Effectiveness of ramelteon in children and adolescents with neuropsychiatric disease-related sleep disorders

Abstract

  Objective: To clarify the effectiveness of ramelteon in children and adolescents with neuropsychiatric diseases with comorbid sleep disorders. Methods: This is a retrospective review of patients aged 6 months to 23 years who were prescribed ramelteon for their sleep disorder (delayed sleep phase syndrome, non-24-hour sleep-wake disorder, and nocturnal awakening) in the Division of Neurology and General Pediatrics between January 1, 2010, and December 31, 2017. We studied the association between the effectiveness of ramelteon and the type of sleep disorder, the dosage of ramelteon per body weight, comorbidities, and other medications taken. Criteria for effectiveness were defined as less awakening or sleep at a desired time. Results: The overall success rate was 130/210 (62%). We could note the effectiveness of ramelteon in 67/104 (64%) patients with delayed sleep phase syndrome, 8/16 (50%) with non-24-hour sleep-wake disorder, and 27/44 (61%) with nocturnal awakening. Regarding comorbidities, ramelteon showed effectiveness in 12/16 (75%) of those with severe visual impairment, 21/30 (70%) with autism spectrum disorder, 19/37 (51%) with school absenteeism with orthostatic dysregulation, 56/87 (64%) with epilepsy, and 17/23 (74%) with cerebral palsy. Adverse events were seen in 11%, which had no association with the dosage per weight. Conclusions: We can use ramelteon safely for sleep disorders in children and adolescents with neuropsychiatric diseases, and expect its effectiveness in those patients with autism spectrum disorder, severe visual impairment, and cerebral palsy.