PEDIATRICS Vol. 119 No. 6 June 2007, pp. 1047-1055 (doi:10.1542/peds.2006-2773)
ARTICLE |
Use of Sleep Medications in Hospitalized Pediatric Patients
a Department of Pediatrics, Children's Hospital of Philadelphia and University of Pennsylvania, Philadelphia, Pennsylvania
b Department of Psychology, Saint Joseph's University, Philadelphia, Pennsylvania
c Division of Ambulatory Pediatrics, Hasbro Children's Hospital and Brown University, Providence, Rhode Island
d Department of Pediatrics, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
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ABSTRACT |
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 TOP ABSTRACT METHODSRESULTSDISCUSSIONREFERENCES |
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OBJECTIVE. Little is known about the medications prescribed for sleep in hospitalized children. The aims of this study were to (1) determine the percentage of hospitalized children who receive medication for sleep disturbances, (2) determine what medications are prescribed for sleep difficulties, and (3) examine medical and demographic variables related to medications prescribed during hospitalization.
PATIENTS AND METHODS. A chart review was conducted for all inpatients at 3 pediatric hospitals across 26 randomly selected days in 2004. Demographic, medical, and medication data were collected on 9440 patients. The sample was 54.5% male, had a mean age of 7.0 years, and was 63% white. Almost 19% of the patients had at least 1 psychiatric diagnosis.
RESULTS. Overall, 6.0% of all hospitalized children (3% of all medically hospitalized children, excluding children with a psychiatric diagnosis) were prescribed medications for sleep, with antihistamines the most frequently prescribed medication (36.6%), followed by benzodiazepines (19.4%); hypnotic agents were the least frequently prescribed (2.2%). Significant differences were found in both the frequency of sleep-medication prescriptions and the types of medications used across hospitals, as well as for age, length of hospitalization, and service that the child was discharged from. Children with a psychiatric diagnosis were more likely to receive a sleep medication, with 22% of children on a psychiatric service receiving a sleep-related medication.
CONCLUSIONS. Approximately 3% to 6% of children are treated pharmacologically with a broad array of sleep medications in hospital settings. Prescription practices vary by hospital, medical service, child age, and diagnosis. The results from this study indicate that medications are being prescribed for sleep in hospitalized children, especially in children with psychiatric diagnoses. However, given that there are neither Food and Drug Administration–approved sleep medications for children nor clinical consensus guidelines regarding their use, clinical trials, practice guidelines, and additional research are clearly needed.
Key Words: insomnia • children • adolescents • pharmacotherapy • hospitalization
Abbreviations: FDA—Food and Drug Administration • ADHD—attention-deficit/hyperactivity disorder • CHOP—Children's Hospital of Philadelphia • CCHMC—Cincinnati Children's Hospital Medical Center • HCH—Hasbro Children's Hospital • NS—not significant • OR—odds ratio • CI—confidence interval
Sleep disturbances are one of the most common behavioral problems experienced by children and adolescents. They are especially prevalent in special populations, including hospitalized children, and few data exist on the treatment of sleep disturbances in this population. A task force on pharmacotherapy for pediatric insomnia sponsored by the American Academy of Sleep Medicine recommended that although nonpharmacological treatments such as sleep hygiene should be the first line of treatment for pediatric insomnia, hypnotic agent use is indicated when the child's insomnia "occurs in the setting of medical illness with associated issues, including pain control, concomitant medication, (and/or) hospitalization."1 However, there are no medications currently approved for pediatric insomnia by the Food and Drug Administration (FDA), thus it is unclear what medications physicians are using to address sleep problems in hospitalized children.
Several surveys of general pediatricians have found that a wide variety of sleep medications are prescribed commonly in nonhospitalized children. A recent study2 found that >75% of 671 community-based pediatric practitioners had recommended nonprescription medications and >50% had prescribed a medication for "insomnia" (defined as significant difficulty falling or staying asleep) in the past 6 months. Alpha agonists were the most frequently prescribed sleep medications (31%), followed by prescription antihistamines (29%), antidepressants (16.4%), and benzodiazepines (12%). Chloral hydrate (12%) and nonbenzodiazepine hypnotic agents (8%) were also prescribed. There were significant differences in types of medications used depending on the age group of the child.
