[The importance of a DLMO-measurement when starting and stopping melatonin in minors].

Researchers looked at studies about stopping melatonin in children and teens with sleep problems, including those with autism or ADHD. They found that sleep improvements from melatonin go away when treatment stops, but there isn't enough research to create clear guidelines about how to safely stop the medication. A special test called DLMO done before starting melatonin can help doctors predict how well the treatment will work and whether it's appropriate to start or stop.

This systematic review examined literature on discontinuing melatonin treatment in children and adolescents with sleep disorders, including those with autism spectrum disorder (ASD) or ADHD. The review found that beneficial effects of melatonin therapy on sleep onset, latency, duration, efficiency, and nocturnal activity diminish after treatment discontinuation. However, researchers could not establish evidence-based guidelines for treatment duration, timing, dosage, or discontinuation methods due to limited empirical research. The study highlighted that dim light melatonin onset (DLMO) measurements before treatment have predictive value for discontinuation outcomes and can help clinicians determine whether melatonin will have chronobiotic versus purely soporific effects.

Clinicians should consider DLMO testing before initiating melatonin to predict treatment effects and appropriateness. Current evidence is insufficient to guide discontinuation protocols, highlighting need for more research. The predictive value of DLMO measurements supports arguments for insurance coverage of this diagnostic test.

The review found limited empirical research on melatonin discontinuation in pediatric populations. Sample sizes and specific study methodologies were not reported, making it difficult to assess the robustness of available evidence.

Melatonin is used as a chronobiotic in the treatment of sleeping disorders to correct disturbances in the circadian rhythm, including in children and adolescents. dim light melatonin onset (DLMO) and the peak in plasma concentration of melatonin contribute to this circadian rhythm. International research shows that the number of prescriptions for melatonin among children and adolescents is increasing significantly. However, there appears to be little empirical research on the best way to taper and/or discontinue melatonin in this population. To assess the available literature regarding the best way to taper and/or discontinue melatonin in minors with sleep problems, with or without autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD).

A systematic review of the literature in the PubMed (Medline) and Embase databases. Several effects of the melatonin therapy on sleep onset, sleep latency, sleep duration, sleep efficiency, and nocturnal activity disappear after discontinuation of the treatment. However, we cannot formulate evidence-based guidelines regarding treatment duration, timing of administration, dosage, or the method of discontinuation. DLMO prior to treatment does, however, have predictive value for the effect of discontinuing melatonin therapy.

A DLMO-measurement prior to starting melatonin treatment provides clinicians with insight into the expected effects of melatonin during therapy. This allows for an estimation of whether melatonin will have not only a soporific but also a chronobiotic effect during treatment. Based on this information, clinicians can consider whether initiating or discontinuing melatonin therapy is appropriate. Consequently, our literature review provides a strong argument for reimbursement of DLMO-measurements by health insurance funds.