Melatonin use is associated with lower proportions of rapid eye movement sleep in children

1. In an observational study of pediatric patients, melatonin use may be associated with a decreased percentage of rapid eye movement (REM) sleep compared to melatonin nonusers.

Evidence Rating Level: 2 (Good)

Melatonin has been used by up to 19% of pediatric patients in the past 30 days. It is available without a prescription, and despite being the most commonly used sleep supplement, there has been little research studying its effects on objective sleep architecture in children. Randomized clinical trials have used data from actigraphy or parent-reported outcomes rather than the gold standard of polysomnography (PSG). Multiple domains of sleep architecture, such as REM sleep and slow-wave sleep, have been linked to pediatric growth, neurodevelopment, and emotional regulation. It is essential to better understand how melatonin affects these domains. This cross-sectional study used a database of 3984 PSG studies from patients evaluated at the Nationwide Children’s Hospital. After excluding duplicate and technically inadequate PSGs, 3392 children were included. Of 346 melatonin users (mean [SD] age, 9.5 [4.7] years), 200 (57.8%) were male, and 146 (42.2%) were female. 6 (1.7%) were Asian, 81 (23.4%) were Black or African American, 13 (3.8%) were Hispanic, 214 (61.8%) were White, and 45 (13.0%) were another race. Patients in the melatonin group had a higher comorbidity burden (mean [SD], 10.0 [2.8] vs 7.1 [3.2] unique ICD-10 chapters; P < .001) and lower rates of obstructive sleep apnea (237 [68.5%] vs 2324 [76.3%]; P = .002). After propensity score matching, 342 melatonin users (98.8%) were matched with 342 nonusers. Melatonin users had a lower median percentage of REM sleep than matched nonusers (16.7% [IQR, 11.6%-22.0%] vs 19.0% [IQR, 14.6%-23.2%]; P = .003). There were no significant differences in the other 14 PSG outcomes (including total sleep time, sleep efficiency, sleep onset latency, non-REM sleep stages, respiratory indices, arousal index, periodic limb movements, and oxygen desaturation index).

Click here to read this study in JAMA Network Open

Image: PD

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