Dikkat Eksikliği Hiperaktivite Bozukluğu olan Çocuk ve Ergenlerde Uyku Bozuklukları ve Melatonin Tedavisi

Yıl 2025, Cilt: 20 Sayı: 1, 78 - 87

Hatice Altun , Semiha Cömertoğlu Arslan

https://doi.org/10.17517/ksutfd.1412903

Öz

Dikkat eksikliği hiperaktivite bozukluğu (DEHB)’nda uyku bozuklukları çok yaygındır. Uyku sorunları DEHB semptomlarını tetikleyebilir veya şiddetlendirebilir, çocukların ve ailelerinin yaşamlarını ve ruhsal sağlığını olumsuz etkileyebilir. DEHB'li çocuklarda uyku sorunlarının etiyolojisi multifaktöriyel olup spesifik birincil uyku bozukluklarına, biyolojik faktörlere, davranışsal faktörlere (sınır belirleme bozukluğu gibi), sosyo-çevresel ve ailesel faktörlere, farmakolojik tedavilerin etkisine veya eşlik eden hastalıklara bağlı olabilir. Erken tanınması ve zamanında yaklaşım DEHB belirtilerinin şiddetinin azaltılmasına katkıda bulunabilir. DEHB'li çocuklarda uyku bozuklukları yönetiminde birinci basamak tedavi; iyi uyku hijyeni, ebeveynlerin uyku eğitimi ve davranışsal tedavi yaklaşımlarını içermelidir. Bu stratejiler başarısız olursa farmakolojik müdahaleler gerekli olabilir ancak DEHB’de uyku bozukluklarının farmakolojik tedavisine yönelik kanıtlar sınırlıdır. Melatonin, uyku bozukluklarında etkinliği, iyi tolere edilebilirliği ve güvenilirliği nedeniyle sıklıkla kullanılmakta olup, özellikle uyku başlangıcında ilerleme, uyku latansında azalma ve total uyku süresinde artma sağlamaktadır. Ancak DEHB’li çocuklarda melatoninin etkinliğini, uzun vadeli sonuçlarını, diğer ilaçlarla etkileşimini değerlendiren çalışmalara ihtiyaç vardır.

Anahtar Kelimeler

Dikkat eksikliği hiperaktivite bozuukluğu, uyku, insomnia, uyku bozuklukları, farmakolojik tedavi, melatonin

Sleep Disorders and Melatonin Treatment in Children and Adolescents with Attention Deficit Hyperactivity Disorder

Öz

Sleep disorders are common in attention deficit hyperactivity disorder (ADHD). Sleep problems can exacerbate ADHD symptoms and hurt the lives and mental health of children and their families. The etiology of sleep problems in children with ADHD is multifactorial and may be due to specific primary sleep disorders, biological factors, behavioral factors (such as boundary setting disorder), socio-environmental, and family factors, the effect of pharmacological treatment, or comorbid disorders. Early recognition and a timely approach may contribute to reducing the severity of ADHD symptoms. First-line therapy in the management of sleep disorders in children with ADHD should include good sleep hygiene, parental sleep education, and behavioral treatment approaches. If these strategies fail, pharmacological interventions may be necessary, but evidence for pharmacological treatment of sleep disorders in ADHD is limited. Melatonin is frequently used in sleep disorders due to its efficacy, good tolerability, and safety. It provides improvement in sleep onset, decrease in sleep latency, and increase in total sleep time. However, there is a need for studies evaluating the effectiveness, long-term results, and drug-drug interactions of melatonin in children with ADHD.

Anahtar Kelimeler

Attention deficit hyperactivity disorder, sleep, insomnia, sleep disorder, pharmaological treatment, melatonin

