van Maanen Annette, Meijer Anne Marie, Smits Marcel G, Oort Frans J
Research Institute Child Development and Education, University of Amsterdam, Amsterdam.
Centre for Sleep-Wake Disorders and Chronobiology, Hospital Gelderse Vallei, Ede, the Netherlands.
Nat Sci Sleep. 2017 Mar 9;9:67-79. doi: 10.2147/NSS.S129203. eCollection 2017.
Melatonin treatment is effective in treating sleep onset problems in children with delayed melatonin onset, but effects usually disappear when treatment is discontinued. In this pilot study, we investigated whether classical conditioning might help in preserving treatment effects of melatonin in children with sleep onset problems, with and without comorbid attention deficit hyperactivity disorder (ADHD) or autism. After a baseline week, 16 children (mean age: 9.92 years, 31% ADHD/autism) received melatonin treatment for 3 weeks and then gradually discontinued the treatment. Classical conditioning was applied by having children drink organic lemonade while taking melatonin and by using a dim red light lamp that was turned on when children went to bed. Results were compared with a group of 41 children (mean age: 9.43 years, 34% ADHD/autism) who received melatonin without classical conditioning. Melatonin treatment was effective in advancing dim light melatonin onset and reducing sleep onset problems, and positive effects were found on health and behavior problems. After stopping melatonin, sleep returned to baseline levels. We found that for children without comorbidity in the experimental group, sleep latency and sleep start delayed less in the stop week, which suggests an effect of classical conditioning. However, classical conditioning seems counterproductive in children with ADHD or autism. Further research is needed to establish these results and to examine other ways to preserve melatonin treatment effects, for example, by applying morning light.
褪黑素治疗对褪黑素分泌延迟的儿童入睡问题有效，但治疗停止后效果通常会消失。在这项初步研究中，我们调查了经典条件反射是否有助于维持褪黑素对有或没有共病注意力缺陷多动障碍（ADHD）或自闭症的入睡问题儿童的治疗效果。在基线周之后，16名儿童（平均年龄：9.92岁，31%患有ADHD/自闭症）接受了3周的褪黑素治疗，然后逐渐停止治疗。通过让儿童在服用褪黑素时饮用有机柠檬水以及在儿童上床睡觉时打开暗红色的灯来应用经典条件反射。将结果与41名未接受经典条件反射的接受褪黑素治疗的儿童（平均年龄：9.43岁，34%患有ADHD/自闭症）进行比较。褪黑素治疗在提前暗光褪黑素分泌起始时间和减少入睡问题方面有效，并且在健康和行为问题上发现了积极效果。停止服用褪黑素后，睡眠恢复到基线水平。我们发现，对于实验组中没有共病的儿童，在停药周睡眠潜伏期和入睡延迟减少，这表明经典条件反射有效果。然而，经典条件反射对患有ADHD或自闭症的儿童似乎适得其反。需要进一步研究来证实这些结果，并研究其他维持褪黑素治疗效果的方法，例如，通过应用早晨的光线。
