Melatonin Use in Children May Slightly Reduce REM Sleep: JAMA
USA: An observational study of 684 propensity score–matched pediatric patients has found that melatonin use was associated with a small reduction in the percentage of REM sleep. However, melatonin was not associated with differences in total sleep time, non-REM sleep stages, respiratory parameters, arousal patterns, or periodic limb movements.
The association with reduced REM sleep was weaker after accounting for psychiatric diagnoses. Because the study was observational, residual confounding cannot be excluded. Prospective studies assessing melatonin dose, timing, and adherence are needed to determine whether melatonin directly affects REM sleep.
The study, published in JAMA Network Open, was conducted by Alen Juginovic from the Department of Neurobiology, Harvard Medical School, Boston, Massachusetts, and Laura Rodman from the Faculty of Veterinary Medicine, University of Zagreb, Zagreb, Croatia.
Melatonin is commonly used for pediatric sleep problems, but its effects on objectively measured sleep architecture remain unclear. Researchers assessed this association using polysomnography (PSG) data from the Nationwide Children’s Hospital Sleep DataBank, covering children evaluated between 2017 and 2019.
The analysis included 3,392 children with adequate PSG and complete clinical data, of whom 346 were melatonin users and 3,046 were nonusers. After propensity score matching for age, sex, BMI percentile, comorbidities, obstructive sleep apnea, and epilepsy, 342 matched pairs were analyzed.
The primary outcome was REM sleep percentage. Researchers also examined total sleep time, sleep efficiency, NREM stages, respiratory measures, arousal index, periodic limb movements, and oxygen desaturation.
Key findings included:
- Melatonin users spent a median of 16.7% of sleep time in REM compared with 19.0% among matched nonusers.
- The difference corresponded to a small effect size (Hedges g, −0.22).
- No significant differences were observed in total sleep time or sleep efficiency.
- NREM sleep stages, respiratory measures, arousal indices, periodic limb movements, and oxygen desaturation also showed no significant differences.
- The REM finding remained evident when alternative matching approaches and repeated PSG recordings were considered.
- After adjustment for attention-deficit/hyperactivity disorder, anxiety, and depression, the difference in REM sleep became smaller but remained statistically significant.
The study was limited by its cross-sectional design, which precludes causal conclusions. Prescription records lacked details on melatonin dose, timing, duration, formulation, and adherence, while over-the-counter use may have been missed. The single-center, referred population and single-night PSG assessment also limit the generalizability of the findings.
The authors concluded that melatonin use was linked to a modest reduction in REM sleep but not to other major sleep parameters. Prospective studies with detailed data on melatonin use and repeated sleep assessments are needed to determine whether this association reflects a direct drug effect or residual confounding.
Reference:
Juginovic A, Rodman L. Melatonin Use and Polysomnographic Sleep Architecture in Children. JAMA Netw Open. 2026;9(8):e2626983. doi:10.1001/jamanetworkopen.2026.26983
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