In addition, a recent survey of 1271 practicing child and adolescent psychiatrists found that insomnia was endorsed as a major problem seen in 28% to 32% of school-aged and adolescent patients, respectively (J.A.O., C. L. Rosen, MD, J.A.M., and L. H. Kirchner, MD, unpublished data, 2006). Medication use by child and adolescent psychiatrists for treating insomnia was very high. For example, for children with attention-deficit/hyperactivity disorder (ADHD), respondents prescribed a variety of medications to treat insomnia in a typical month, including alpha agonists (clonidine; 81%), sedating antidepressants (71%), trazodone (60%), atypical antipsychotic agents (34%), and nonbenzodiazepine hypnotic agents (18%). For children with insomnia associated with mental retardation and developmental delay (autism and pervasive developmental delay), respondent use was similar (67%, 76%, 67%, 52%, and 22%) for these same prescription medications, respectively. In addition, nonprescription antihistamines were recommended for insomnia by more than two thirds of psychiatrists for children with ADHD and by at least 40% of psychiatrists for children with mental retardation and developmental delay (autism and pervasive developmental delay).
In another study exploring prescriptions for sleep problems, 20% of children had received at least 1 dose of a sleep medication. This study involved >38000 Medicaid recipients in Michigan.3 There was a wide variation in prescribing practices by region in the state and by individual practitioner. Finally, a recent analysis, which reviewed prescription drug claims of 2.4 million Americans between 2000 and 2004, reported that the number of children and adolescents between the ages of 10 and 19 years using sleeping medications rose from 0.16% to 0.3%, an increase of 85%. Across the entire pediatric age range (0–19 years), a total of 39% of the patients who were prescribed sleep medication were also on another psychotropic medication.4
It is expected that hospitalized children are at risk for pediatric insomnia because of both environmental factors related to hospitalization and medically related issues, such as pain and anxiety. Few studies have investigated sleep problems in this population, although several studies have been performed in adult hospitalized patients. Studies of adult patients have found reduced sleep time and sleep efficiency, as well as increased awakenings and more daytime sleep.5 Up to one third of adult patients report insomnia,6,7 and between 50% and 75% of adult hospitalized patients are prescribed a sedative or hypnotic agent to improve sleep.8 Less is known about pediatric sleep disturbances while hospitalized, although sleep problems are common. Hagemann9,10 found that hospitalized children 3 to 8 years old lose 20% to 25% of their expected sleep time, primarily because of prolonged sleep latencies. Other studies by White and colleagues11,12 noted significantly later bedtimes in children when hospitalized. No studies, however, have investigated the use of medications to treat sleep disturbances in hospitalized pediatric patients.
Thus, the purpose of this descriptive study was to examine the use of sleep medications in hospitalized children. The aims of this study were (1) to determine the percentage of hospitalized children who receive medication for sleep disturbances, (2) to determine what medications are prescribed for sleep difficulties, and (3) to examine medical and demographic variables related to medications used for sleep difficulties in pediatric hospitals.
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METHODS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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Participants and Procedure
Twenty-six days in 2004 were selected randomly for a chart review of patients who were hospitalized on those dates at each of 3 children's hospitals (Children's Hospital of Philadelphia (CHOP; 381 beds), Cincinnati Children's Hospital Medical Center (CCHMC; 324 beds), and Hasbro Children's Hospital (HCH; 87 beds). The range of dates controlled for biases that may have resulted from time of year, day of week, and inpatient staff coverage. Electronic medical records were reviewed at CHOP and CCHMC, whereas HCH reviewed paper medical records. Because of an absence of data during a changeover of the medical records system at CHOP, only 25 days were included, and because of the labor intensity of reviewing records by hand, only 17 days at HCH were included. Patients who were admitted for >1 of the selected dates had their data included in the database only for the first date that they appeared. This resulted in 9440 patient records in the current data set. This study was approved by the institutional review board of each hospital. Information was deidentified to protect patient confidentiality.
