Çocuk ve Ergenlerde Uyku Bozukluklarının Tedavisinde Kullanılan İlaçlar
Özet
Çocuk ve ergenlerde uyku bozukluklarının farmakolojik tedavisi, bu yaş grubuna yönelik onaylanmış ilaçların eksikliği ve sınırlı klinik veriler nedeniyle büyük bir hassasiyet gerektirmektedir. Mevcut uygulamalar genellikle yetişkin verilerine veya vaka raporlarına dayanmakta, ilaç tedavisi ise nadiren tek seçenek olarak sunulup mutlaka davranışsal stratejiler ve uyku hijyeni eğitimleri ile desteklenmektedir. Tedavi planlanırken net hedefler belirlenmeli, en düşük dozla başlanmalı ve özellikle bağımlılık veya rebound uykusuzluk riski taşıyan benzodiazepinler gibi ajanların kesilme süreci kademeli olarak yönetilmelidir. Klinik pratikte en sık reçete edilen seçenekler arasında antihistaminikler, melatonin ve DEHB ile ilişkili durumlarda alfa agonistler (klonidin) yer almaktadır. Melatonin, özellikle nörogelişimsel bozukluğu olan çocuklarda etkinliği ampirik olarak daha fazla desteklenen bir seçenek olarak öne çıkarken; antidepresanlar ve antipsikotikler genellikle eşlik eden psikiyatrik tanılar varlığında tercih edilmektedir. Güvenlik profili açısından, ilaçların metabolizma farklılıkları, potansiyel yan etkileri ve diğer ilaçlarla etkileşimleri titizlikle izlenmelidir. Sonuç olarak, çocuklara özgü tedavi algoritmalarının geliştirilmesi ve multidisipliner bir yaklaşım benimsenmesi, tedavinin başarısı ve güvenliği için kritik öneme sahiptir.
The pharmacological treatment of sleep disorders in children and adolescents requires significant sensitivity due to the lack of approved medications for this age group and limited clinical data. Current practices are generally based on adult data or case reports, and drug therapy is rarely offered as the sole option, necessarily being supported by behavioral strategies and sleep hygiene education. When planning treatment, clear goals should be established, starting with the lowest dose, and the discontinuation process of agents such as benzodiazepines, which carry risks of addiction or rebound insomnia, must be managed gradually. In clinical practice, the most frequently prescribed options include antihistamines, melatonin, and alpha agonists (clonidine) in cases associated with ADHD. Melatonin stands out as an option with more empirical support for its effectiveness, especially in children with neurodevelopmental disorders, while antidepressants and antipsychotics are generally preferred in the presence of comorbid psychiatric diagnoses. Regarding safety profiles, metabolic differences of drugs, potential side effects, and interactions with other medications must be rigorously monitored. Consequently, developing child-specific treatment algorithms and adopting a multidisciplinary approach are critical for the success and safety of the treatment.
Referanslar
Mindell JA, Emslie G, Blumer J, Genel M, Glaze D, Ivanenko A, et al. Pharmacologic management of insomnia in children and adolescents: Consensus statement. Pediatrics. 2006;117(6).
Öztop DB, Lushi-Şan Z. Uyku Bozukluklarının Tedavisi. In: Çocuk ve Ergen Psikofarmakolojisi. 2015. p. 277–301.
Owens JA. Pharmacology of Sleep. In: Principles and Practice of PEDIATRIC SLEEP MEDICINE. 2014. p. 53–61.
Owens JA, Rosen CL, Mindell JA. Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics. 2003 May 1;111(5 Pt 1):e628–35.
Mindell JA, Kuhn B, Lewin DS, Meltzer LJ, Sadeh A. Behavioral treatment of bedtime problems and night wakings in infants and young children. Sleep. 2006;29(10):1263–76.
Mindell JA, Williamson AA. Benefits of a bedtime routine in young children: Sleep, development, and beyond. Vol. 40, Sleep Medicine Reviews. Sleep Med Rev; 2018. p. 93–108.
Bhargava S. Diagnosis and management of common sleep problems in children. Vol. 32, Pediatrics in Review. 2011. p. 91–9.
Pelayo R, Dubik M. Pediatric Sleep Pharmacology. Semin Pediatr Neurol. 2008 Jun;15(2):79–90.
