Elsevier

Sleep Medicine

Volume 3, Issue 2, March 2002, Pages 159-161
Sleep Medicine

Case report
Dose response to melatonin treatment for disordered sleep rhythm in a blind child

https://doi.org/10.1016/S1389-9457(01)00159-9Get rights and content

Abstract

We assessed the effectiveness and safety of melatonin in normalizing sleep in a 7-year-old blind child with a longstanding sleep/wake cycle disorder, using a double-masked, randomized treatment trial of placebo, a physiological dose (0.14 mg) and a supraphysiological dose (2.2 mg) of melatonin. Sleep onset and sleep offset were erratic and inappropriately early with placebo and low dose melatonin, but improved significantly on high dose melatonin. This report confirms that melatonin may be effective in treatment of disordered sleep rhythm in blind children, and illustrates a protocol that enables dose adjustment for optimal treatment response.

Introduction

Blindness is often accompanied by disrupted circadian rhythms and sleep problems [1]. Melatonin treatment has been successful in restoring a normal sleep pattern in some blind adults and children [2], [3]. We describe results of a placebo-controlled masked study of two doses of melatonin in a blind child.

Section snippets

Case report

The patient is a 7-year-old boy with blindness, static encephalopathy and long standing sleep disorder. He suffered birth asphyxia and has septo-optic dysplasia with lack of light perception, absent pupillary light reflexes and hypopituitarism that is well controlled by growth hormone, thyroxine and cortisol. His sleep pattern is disruptive, he falls asleep between 16:00 and 18:00 h or earlier and gets up between 01:00 and 04:00 h. The family history did not disclose any sleep disorder or other

Methods

The Institutional Review Board approved the protocol and the parents gave written consent. The study consisted of three consecutive 8-week treatment phases of melatonin or placebo using a randomized double-masked design that followed an initial phase of 4 weeks of adaptation to the protocol. Placebo, low dose melatonin (7 μg/kg) and high dose melatonin (110 μg/kg) were assigned in random order by the investigational drug pharmacist. Investigators and parents remained blinded to the dose used in

Results

The order of treatment was phase 1-placebo, phase 2-low dose melatonin and phase 3-high dose melatonin. During the 4 weeks of adaptation and the 8 weeks of phase 1 the child cooperated with continuous use of the actigraph. The sleep logs and actigraphy demonstrated erratic sleep, particularly irregular sleep onset time often in the mid-afternoon – 15:30 or 16:00 h. In addition, waking times were inappropriately early, 01:00–04:00 h. The observation noted in the sleep diary that the child would

Discussion

An impact of birth asphyxia on the child's sleep problem cannot be excluded, although children with static encephalopathy without blindness typically present multiple nocturnal awakenings rather than an abnormal sleep rhythm. This child's sleep problem may be classified as advanced sleep phase syndrome, as described in some adults with blindness [9]. Alternatively, because of the anatomic abnormality of the anterior visual pathways, we surmise that this child had disrupted circadian rhythm

Acknowledgements

Supported in part by USPHS Grant RR-08084 from the National Center for Research Resources, General Clinical Research Centers Program, NIH, by the Abrahamson Pediatric Eye Institute and by grant EY00384 from the National Eye Institute (W.V.G.).

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1

Present address: The Smith-Kettlewell Eye Institute, 2318 Filmore Street, San Francisco, CA 94115-1821, USA.

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