Kaynakça

• Salari N, Ghasemi H, Abdoli N, Rahmani A, Shiri MH, Hashemian AH, et al. The global prevalence of ADHD in children and adolescents: a systematic review and meta-analysis. Italian Journal of Pediatrics. 2023;49(1):48.
• American Psychiatric Association D, Association AP. Diagnostic and statistical manual of mental disorders: DSM-5: American psychiatric association Washington, DC; 2013.
• Faraone SV, Asherson P, Banaschewski T, Biederman J, Buitelaar JK, Ramos-Quiroga JA, et al. Attention-deficit/hyperactivity disorder. Nature reviews Disease primers. 2015;1(1):1-23.
• Palladino VS, McNeill R, Reif A, Kittel-Schneider S. Genetic risk factors and gene–environment interactions in adult and childhood attention-deficit/hyperactivity disorder. Psychiatric genetics. 2019;29(3):63-78.
• Arias-Mera C, Paillama-Raimán D, Lucero-González N, Leiva-Bianchi M, Avello-Sáez D. Relation between sleep disorders and attention deficit disorder with hyperactivity in children and adolescents: A systematic review. Research in Developmental Disabilities. 2023;137:104500.
• Gruber R, Wiebe S, Montecalvo L, Brunetti B, Amsel R, Carrier J. Impact of sleep restriction on neurobehavioral functioning of children with attention deficit hyperactivity disorder. Sleep. 2011;34(3):315-323.
• Bond L, McTiernan D, Connaughton M, Heron E, Coogan A, McGrath J. Sleep problems in children and adolescents in an attention deficit hyperactivity disorder service. Irish Journal of Psychological Medicine. 2023:1-9.
• Craig SG, Weiss MD, Hudec KL, Gibbins C. The functional impact of sleep disorders in children with ADHD. Journal of attention Disorders. 2020;24(4):499-508.
• Langberg JM, Molitor SJ, Oddo LE, Eadeh H-M, Dvorsky MR, Becker SP. Prevalence, patterns, and predictors of sleep problems and daytime sleepiness in young adolescents with ADHD. Journal of attention disorders. 2020;24(4):509-523.
• Raman S, Coogan AN. Closing the loop between circadian rhythms, sleep, and Attention Deficit Hyperactivity Disorder. Handbook of behavioral neuroscience: Elsevier; 2019. p. 707-16.
• Martin CA, Papadopoulos N, Rinehart N, Sciberras E. Associations between child sleep problems and maternal mental health in children with ADHD. Behavioral Sleep Medicine. 2021;19(1):12-25.
• Sung V, Hiscock H, Sciberras E, Efron D. Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Archives of pediatrics & adolescent medicine. 2008;162(4):336-342.
• Wajszilber D, Santiseban JA, Gruber R. Sleep disorders in patients with ADHD: impact and management challenges. Nature and science of sleep. 2018:453-480.
• Yürümez E, Kılıç BG. Relationship between sleep problems and quality of life in children with ADHD. Journal of attention disorders. 2016;20(1):34-40.
• Becker SP, Cusick CN, Sidol CA, Epstein JN, Tamm L. The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. European child & adolescent psychiatry. 2018;27:353-365.
• Lycett K, Mensah FK, Hiscock H, Sciberras E. A prospective study of sleep problems in children with ADHD. Sleep Medicine. 2014;15(11):1354-61.
• Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. Journal of the American Academy of Child & Adolescent Psychiatry. 2009;48(9):894-908.
• Eyuboglu M, Eyuboglu D. Behavioural sleep problems in previously untreated children with attention deficit hyperactivity disorder. Psychiatry and Clinical Psychopharmacology. 2018;28(1):19-24.
• Díaz-Román A, Hita-Yáñez E, Buela-Casal G. Sleep characteristics in children with attention deficit hyperactivity disorder: systematic review and meta-analyses. Journal of Clinical Sleep Medicine. 2016;12(5):747-756.
• Scarpelli S, Gorgoni M, D’Atri A, Reda F, De Gennaro L. Advances in understanding the relationship between sleep and attention deficit-hyperactivity disorder (ADHD). Journal of clinical medicine. 2019;8(10):1737.
• Lecendreux M, Konofal E, Bouvard M, Falissard B, Mouren-Siméoni M-C. Sleep and alertness in children with ADHD. The Journal of Child Psychology and Psychiatry and Allied Disciplines. 2000;41(6):803-12.
• Platon MR, Bueno AV, Sierra JE, Kales S. Hypnopolygraphic alterations in attention deficit disorder (ADD) children. International Journal of Neuroscience. 1990;53(2-4):87-101.
