Proceedings of The Physiological Society

Sleep Sleep and Circadian Rhythms (London, UK) (2018) Proc Physiol Soc 42, C16

Poster Communications

The use of melatonin in the treatment of paediatric sleep disorders in the UK

M. Basra1, S. Terry1, D. Wringe1, M. J. Morrell1,2,3

1. Clinical Research and Innovation Theme, Imperial College School of Medicine, London, United Kingdom. 2. Academic Unit of Sleep and Ventilation, National Heart and Lung Institute, Imperial College London, London, United Kingdom. 3. National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton & Harefield National Health Service Foundation Trust, London, United Kingdom.

  • Figure 1: Interviewees and their roles

  • Figure 2: Codes (blue), concepts (green) and categories (yellow) from analysis of interviews.

Sleep disorders such as obstructive sleep apnoea and sleep onset insomnia occur in 3.7% of children. [1] Melatonin is a sleep-promoting pineal hormone, regulated by the suprachiasmatic nucleus [2] that is sometimes prescribed off-label for sleep disorders in children. [3] Oral melatonin is moderately expensive, costing £15-75/month dependent on dosage. [4] Side effects are uncommon, but include hyperactivity, nightmares and constipation. [5] Alternative management strategies for paediatric sleep disorders include behavioural therapies. Aim: To carry out an exploratory study to investigate clinical perspectives on the use of melatonin in the treatment of paediatric sleep disorders. Methods: A Qualitative exploratory study was carried out using semi-structured interviews of 15-30 minutes, either face-to-face or via video or telephone calls; dialogue was transcribed during interviews. Chain sampling was used to select interviewees. Inclusion criteria: professionals with experience of paediatric sleep disorders: 14 contacted, 10 respondents interviewed (Figure 1). Data thematically analysed via open coding (Figure 2). Results: Misconceptions about melatonin and its use in treating paediatric sleep disorders were reported in healthcare professionals and parents, possibly producing suboptimal prescription practices and unrealistic expectations. This could impair the quality of care in paediatric patients with sleep disorders, and may incur costs upon the NHS, as shown in Figure 2. Behavioural interventions could also be useful and implemented prior to or in conjunction with melatonin treatment, but access to behavioural treatments appears to be limited in many parts of England and Scotland. Melatonin has become the "sleeping aid of choice" for paediatricians, and high prescription rates may not be detrimental provided prescribers are well-informed, as sleep deprivation has profound effects in children. Conclusions: Current melatonin prescribing practices could be improved in physicians who treat paediatric sleep disorders but who are not sleep experts. Behavioural interventions may be more effective than melatonin in paediatric sleep disorders. There is an apparent lack of awareness of paediatric sleep disorders amongst medical students, and therefore awareness of treatment options and the role of melatonin vs behavioural treatments. Future work: Investigate current prescribing practices of melatonin in a larger sample of paediatric professionals. Raise awareness of paediatric sleep disorders and the necessary treatments for them. Investigate sleep education across UK medical schools and raise awareness of paediatric sleep disorders and treatment options amongst medical students who may become paediatricians.

Where applicable, experiments conform with Society ethical requirements