Ekambaram V, Owens J. Medications Used for Pediatric Insomnia. Vol. 30, Child and Adolescent Psychiatric Clinics of North America. 2021. p. 85–99.
Sateia MJ, Buysse DJ, Krystal AD, Neubauer DN, Heald JL. Clinical Practice Guideline for the Pharmacologic Treatment of Chronic Insomnia in Adults: An American academy of sleep medicine clinical practice guideline. J Clin Sleep Med. 2017;13(2):307–49.
Dujardin S, Pijpers A, Pevernagie D. Prescription Drugs Used in Insomnia. Vol. 13, Sleep Medicine Clinics. Elsevier; 2018. p. 169–82.
Maski K, Owens J. Pediatric Sleep Disorders. Vol. 24, CONTINUUM Lifelong Learning in Neurology. Continuum (Minneap Minn); 2018. p. 210–27.
Pelayo R, Dubik M. Pediatric Sleep Pharmacology. Semin Pediatr Neurol. 2008 Jun;15(2):79–90.
Zisapel N. Drugs for insomnia. Vol. 17, Expert Opinion on Emerging Drugs. Taylor & Francis; 2012. p. 299–317.
Merenstein D, Diener-West M, Halbower AC, Krist A, Rubin HR. The trial of infant response to diphenhydramine: The TIRED study - A randomized, controlled, patient-oriented trial. Arch Pediatr Adolesc Med. 2006;160(7):707–12.
Owens JA, Rosen CL, Mindell JA, Kirchner HL. Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey. Sleep Med. 2010 Aug;11(7):692–700.
Troester MM, Pelayo R. Pediatric Sleep Pharmacology: A Primer. Semin Pediatr Neurol. 2015;22(2):135–47.
Ioachimescu OC, El-Solh AA. Pharmacotherapy of insomnia. Vol. 13, Expert Opinion on Pharmacotherapy. Taylor & Francis; 2012. p. 1243–60.
Matheson E, Hainer BL. Insomnia: Pharmacologic Therapy. Am Fam Physician. 2017;96(1):29–35.
Witek MW, Rojas V, Alonso C, Minami H, Silva RR. Review of benzodiazepine use in children and adolescents. Vol. 76, Psychiatric Quarterly. Springer; 2005. p. 283–96.
Möhler H, Fritschy JM, Rudolph U. A new benzodiazepine pharmacology. Vol. 300, Journal of Pharmacology and Experimental Therapeutics. 2002. p. 2–8.
Zammit GK, Corser B, Doghramji K, Fry JM, James S, Krystal A, et al. Sleep and residual sedation after administration of zaleplon, zolpidem, and placebo during experimental middle-of-the-night awakening. J Clin Sleep Med. 2006 Oct 15;2(4):417–23.
Zammit G. Comparative tolerability of newer agents for insomnia. Vol. 32, Drug Safety. Springer; 2009. p. 735–48.
Liu J, Wang LN. Ramelteon in the treatment of chronic insomnia: Systematic review and meta-analysis. Vol. 66, International Journal of Clinical Practice. John Wiley & Sons, Ltd; 2012. p. 867–73.
Owens JA, Moturi S. Pharmacologic Treatment of Pediatric Insomnia. Vol. 18, Child and Adolescent Psychiatric Clinics of North America. 2009. p. 1001–16.
Owens JA, Rosen CL, Mindell JA, Kirchner HL. Use of pharmacotherapy for insomnia in child psychiatry practice: A national survey. Sleep Med. 2010 Aug 1;11(7):692–700.
Wichniak A, Wierzbicka A, Jernajczyk W. Sleep and Antidepressant Treatment. Curr Pharm Des. 2012 Oct 23;18(36):5802–17.
Kierlin L, Littner MR. Parasomnias and antidepressant therapy: A review of the literature. Front Psychiatry. 2011;2(DEC):71.
Keshavan MS, Prasad KM, Montrose DM, Miewald JM, Kupfer DJ. Sleep quality and architecture in quetiapine, risperidone, or never-treated schizophrenia patients. Vol. 27, Journal of Clinical Psychopharmacology. 2007. p. 703–5.