Variables Extracted
Demographic and Medical Information
Information was collected on the child's age, gender, race, and zip code. The last variable was used to provide information on socioeconomic status. Through the US Census data, we identified median household income. In addition, the child's length of hospitalization and diagnosis(es) were gathered. Using International Classification of Diseases, Ninth Revision, diagnoses and codes, we identified patients with at least 1 psychiatric diagnosis (290–319), an autism spectrum disorder diagnosis (299), ADHD (314), and/or a cancer diagnosis (140–208)
Medications
Eight classes of medications (inclusive of 22 medications) were identified as potential sleep medications on the basis of previous studies and clinical experience. A list of these medications can be found in Table 1. Because there are no FDA-approved medications for pediatric insomnia, each of these medications could potentially have been prescribed for another reason. In this study, a medication was labeled as a "sleep medication" if it was (1) prescribed and administered on the specific target date as a once/daily dosing between 6:00 PM and 4:00 AM or (2) prescribed as needed but given only once that day between 6:00 PM and 4:00 AM.
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RESULTS |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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Sample Demographics
The overall sample was 54.5% male, with a mean age of 7.0 years (SD: 6.3, range: 0–18 years inclusive). Children were 63% white, 26% black, 4% Hispanic, and 1.2% Asian. The median household income (based on zip code) was $44402. In terms of diagnoses, 18.6% of patients had at least 1 psychiatric diagnosis, and 5.0% had a cancer diagnosis.
One-way analyses of variance and 
2 analyses were used to examine demographic differences between the 3 sites. Because of the large number of subjects and analyses conducted, a more conservative P value was set at .01 for all analyses. Significant differences were found between the sites for child's age (F2,9437 = 106.5; P < .001), median household income (F2,9330 = 53.8; P < .001), child's race (82 = 764.9; P < .001), short (
7 days) hospitalization versus longer hospitalization (>7 days) (22 = 29.7; P < .001), and whether the child had a psychiatric diagnosis (22 = 855.9; P < .001). A breakdown of the descriptive data for the demographic variables according to site is included in Table 2.
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Frequency of Prescribed Medications for Sleep
The first aim of this study was to examine the frequency of sleep medications prescribed in hospitalized pediatric patients. Six percent of patients in this study were prescribed a medication from the list of potential sleep medications (Table 1). Of those prescribed sleep medications, 89% were prescribed 1 sleep medication, 10% were prescribed 2 sleep medications, and 1% were prescribed 3 sleep medications. As seen in Table 3, antihistamines were the most frequently prescribed medication (36.6%), followed by benzodiazepines (19.4%). Other common medications included antipsychotic agents (16.4%) and alpha agonists (10.4%). Nonbenzodiazepine hypnotic agents (eg, zolpidem, zaleplon) were the least frequently prescribed class of medications (2.2%).
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Differences in Frequency of Sleep Medications for Demographic and Medical Variables
The second aim of the study was to examine whether there were any differences in prescribing patterns on the basis of demographic or medical variables.
2 analyses were used to examine differences on demographic and medical variables for children who received a sleep medication and children who did not receive a sleep medication. As seen in Table 4, a significant difference was found for site (2 = 102.3; P < .001), with a lower percentage of patients at CHOP receiving sleep mediations than the other 2 sites. No differences in the frequency of sleep medications was found on the basis of the child's gender (12 = 0.3, not significant [NS]). To make the differences in age more meaningful, this variable was divided into 4 age groups (infant, toddler, child, and adolescent), and a significant difference was found for age (32 = 232.8; P < .001), suggesting that the frequency of sleep medications increases with increasing age. A significant difference in the frequency of sleep medications was also found for race (42 = 19.7; P < .001), with more white and black patients prescribed sleep medications than Hispanic and Asian patients. Hospital length (7 vs >7 days) was also significantly different (12 = 105.9; P < .001), suggesting medications were more frequently prescribed during short-term hospitalizations.
