Farmacoriflessioni
La melatonina nei disturbi del sonno in bambini e adolescenti con problemi neurocomportamentali
Use of melatonin in sleep disorders in children and adolescents with neuro-behavioural problems. Efficacy and safety profile
Federico Marchetti, Enrico Cocchi
UOC di Pediatria e Neonatologia, Ospedale di Ravenna, Dipartimento di Scienze Mediche e Chirurgiche (DIMEC), Università di Bologna
Ottobre 2024 - pagg. 505 -508 | DOI: 10.53126/MEB43505
Abstract
Melatonin, a neurohormone produced by the pineal gland, regulates the sleep-wake circadian rhythm. Sleep disorders are prevalent in children, especially those with neurodevelopmental disorders like autism and other neurodisabilities and affect about 50-75% of this population. The use of melatonin to improve sleep in this population has been debated for over 20 years, with recent re-views addressing its efficacy and safety. Melatonin significantly improves sleep latency and total sleep time in children with autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and other neurodevelopmental disorders. However, its effectiveness in reducing night awakenings is limited. Short-term use shows no significant association with serious adverse effects, though mild side effects like headache, nausea, drowsiness, and mood changes are common. Long-term safety data are limited but suggest no significant impact on puberty onset or bone health. Dosing and timing of melatonin administration vary widely, and individualized treatment plans are recommended. The use of melatonin should be accompanied by behavioural interventions, and po-tential side effects should be monitored closely.
Riassunto
La melatonina, un neuroormone prodotto dalla ghiandola pineale, regola il ritmo circadiano sonno-veglia. I disturbi del sonno sono prevalenti nei bambini con disturbi dello sviluppo neurologico, (autismo e altre neurodisabilità) e colpiscono circa il 50-75% di questa popolazione. L'uso della melatonina per migliorare il sonno in questa popolazione è stato dibattuto per oltre 20 anni, con recenti revisioni che ne hanno affrontato l'efficacia e la sicurezza. La melatonina migliora significativamente la latenza del sonno e il tempo totale di sonno nei bambini con disturbo dello spettro autistico (ASD), disturbo da deficit di attenzione/iperattività (ADHD) e altri disturbi dello sviluppo neurologico. Tuttavia, la sua efficacia nel ridurre i risvegli notturni è limitata. L'uso a breve termine non mostra alcuna associazione significativa con gravi effetti avversi, sebbene siano comuni lievi effetti collaterali come mal di testa, nausea, sonnolenza e cambiamenti di umore. I dati sulla sicurezza a lungo termine sono limitati ma non suggeriscono alcun impatto significativo sull'inizio della pubertà o sulla salute delle ossa. Il dosaggio e la tempistica della somministrazione di melatonina variano ampiamente e si raccomandano piani di trattamento personalizzati. L'uso di melatonina dovrebbe essere accompagnato da interventi comportamentali e i potenziali effetti collaterali dovrebbero essere monitorati attentamente.
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Corrispondenza: federico.marchetti@auslromagna.it