho

Título

WHEN, HOW, AND WHAT ARE THE OUTCOMES OF EXOGENOUS MELATONIN INDICATED IN A PEDIATRIC SLEEP CLINIC

Introdução

Melatonin is an endogenous hormone primarily produced by the pineal gland. One of melatonin's primary functions is the regulation of sleep, increasing the propensity for sleep and adjusting circadian rhythm control. Melatonin has gained attention for its potential therapeutic benefits in managing sleep disorders in pediatric populations, leading to increasing indiscriminate use in several countries. Despite the growing use of melatonin in pediatric patients, there is a lack of data on its long-term effects, optimal dosing regimens, and potential interactions with other medications.

Objetivo

This study aimed to evaluate melatonin use among patients attending a pediatric sleep outpatient clinic.

Método

A retrospective analysis based on the medical records of pediatric patients treated at the pediatric sleep clinic of the Child and Adolescent Institute of the Hospital das Clínicas of the University of São Paulo Medical School (HCFMUSP) from 2018 to 2023. Cases that used melatonin at the first consultation or started using it during clinical follow-up were evaluated. Patients who did not continue follow-up were excluded from the study.

Resultados

Twenty-eight patients using melatonin were identified out of a total of 198. 50% were female. The mean age was 8.75 years, ranging from 1.9 to 15 years. Only five patients reached melatonin use. Four groups were divided: circadian rhythm disorder, including Smith-Magenis Syndrome (SMS) and delayed sleep phase syndrome; insomnia associated with neurodevelopmental disorder; neurogenetic syndromes; and narcolepsy. The mean initial dose of melatonin after the first consultation, excluding patients diagnosed with SMS and rapid eye movement sleep behavior disorder (who received higher doses), was 0.6 mg + or - 0.72 mg. After gathering
testimonies from caregivers during follow-up appointments, 71% considered the use of melatonin to be satisfactory.

Conclusão

We have found that the use of melatonin for specific indications and at physiological doses provides a satisfactory clinical response, particularly in cases of circadian rhythm disorder and insomnia associated with neurodevelopmental disorders.

Referências

1. Cipolla‐Neto J, Amaral FG, Afeche SC, Tan DX, Reiter RJ. Melatonin, energy metabolism, and obesity: a review. J Pineal Res. 2014 May 5;56(4):371–81.
2. Nielsen ES, Rasmussen L, Hellfritzsch M, Thomsen PH, Nørgaard M, Laursen T. Trends in Off‐Label Prescribing of Sedatives, Hypnotics and Antidepressants among Children and Adolescents – A Danish, Nationwide Register‐Based Study. Basic Clin Pharmacol Toxicol. 2017 Apr 5;120(4):360–7.
3. Hartz I, Handal M, Tverdal A, Skurtveit S. Paediatric Off‐Label Use of Melatonin – A Register Linkage Study between the Norwegian Prescription Database and Patient Register. Basic Clin Pharmacol Toxicol. 2015 Oct 9;117(4):267–73.

Palavras Chave

Melatonin; Infant Sleep; Sleep Wake Disorders