McArthur A J, Budden S S
Department of Psychiatry, Oregon Health Sciences University, Portland 97201-3098, USA.
Dev Med Child Neurol. 1998 Mar;40(3):186-92. doi: 10.1111/j.1469-8749.1998.tb15445.x.
Nine girls with Rett syndrome (mean age, 10.1 years) were monitored 24 hours a day over a period of 10 weeks using wrist actigraphy. Baseline sleep-wake patterns were assessed for 1 week. Subsequently, patients underwent a 4-week melatonin treatment period in a double-blind, placebo-controlled, crossover protocol that employed a 1-week washout between treatment trials. Melatonin doses ranged from 2.5 to 7.5 mg, based upon individual body weight. Baseline sleep quality was poor compared with healthy children. At baseline the group demonstrated a low sleep efficiency (mean [+/- SE], 68.0+/-3.9%), long sleep-onset latency (42.1+/-12.0 minutes), and a short and fragmented total sleep time (7.5+/-0.3 hours; 15+/-2 awakenings per night). Melatonin significantly decreased sleep-onset latency to (mean +/- SE) 19.1+/-5.3 minutes (P<0.05) during the first 3 weeks of treatment. While the variability of individual responsiveness was high, melatonin appeared to improve total sleep time and sleep efficiency in the patients with the worse baseline sleep quality. Finally, a 4-week administration of melatonin appears to be a safe treatment as no adverse side effects were detected, yet long-term effects of chronic melatonin use in pediatric patients are unknown at this time.
对9名雷特综合征女孩（平均年龄10.1岁）使用腕部活动记录仪进行了为期10周的每日24小时监测。评估了1周的基线睡眠-觉醒模式。随后，患者按照双盲、安慰剂对照、交叉方案接受了为期4周的褪黑素治疗期，治疗试验之间有1周的洗脱期。根据个体体重，褪黑素剂量范围为2.5至7.5毫克。与健康儿童相比，基线睡眠质量较差。在基线时，该组表现出睡眠效率低（平均[±标准误]，68.0±3.9%）、入睡潜伏期长（42.1±12.0分钟）以及总睡眠时间短且碎片化（7.5±0.3小时；每晚15±2次觉醒）。在治疗的前3周，褪黑素显著将入睡潜伏期缩短至（平均±标准误）19.1±5.3分钟（P<0.05）。虽然个体反应性的变异性很高，但褪黑素似乎改善了基线睡眠质量较差患者的总睡眠时间和睡眠效率。最后，4周的褪黑素给药似乎是一种安全的治疗方法，因为未检测到不良副作用，但目前尚不清楚儿科患者长期使用褪黑素的长期影响。