• Van der Heijden KB, Smits MG, Someren EJV, Boudewijn Gunning W. Idiopathic chronic sleep onset insomnia in attention‐deficit/hyperactivity disorder: A circadian rhythm sleep disorder. Chronobiology international. 2005;22(3):559-570.
• Ogundele MO, Yemula C. Management of sleep disorders among children and adolescents with neurodevelopmental disorders: A practical guide for clinicians. World Journal of Clinical Pediatrics. 2022;11(3):239.
• Owens J, Gruber R, Brown T, Corkum P, Cortese S, O’Brien L, et al. Future research directions in sleep and ADHD: report of a consensus working group. Journal of attention disorders. 2013;17(7):550-564.
• Weiss MD, Salpekar J. Sleep problems in the child with attention-deficit hyperactivity disorder: defining aetiology and appropriate treatments. CNS drugs. 2010;24:811-28.
• Morash-Conway J, Gendron M, Corkum P. The role of sleep quality and quantity in moderating the effectiveness of medication in the treatment of children with ADHD. ADHD Attention Deficit and Hyperactivity Disorders. 2017;9:31-38.
• Robb AS, Findling RL, Childress AC, Berry SA, Belden HW, Wigal SB. Efficacy, safety, and tolerability of a novel methylphenidate extended-release oral suspension (MEROS) in ADHD. Journal of Attention Disorders. 2017;21(14):1180-1191.
• Ricketts EJ, Sturm A, McMakin DL, McGuire JF, Tan PZ, Smalberg FB, et al. Changes in sleep problems across attention-deficit/hyperactivity disorder treatment: findings from the multimodal treatment of attention-deficit/hyperactivity disorder study. Journal of child and adolescent psychopharmacology. 2018;28(10):690-8.
• Chin W-C, Huang Y-S, Chou Y-H, Wang C-H, Chen K-T, Hsu JF, et al. Subjective and objective assessments of sleep problems in children with attention deficit/hyperactivity disorder and the effects of methylphenidate treatment. biomedical journal. 2018;41(6):356-63.
• Faraone SV, Po MD, Komolova M, Cortese S. Sleep-associated adverse events during methylphenidate treatment of attention-deficit/hyperactivity disorder: A meta-analysis. The Journal of clinical psychiatry. 2019;80(3):19675.
• Yoo JH, Sharma V, Kim J-W, McMakin DL, Hong S-B, Zalesky A, et al. Prediction of sleep side effects following methylphenidate treatment in ADHD youth. NeuroImage: Clinical. 2020;26:102030.
• Mulraney M, Giallo R, Lycett K, Mensah F, Sciberras E. The bidirectional relationship between sleep problems and internalizing and externalizing problems in children with ADHD: a prospective cohort study. Sleep medicine. 2016;17:45-51.
• Blackmer AB, Feinstein JA. Management of sleep disorders in children with neurodevelopmental disorders: a review. Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. 2016;36(1):84-98.
• Arboledas GP, Insuga VS, Luque MJJ, Gomariz CF, Vicario IH, Rosello AL, et al. Insomnia in children and adolescents. A consensus document. Anales de Pediatría (English Edition). 2017;86(3):165. e1-. e11.
• Ogundele MO, Yemula C, Ayyash HF. Clinical Assessment of Children and Young People with Sleep Problems and Co-Morbid Neurodevelopmental Disorders. 2023.
• Cortese S, Brown TE, Corkum P, Gruber R, O’Brien LM, Stein M, et al. Assessment and management of sleep problems in youths with attention-deficit/hyperactivity disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2013;52(8):784-96.
• Shatkin JP, Pando M. Diagnosis and treatment of common sleep disorders in adolescence. Adolescent Psychiatry. 2015;5(3):146-63.
• Buckley AW, Hirtz D, Oskoui M, Armstrong MJ, Batra A, Bridgemohan C, et al. Practice guideline: Treatment for insomnia and disrupted sleep behavior in children and adolescents with autism spectrum disorder: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2020;94(9):392-404.
• Bruni O, Angriman M, Calisti F, Comandini A, Esposito G, Cortese S, et al. Practitioner review: treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. Journal of Child Psychology and Psychiatry. 2018;59(5):489-508.
• Tsai M-H, Hsu J-F, Huang Y-S. Sleep problems in children with attention deficit/hyperactivity disorder: current status of knowledge and appropriate management. Current psychiatry reports. 2016;18:1-9.
• Rolling J, Rabot J, Schroder CM. Melatonin Treatment for Pediatric Patients with Insomnia: Is There a Place for It? Nature and Science of Sleep. 2022:1927-1944.
