It is not always possible to achieve spontaneous sleep of children for EEG recording, leading to occasional utilisation of pharmacological sleep inducing agents. Most commonly used agent in Clinical Department of Child, Adolescent and Developmental Neurology (in Slovenian KOOMRN) in recent years is oral melatonin, that sometimes fails to induce or sustain sleep, particularly in patients with complex behavioural issues (developmental delay, pervasive developmental disorders, intellectual disability). Henceforth, this study compares it's efficacy with dexmedetomidine, that is specific agonist for alpha 2 receptors in locus coeruleus, which activate engonenes ways for sleep with inhibiting neural noradrenalgic activity.
This prospective, randomized, parallel assignment study recruited 156 children between the ages of 1 and 19, who were hospitalised in KOOMRN for sleep EEG recording. The participants were randomly by draw divided into three groups: melatonin group - M (n=54; dose:0.1mg/kg), dexmedetomidine sublingual group - DS (n=51, dose: 3mcg/kg) or dexmedetomidine intranasal group - DN (n=51, dose: 3mcg/kg). ). In case the participant did not reach at least the first stage of sleep 30 minutes after the first drug application, the draw was held again for the second drug. The participant who received melatonin as the first drug, then received dexmedetomidine as the second drug, and vice versa. The groups were compared according to several parameters regarding efficacy and safety, application difficulty, aversive behavior, and impact on sleep. Comparisons were also made among different age groups as well as complex behavioral problems.
Sleep was obtained in 99.4% of participants, 93.6% after the first application of the drug. D was more efficient at the first application than M (p ⡤ 0.001, D was efficient in 99%, M in 81.8%). D was more efficient in all age groups and in the group of patients with complex developmental issues, where D was efficient in 100% and M in 73.4% (p ⡤ 0,001). On average, the participants fell asleep after 18.1 minutes (SD 8,661). The patients fell asleep the fastest after intranasal application of D, yet a statistically significant difference was detected only between the DS and DN groups (p = 0.006; M (M): 16.75, SD (M): 6.758; M (DS): 22.25, SD (DS): 9.123; M (DN): 16.24, SD (DN): 8.437). Participants in the youngest age group fell asleep the fastest, and the oldest group took the longest. During the entire EEG recording slept 78,3% of the participants. The participants in all three groups spent the longest time/most of the time during the recording in the 2nd nREM phase of sleep. Nevertheless, the children who received D were more likely to reach deeper stages of sleep (p < 0,05). Additionally, the vital signs were monitored throughout the recodring and demonstrated that no one in the study developed respiratory depression, bradycardia, desaturation, or hypotension. Restlessness was present in 32.7% of children before the application of the agent and in only 18.6% after the application. Intranasal application was the most difficult while oral application was the easiest (p < 0,05).
In conclusion, melatonin and dexmedetomidine are both safe to use for sleep induction prior to EEG recording in children. However, dexmedetomidine, especially with intranasal application, is more effective at inducing sleep than melatonin, particularly in children with complex behavioral issues.
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