Long-Term Melatonin Therapy for Adolescents and Young Adults with Chronic Sleep Onset Insomnia and Late Melatonin Onset: Evaluation of Sleep Quality, Chronotype, and Lifestyle Factors Compared to Age-Related Randomly Selected Population Cohorts
Tom C. Zwart 1,2
, Marcel G. Smits 3,4, Toine C.G. Egberts 2,5, Carin M.A. Rademaker 5 and Ingeborg M. Van Geijlswijk 1,2,*
, Marcel G. Smits 3,4, Toine C.G. Egberts 2,5, Carin M.A. Rademaker 5 and Ingeborg M. Van Geijlswijk 1,2,*
1
Faculty of Veterinary Medicine, Pharmacy Department, Utrecht University, Utrecht 3584 CM, The Netherlands
2
Utrecht Institute for Pharmaceutical Sciences (UIPS), Department of Pharmacoepidemiology and Clinical Pharmacology, Faculty of Science, Utrecht University, Utrecht 3584 CG, The Netherlands
3
Department of Sleep-wake disorders and Chronobiology, Gelderse Vallei Hospital, Ede 6716 RP, The Netherlands
4
Governor Kremers Centre, Maastricht University, Maastricht 6229 GR, The Netherlands
5
Department of Clinical Pharmacy, Division of Laboratory and Pharmacy, University Medical Centre Utrecht, Utrecht 3584 CX, The Netherlands
*
Author to whom correspondence should be addressed.
Healthcare 2018, 6(1), 23; https://doi.org/10.3390/healthcare6010023
Received: 8 February 2018 / Revised: 23 February 2018 / Accepted: 27 February 2018 / Published: 2 March 2018
Abstract
The extent of continuance of melatonin therapy initiated in pre-pubertal children with chronic sleep onset insomnia (CSOI) was investigated in young adult life. Sleep timing, sleep quality, adverse events, reasons for cessation of therapy, and patient characteristics with regard to therapy regimen, chronotype and lifestyle factors possibly influencing sleeping behavior were assessed. With an online survey using questionnaires (Pittsburgh Sleep Quality Index, Insomnia Severity Index, Morningness-Eveningness Questionnaire, and Munich Chronotype Questionnaire), outcomes were measured and compared with age-related controls. These controls were extracted from published epidemiological research programs applying the same questionnaires. At the moment of the survey, melatonin was still continued by 27.3% of the patients, with a mean treatment duration of 10.8 years. The overall average treatment duration was 7.1 years. Sleep quality of both discontinued and persistent melatonin users did not deviate from controls. Sleep timing and chronotype scores indicated evening type preference in all responders. Adverse events were scarce but the perceived timing of pubertal development suggested a tendency towards delayed puberty in former and current users of melatonin. This study may underestimate the number of children that are able to stop using melatonin due to the response rate (47.8%) and appeal for continuing users. Sleep timing parameters were based on self-reported estimates. Control populations were predominantly students and were of varying nationalities. The statistical power of this study is low due to the limited sample size. Melatonin therapy sustained for 7.1 years does not result in substantial deviations of sleep quality as compared to controls and appears to be safe. The evening type preference suggests a causal relation with CSOI. This study shows that ten years after initiation of treatment with melatonin for CSOI, approximately 75% of the patients will have normal sleep quality without medication. View Full-Text
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Zwart, T.C.; Smits, M.G.; Egberts, T.C.; Rademaker, C.M.; Van Geijlswijk, I.M. Long-Term Melatonin Therapy for Adolescents and Young Adults with Chronic Sleep Onset Insomnia and Late Melatonin Onset: Evaluation of Sleep Quality, Chronotype, and Lifestyle Factors Compared to Age-Related Randomly Selected Population Cohorts. Healthcare 2018, 6, 23.
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