Melatonin Use Not Associated With Major Changes in Children's Sleep Architecture: JAMA
In a propensity score–matched cross-sectional study of 684 children, outpatient melatonin use was not found to be associated with significant changes in total sleep time, non-REM sleep stages, respiratory parameters, arousal patterns, or periodic limb movements. Although a small reduction in REM sleep percentage was observed, but this association weakened after accounting for psychiatric diagnoses, suggesting possible residual confounding. Therefore, prospective studies are needed to determine whether melatonin directly influences REM sleep. The study was published in JAMA Network Open by Alen J. and colleagues.
The objective sleep architecture was evaluated using the analysis of the de-identified data from the PSG recordings and EHRs gathered between 2017 and 2019 from an academic pediatric sleep laboratory. The analytic sample size included 3,392 patients (age of mean value, 8.0 years; 1,924 males [56.7%]), which includes 346 cases of melatonin use and 3,046 cases of no melatonin use. The formal analysis of the data occurred from January to March 2026.
To avoid bias due to indication, 1:1 nearest-neighbor propensity score matching was performed on critical covariates that included age, gender, body mass index percentile, total comorbid burden, obstructive sleep apnea, and epilepsy. The final matched cohort included 684 cases (342 users and 342 nonusers). The primary prespecified outcome was percentage of REM sleep, and 14 other PSG variables were analyzed using Benjamini-Hochberg FDR correction.
Key findings:
- Melatonin consumers had significantly lower mean REM sleep percentage than their matched counterparts (16.7% [IQR, 11.6%–22.0%] vs 19.0% [IQR, 14.6%–23.2%]; Hedges g = −0.22 [95% confidence interval (CI), −0.32 to −0.11]; and false discovery rate (FDR)-corrected P = .003).
- The two groups did not differ significantly with respect to the other 14 exploratory outcomes, such as total sleep time, sleep efficiency or non-REM stages (N1, N2, N3), respiratory disturbance indices, arousal index, periodic limb movements and oxygen desaturation index (FDR-corrected P > .05).
- The negative correlation with REM sleep remained significant even after varying the number of non-users.
- After accounting for certain common psychiatric disorders (attention deficit hyperactivity disorder, anxiety, depression), there were still differences, albeit weaker ones, found (16.6% [IQR, 11.6%–22.0%] vs 18.4% [IQR, 13.4%–22.8%]; Hedges g = −0.17 [95% CI, −0.27 to −0.06]; P = .01).
In summary, in this cross-sectional study involving 684 propensity score-matched children, outpatient melatonin administration was found to be associated with a modest decrease in the percentage of REM sleep but no associations with any other measures of sleep duration, non-REM sleep stage, breathing, arousal or periodic limb movements.
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