• Tordjman S, Chokron S, Delorme R, Charrier A, Bellissant E, Jaafari N, et al. Melatonin: pharmacology, functions and therapeutic benefits. Current neuropharmacology. 2017;15(3):434-443.
• Karasek M, Winczyk K. Melatonin in humans. Journal of physiology and pharmacology. 2006;57:19.
• Comai S, Ochoa-Sanchez R, Gobbi G. Sleep–wake characterization of double MT1/MT2 receptor knockout mice and comparison with MT1 and MT2 receptor knockout mice. Behavioural brain research. 2013;243:231-238.
• Givler D, Givler A, Luther PM, Wenger DM, Ahmadzadeh S, Shekoohi S, et al. Chronic Administration of Melatonin: Physiological and Clinical Considerations. Neurology International. 2023;15(1):518-533.
• Yuge K, Nagamitsu S, Ishikawa Y, Hamada I, Takahashi H, Sugioka H, et al. Long-term melatonin treatment for the sleep problems and aberrant behaviors of children with neurodevelopmental disorders. BMC psychiatry. 2020;20:1-14.
• Abdelgadir IS, Gordon MA, Akobeng AK. Melatonin for the management of sleep problems in children with neurodevelopmental disorders: a systematic review and meta-analysis. Archives of disease in childhood. 2018;103(12):1155-1162.
• Hoebert M, Van Der Heijden KB, Van Geijlswijk IM, Smits MG. Long‐term follow‐up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. Journal of pineal research. 2009;47(1):1-7.
• Masi G, Fantozzi P, Villafranca A, Tacchi A, Ricci F, Ruglioni L, et al. Effects of melatonin in children with attention-deficit/hyperactivity disorder with sleep disorders after methylphenidate treatment. Neuropsychiatric disease and treatment. 2019:663-667.
• Larsson I, Aili K, Lönn M, Svedberg P, Nygren JM, Ivarsson A, et al. Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review. Sleep Medicine. 2022.
• Rzepka-Migut B, Paprocka J. Efficacy and safety of melatonin treatment in children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder—a review of the literature. Brain sciences. 2020;10(4):219.
• Checa-Ros A, Muñoz-Hoyos A, Molina-Carballo A, Viejo-Boyano I, Chacín M, Bermúdez V, et al. Low Doses of Melatonin to Improve Sleep in Children with ADHD: An Open-Label Trial. Children. 2023;10(7):1121.
• der HEIJDEN KBV, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. Journal of the American Academy of Child & Adolescent Psychiatry. 2007;46(2):233-241.
• Tjon Pian Gi CV, Broeren JP, Starreveld JS, A Versteegh FG. Melatonin for treatment of sleeping disorders in children with attention deficit/hyperactivity disorder: a preliminary open label study. European Journal of Pediatrics. 2003;162:554-555.
• Mohammadi MR, Mostafavi SA, Keshavarz SA, Eshraghian MR, Hosseinzadeh P, Hosseinzadeh-Attar MJ, et al. Melatonin effects in methylphenidate treated children with attention deficit hyperactivity disorder: a randomized double blind clinical trial. Iranian journal of psychiatry. 2012;7(2):87.
• Weiss MD, Wasdell MB, Bomben MM, Rea KJ, Freeman RD. Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. Journal of the American Academy of Child & Adolescent Psychiatry. 2006;45(5):512-519.
• Bruni O, Alonso-Alconada D, Besag F, Biran V, Braam W, Cortese S, et al. Current role of melatonin in pediatric neurology: clinical recommendations. european journal of paediatric neurology. 2015;19(2):122-133.
• Zwart TC, Smits MG, Egberts TC, Rademaker CM, Van Geijlswijk IM, editors. 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: MDPI.
• Boafo A, Greenham S, Alenezi S, Robillard R, Pajer K, Tavakoli P, et al. Could long-term administration of melatonin to prepubertal children affect timing of puberty? A clinician’s perspective. Nature and science of sleep. 2019:1-10.
• Pelayo R, Yuen K. Pediatric sleep pharmacology. Child and Adolescent Psychiatric Clinics. 2012;21(4):861-883.
• Carr R, Wasdell MB, Hamilton D, Weiss MD, Freeman RD, Tai J, et al. Long‐term effectiveness outcome of melatonin therapy in children with treatment‐resistant circadian rhythm sleep disorders. Journal of pineal research. 2007;43(4):351-9.
• Van Geijlswijk IM, Mol RH, Egberts TC, Smits MG. Evaluation of sleep, puberty and mental health in children with long-term melatonin treatment for chronic idiopathic childhood sleep onset insomnia. Psychopharmacology. 2011;216:111-120.