Galli-Carminati Giuliana, Deriaz Nicolas, Bertschy Gilles
Division of adult psychiatry, Department of Psychiatry, University Hospital of Geneva, Geneva, Switzerland.
Swiss Med Wkly. 2009 May 16;139(19-20):293-6. doi: 10.4414/smw.2009.12342.
Melatonin may be used to treat sleep disorders in both children and adults with intellectual disability. The evidence for its efficacy, potential adverse effects and drug interactions are reviewed in the context of prescription of melatonin to patients with autism.
This study presents the use of melatonin to treat severe circadian sleep-wake disturbances in 6 adults with autism. Melatonin was initiated at a daily dose of 3 mg at nocturnal bedtime. If this proved ineffective, the melatonin dose was titrated over the following 4 weeks at increments of 3 mg/2 weeks up to a maximum of 9 mg, unless it was tolerated. Assessments included Clinical Global Impression-Severity (CGI-S) and CGI-Improvement (CGI-I).
Melatonin administered in the evening dramatically improved the sleep-wake pattern in all patients. Melatonin appears to be effective in reducing sleep onset latency and is probably effective in improving nocturnal awakenings and total sleep time in adults with autism. Its effectiveness remained stable for the 6-month period of administration. Melatonin was well tolerated in all patients and no side effects were noted during the therapy.
Melatonin appears to be promising as an efficient and seemingly safe alternative for treatment of severe circadian sleep disturbances in adults with autism. There may be heterogeneity of response depending on the nature of the sleep problem and cause of the intellectual disability or associated disabilities. Further studies are necessary before firm conclusions can be drawn and guidelines for the use of melatonin in people with autism formulated.
褪黑素可用于治疗儿童和成人智力障碍患者的睡眠障碍。本文在给自闭症患者开具褪黑素处方的背景下，对其疗效、潜在不良反应和药物相互作用的证据进行了综述。
本研究介绍了褪黑素用于治疗6名成年自闭症患者严重昼夜节律性睡眠-觉醒障碍的情况。褪黑素于夜间就寝时开始服用，初始剂量为每日3毫克。如果证明无效，在接下来的4周内，以每2周增加3毫克的幅度滴定褪黑素剂量，直至最大剂量9毫克，除非患者能够耐受。评估包括临床总体印象-严重程度（CGI-S）和临床总体印象-改善程度（CGI-I）。
晚上服用褪黑素显著改善了所有患者的睡眠-觉醒模式。褪黑素似乎能有效缩短入睡潜伏期，可能对改善成年自闭症患者的夜间觉醒和总睡眠时间有效。在给药的6个月期间，其有效性保持稳定。所有患者对褪黑素耐受性良好，治疗期间未观察到副作用。
褪黑素似乎有望成为治疗成年自闭症患者严重昼夜节律性睡眠障碍的一种有效且看似安全的替代方法。根据睡眠问题的性质以及智力障碍或相关残疾的原因，反应可能存在异质性。在得出确切结论并制定自闭症患者使用褪黑素的指南之前，还需要进一步研究。
