Melatonin

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From _Medscape Medical News_ (http://www.medscape.com/news)

SLEEP 2009: Melatonin May Counter Sleep Disorders in Autistic Children

Jim Kling

June 10, 2009 (Seattle, Washington) — A pilot study in children with autism

spectrum disorders (ASD) suggests that low-dose melatonin may be an

effective treatment for insomnia in these patients. In this study, positive

effects of treatment were seen on both sleep and daytime behavior.

Melatonin " does appear to be effective, " Beth Malow, MD, professor of

neurology at Vanderbilt University, in Nashville, Tennessee, said during her

presentation. She emphasized that the study was small and that more work needs

to be done.

" Kids with autism who have some sleep problems are candidates for melaton

in, and I believe that large, randomized clinical trials of melatonin are

well warranted, " she concluded.

Dr. Malow presented the findings here at SLEEP 2009: 23rd Annual Meeting of

the Associated Professional Sleep Societies.

Increasing Melatonin Use

Children with ASD may experience insomnia, the researchers note, and

parents are increasingly turning to melatonin as a sleep aid. However, not much

is known about its potential adverse effects. Melatonin also comes in a wide

variety of formulations, some with additives such as antihistamines or

vitamins.

Parents perceive melatonin as a natural treatment, but the wide variety of

formulations makes it difficult for practicing physicians to assess its

utility. " I don't know what they're taking, " said 1 attendee, referring to his

autistic patients.

To better assess melatonin's safety and efficacy in autistic children, the

researchers conducted a 17-week study of children with ASD who had trouble

falling asleep.

The study enrolled children aged 4 to 10 years diagnosed with ASD who

required at least 30 minutes to fall asleep on 3 out of 7 nights of the week.

Parents received behavioral sleep education before melatonin treatments

began, and this was continued through the study. Parents filled out sleep and

behavioral survey forms at the beginning and end of all study procedures.

Patients wore actigraphy watches (Respironics) for 17 weeks.

After 3 weeks, patients were given 1-mg melatonin (Natrol). Every 3 weeks

thereafter, the dose was escalated to 3 mg, 6 mg, and 9 mg, until the

patient fell asleep within 30 minutes at least 5 out of 7 nights per week. Pre-

and posttreatment actigraphy measures were analyzed using a Wilcoxon

signed-ranks test.

Ten patients completed the study with no adverse effects. Three required a

dose of 1 mg, 5 required 3 mg, and 2 required 6 mg to achieve the desired

end point. No patients required a 9-mg dose.

Patients started with a mean sleep latency of 38.7 minutes that was reduced

to a mean of 21.8 minutes with treatment (P = 0.039).

The Children's Sleep Habits Questionnaire showed improvement in sleep-onset

delay (P = 0.008) and sleep duration (P = 0.004), repetitive-behavior

scale domains of compulsive (P = 0.002) and ritualistic behavior (P = 0.004),

and Parent Interview for Autism domain of affective responses (P = 0.02).

Definite Promise

Asked for perspective on these findings, Judith Owens, MD, professor of

pediatrics at Brown Medical School, in Providence, Rhode Island, who moderated

the session, said the data support the safety, tolerability, and efficacy

of melatonin in this patient population.

" This was open label, so you can't get solid conclusions of efficacy, but

it definitely has promise, " Dr. Owens told Medscape Neurology.

The project was supported by grants from the Autism Speaks/Dana

Foundation, the National Institutes of Health, and Vanderbilt University.

Melatonin

was provided by Natrol. Dr. Malow and Dr. Owens have disclosed no relevant

financial relationships.

SLEEP 2009: 23rd Annual Meeting of the Associated Professional Sleep

Societies: Abstract 0189. Presented June 8, 2009.

Authors and Disclosures

Journalist

Jim Kling

Jim Kling is a freelance writer for Medscape.

Medscape Medical News © 2009 Medscape, LLC

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