Farmacoterapia da insônia na infância e adolescência: uma revisão sistemática

Abstract

Among sleep disorders, insomnia is the most prevalent worldwide, affecting approximately 45% of the global population. It is estimated that 25% of children and 34% of adoles- cents experience difficulties sleeping. Insomnia Disorder (ID) has its own neurobiological mechanisms associated with behavioral, cognitive, and psychosocial changes. Additionally, insomnia is commonly observed as a comorbidity in children, especially those with neu- rodevelopmental disorders. Pharmacological treatments investigated for pediatric insomnia include antihistamines, benzodiazepines, Z-class drugs and melatonin. However, there is limited evidence for the prescription of these medications. This study aims to identify the current pharmacological treatment used in insomniac children and adolescents, evaluating efficacy, safety, and adverse effects. An extensive literature search was conducted, encom- passing electronic bibliographic databases and clinical trial registries, between December 2022 and January 2023. Among the 181 studies identified, only 10 were included in the analysis. It was observed that 12.5% of the studies were considered to have low risk of bias in all domains, while 37.5% had identified issues in at least one domain, which could affect the validity of the results. Additionally, 50% of the randomized studies were classified as high risk of bias, suggesting a significant potential for bias. Melatonin was the most investigated drug in the selected studies. Regarding adverse effects, side effects were reported with the use of supplemental melatonin, eszopiclone, and flurazepam. To obtain more robust conclusions about the efficacy and safety of the investigated medications, study replication and further research are needed.