Journal des troubles du sommeil et de la thérapie
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Sleeping Pills and Quality of Wake Time: The Missing Link

Sohil A Khan1, Treasure M McGuire and Helen S Heussler

Background: The rising incidence of insomnia in a 24/7 global society quantifies the burden for the individual, in terms of reduced quality of life (QOL), and for society at large, in terms of work absenteeism, disability, and health care costs. Aim: To evaluate research on hypnosedatives (benzodiazepines, non-benzodiazepines) and complementary medicines in paediatric insomnia where quality of wake time is one of the key efficacy outcomes. Design and setting: Retrospective data analysis of clinical studies in paediatric insomnia

Methods: A systematic review of clinical studies of hypnosedatives and complementary medicines in paediatric insomnia was conducted. PubMed and Cochrane Central Register of Controlled Trials (January 2002- August 2013) were searched for studies in children aged 3 to18 years (male or female). Quality of wake time and/or health related QOL parameters were assessed as the outcomes. Results: From 31 potentially relevant studies, only one, involving melatonin, met the inclusion criteria. One hundred and forty six children (aged 3 to15 years 8 months) diagnosed with insomnia were evaluated in a 12 week double masked randomised placebo controlled phase III multi-centre trial. Child behaviour and family functioning showed some improvement and favoured use of melatonin but was not statistically significant. There were no controlled clinical studies evaluating the impact of benzodiazepines and non-benzodiazepines hypnosedatives on quality of wake time in the management of paediatric insomnia.

Conclusion: Data on quality of wake time in children with insomnia are scarce. Research has focused on addressing the metrics of sleep, with quality of wake time notably ignored. QOL measurement provides valuable information about the psychological and social impact of treatment on children with insomnia. Complementary medicines such as melatonin appear to improve the quality of wake time in paediatric insomnia where there are comorbid conditions; but further research is needed.