Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities

Oliviero Bruni; Marco Angriman; Fabrizio Calisti; Alessandro Comandini; Giovanna Esposito; Samuele Cortese; Raffaele Ferri

doi:10.1111/jcpp.12812

Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities

J Child Psychol Psychiatry. 2018 May;59(5):489-508. doi: 10.1111/jcpp.12812. Epub 2017 Sep 18.

Authors

Oliviero Bruni¹, Marco Angriman², Fabrizio Calisti³, Alessandro Comandini³, Giovanna Esposito³, Samuele Cortese^{4

5

6}, Raffaele Ferri⁷

Affiliations

¹ Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
² Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Central Hospital of Bolzano, Bolzano, Italy.
³ Angelini, Research Center, S.Palomba, Rome, Italy.
⁴ Academic Unit of Psychology, Developmental Brain-Behavior Laboratory, University of Southampton, Southampton, UK.
⁵ New York University Child Study Center, New York, NY, USA.
⁶ Solent NHS Trust, Southampton, UK.
⁷ Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy.

PMID: 28921528
DOI: 10.1111/jcpp.12812

Abstract

Background: Sleep disturbances, in particular insomnia, represent a common problem in children with neurodevelopmental disabilities (NDDs). Currently, there are no approved medications for insomnia in children by the US Food and Drug Administration or European Medicines Agency and therefore they are prescribed off-label. We critically reviewed pediatric literature on drugs as well as nonpharmacological (behavioral) interventions used for sleep disturbances in children with NDDs.

Methods: PubMed, Ovid (including PsycINFO, Ovid MEDLINE^® , and Embase), and Web of Knowledge databases were searched through February 12, 2017, with no language restrictions. Two authors independently and blindly performed the screening.

Results: Good sleep practices and behavioral interventions, supported by moderate-to-low level evidence, are the first recommended treatments for pediatric insomnia but they are often challenging to implement. Antihistamine agents, such as hydroxyzine or diphenhydramine, are the most widely prescribed sedatives in the pediatric practice but evidence supporting their use is still limited. An increasing body of evidence supports melatonin as the safest choice for children with NDDs. Benzodiazepines are not recommended in children and should only be used for transient insomnia, especially if daytime anxiety is present. Only few studies have been carried out in children's and adolescents' zolpidem, zaleplon, and eszopiclone, with contrasting results. Limited evidence supports the use of alpha-agonists such as clonidine to improve sleep onset latency, especially in attention deficit/hyperactivity disorder subjects. Tricyclic antidepressants, used in adults with insomnia, are not recommended in children because of their safety profile. Trazodone and mirtazapine hold promise but require further studies.

Conclusions: Here, we provided a tentative guide for the use of drugs for insomnia in children with NDDs. Well-controlled studies employing both objective polysomnography and subjective sleep measures are needed to determine the efficacy, effectiveness, and safety of the currently prescribed pediatric sleep medicines in children with NDDs.

Keywords: Sleep disorders; drug effects; insomnia; neurodevelopmental disorders.

Publication types

Research Support, Non-U.S. Gov't
Review

MeSH terms

Adolescent
Child
Humans
Neurodevelopmental Disorders / complications*
Sleep Initiation and Maintenance Disorders / drug therapy*
Sleep Initiation and Maintenance Disorders / etiology