A Review of the Use of Clonidine as a Sleep Aid in the Child and Adolescent Population

Nguyen, Mathew; Tharani, Shalini; Rahmani, Mariam; Shapiro, Michael A.

doi:10.1177/0009922813502123

Cited by 38 publications

(20 citation statements)

References 29 publications

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“…It would also be helpful to compare the effectiveness of melatonin with alternative pharmacological interventions that act on neurophysiological sleep mechanisms, such as sedation. None of the studies on clonidine – a sedative known to be used with children – met our eligibility criteria; therefore further research is needed to clarify any possible role clonidine may have. Further research is also needed on different formulations and dosages of pharmacological interventions.…”

Section: Discussionmentioning

confidence: 99%

Oral melatonin for non‐respiratory sleep disturbance in children with neurodisabilities: systematic review and meta‐analyses

Parker

Beresford

Dawson³

et al. 2019

Develop Med Child Neuro

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Aim To evaluate the effectiveness of pharmacological interventions for managing non‐respiratory sleep disturbances in children with neurodisabilities. Method We performed a systematic review and meta‐analyses of randomized controlled trials ( RCT s). We searched 16 databases, grey literature, and reference lists of included papers up to February 2017. Data were extracted and assessed for quality by two researchers (B.B., C.M., G.S., A.S., A.P.). Results Thirteen trials were included, all evaluating oral melatonin. All except one were at high or unclear risk of bias. There was a statistically significant increase in diary‐reported total sleep time for melatonin compared with placebo (pooled mean difference 29.6min, 95% confidence interval [ CI ] 6.9–52.4, p =0.01). Statistical heterogeneity was high (97%). For the single RCT with low risk of bias, the unadjusted mean difference in total sleep time was 13.2 minutes (95% CI −13.3 to 39.7) favouring melatonin, while the mean difference adjusted for baseline total sleep time was statistically significant (22.4min, 95% CI 0.5–44.3, p =0.04). Adverse event profile suggested that melatonin was well‐tolerated. Interpretation There is a paucity of evidence on managing sleep disturbances in children with neurodisabilities, and it is mostly of limited scope and poor quality. There is evidence of the benefit and safety of melatonin compared with placebo, although the extent of this benefit is unclear. What this paper adds Melatonin for the management of non‐respiratory sleep disturbances in children with neurodisabilities was well tolerated with minimal adverse effects. The extent of benefit and which children might benefit most from melatonin use is uncertain. Benefit may be greatest in those with autism spectrum disorder; however, this finding should be interpreted with caution.

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Section: Discussionmentioning

confidence: 99%

Oral melatonin for non‐respiratory sleep disturbance in children with neurodisabilities: systematic review and meta‐analyses

Parker

Beresford

Dawson³

et al. 2019

Develop Med Child Neuro

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“…The reduced firing of presynaptic neurons releasing norepinephrine into the prefrontal cortex improves the impulsive and hyperactive behavior seen in attention-deficit/hyperactivity disorder. 17 Adjunctive effects on serotonin and c-aminobutyric acid receptors make a-2 agonists the most widely used medications to treat insomnia in children with attention-deficit/hyperactivity disorder. 18 Clonidine is also useful in the treatment of chronic pain disorders and opiate, benzodiazepine, alcohol, cocaine, food, and tobacco withdrawal.…”

Section: Clonidinementioning

confidence: 99%

Alpha-2 Adrenergic Receptor Agonists: A Review of Current Clinical Applications

Giovannitti¹,

Thoms

Crawford

2015

Anesthesia Progress

449

265

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The a-2 adrenergic receptor agonists have been used for decades to treat common medical conditions such as hypertension; attention-deficit/hyperactivity disorder; various pain and panic disorders; symptoms of opioid, benzodiazepine, and alcohol withdrawal; and cigarette craving.1 However, in more recent years, these drugs have been used as adjuncts for sedation and to reduce anesthetic requirements. This review will provide an historical perspective of this drug class, an understanding of pharmacological mechanisms, and an insight into current applications in clinical anesthesiology.

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“…The inhibition of the efferent sympathetic pathway results in a decrease in the vascular tone of the heart and kidneys and peripheral vasculature, and a decrease in peripheral resistance, which is the main mechanism by which clonidine regulates blood pressure. 17 Clonidine has been used for the treatment of ADHD, [12][13][14] and was also recently found to have a sedating effect, most likely as a result of its affinity for the a 2B -receptor subtype expressed in the thalamus, 18 and the a 2A -and a 2C -adrenoceptor subtypes expressed in neurons in the locus coeruleus and axons throughout the cortex. 19 The mechanisms by which clonidine improved enuresis in the present refractory patients are not clear, but there are two possibilities.…”

Section: Discussionmentioning

confidence: 99%