Date of Award

2014

Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant

Department Chair

John Cavenagh, PhD, PA-C

Abstract

OBJECTIVE: The objective of this selective EBM review is to determine whether or not melatonin is an effective treatment for sleep problems in Autism.

STUDY DESIGN: Review of three English language, randomized controlled blinded trials published within peer-reviewed journals from 2006-2010 evaluating the efficacy of Melatonin as an oral sleep supplement in diagnosed autistic children.

DATA SOURCES: A double blind, randomized, placebo-controlled, crossover trial; a randomized controlled crossover trial; and a randomized controlled trial found using Cochrane, PubMed, and DynaMed.

OUTCOMES MEASURED: Total night’s sleep duration, number of awakenings, and sleep latency time were all measured using both sleep diaries, completed by the parents or caregivers, as well as Actiwatch, a device worn to measure the activity of a participant. Common side effects of Melatonin were measured using a Side Effects Questionnaire (SEQ).

RESULTS: Wirojanan et al. 2008 reported night sleep duration was longer on Melatonin than placebo by 21 minutes (p=0.02). Wright et al. 2010 reported a significant difference between Melatonin and placebo in total sleep by an average of 52.3 minutes (p=0.002). Garstang et al. 2006 reported an increase from 8.05h to 9.84h total sleep duration. Wirojanan et al. 2008 and Wright et al. 2010 reported no significant difference in number of night awakenings. Garstang et al. 2006 reported a difference between 0.35 baseline to 0.08 with Melatonin. Wirojanan et al. 2008 reported a mean sleep-onset latency shorter by 28 minutes (p=0.0001). Wright et al. 2010 reported an improvement of sleep latency by an average of 47 min (p=0.004). Garstang et al. 2006 reported a difference in sleep latency from 2.6h baseline to 1.06h with use of Melatonin. Wright et al. 2010 reported no significant side effects in the SEQ.

CONCLUSION: The results of the three studies presented evidence that the use of Melatonin to improve sleep problems in children with Autism is a safe and effective treatment option. While there is no significant improvement in the number of times a child awakens during the night, there is statistical significance to show using Melatonin improves sleep latency and total night’s sleep.

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