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In terms of diagnosis, a difference in whether the child was on a sleep medication was found depending on whether the child had a psychiatric diagnosis (
12 = 575.8; P < .001), indicating that more children with a psychiatric diagnosis were given a sleep medication than those without a psychiatric diagnosis. Within the psychiatric diagnoses, children with autism spectrum disorders (12 = 133.6; P < .001) and ADHD (12 = 200.6; P < .001) were more likely than children without those disorders to have sleep medications prescribed. No difference was found for children with a cancer diagnosis (12 = 0.5, NS).
Differences in Type of Sleep Medications for Medical Variables
A second set of 2 analyses were used to examine differences in demographic and medical variables between the classes of sleep medications prescribed. A significant difference in the type of medications prescribed was found for the 3 hospitals (142 = 68.8; P < .001; see Table 3 for frequencies and percentages). Significant differences were also found for the service from which the child was discharged from (282 = 198.7; P < .001), whether the child had a psychiatric diagnosis (72 = 168.9; P < .001), autism spectrum disorder diagnosis (72 = 29.8; P < .001), and ADHD diagnosis (72 = 74.9; P < .001), as well as whether the child had a cancer diagnosis (72 = 34.2; P < .001; see Table 5 for frequency and percentages).
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Demographic and Medical Predictors of Prescribing Patterns
A logistic regression analysis was used to examine factors predicting the likelihood that a patient was given a sleep medication. Demographic and medical predictors were psychiatric diagnosis (presence or absence), child's age, length of hospitalization (
7days or >7 days), race (white, black, Hispanic, Asian, other), and hospital service (general pediatrics, surgery, critical care, subspecialty, psychiatry). A test of the full model with all 5 predictors against a constant-only model was statistically significant (112 = 579.9; P < .001), indicating that the predictors, as a set, reliably distinguish between patients who were prescribed a sleep medication and those who were not. However, an examination of the Wald test revealed that race did not provide a significant predictor, thus the model was rerun without race, and remained statistically significant (72 = 572.4; P < .001). Table 6 shows regression coefficients, Wald statistics, odds ratios (ORs), and 95% confidence intervals (CIs) for ORs for each of the predictors in the final model. Patients were 2.7 times more likely to have a psychiatric diagnosis, twice as likely to have a short hospitalization, and 1.6 times more likely to be on the psychiatric service.
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Secondary Chart Review at HCH
Because the proxy method may overestimate the frequency that medications are prescribed for sleep, a secondary chart review was conducted on the HCH charts, because this data collection approach allowed us to examine reasons why patients were given certain medications. Although 39 (4.8%) of 804 patients were identified as being on
1 medication for sleep, the secondary chart review indicated that only about half of these patients (n = 18; 46%) were actually taking these medications for sleep. The sleep medications used were clonidine (n = 4), diazepam (n = 2), diphenhydramine (n = 6), trazodone (n = 4), and zolpidem (n = 4).
Secondary Analysis Without Patients With a Psychiatric Diagnosis
Because some medications that are included in this study may be primarily used for psychiatric disorders, with the secondary benefit of improving sleep, the overall results of this study may be biased by the large percentage of patients with a psychiatric diagnosis. Thus, additional analyses were conducted across sites to examine the frequency of medications prescribed for sleep, excluding patients with a psychiatric diagnosis (n = 1754). Of these patients, 3.2% (n = 243) were prescribed a medication for sleep, with 91% of patients prescribed 1 medication and 9% prescribed 2 medications for sleep. As seen in Table 7, antihistamines continued to be the most frequently prescribed medication (39.1%); however, benzodiazepines were also prescribed commonly (38.0%). Hypnotic agents continued to be the least frequently prescribed class of medications (2.3%).
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In terms of demographic and medical differences, differences continued to be found in the prescribing practices of the 3 sites, both in frequency (
22 = 30.2; P < .001), and class of medications prescribed (142 = 30.4; P < .01), with the overall rate of prescriptions more similar between CHOP and CCHMC compared with HCH (see Table 7). Significant differences continued to be found for age (32 = 63.8; P < .001), with medication use increasing with chronological age, and length of hospitalization (12 = 27.9; P < .001), with medications prescribed more often for patients who have shorter hospitalizations. No differences were found for gender (12 = 0.03, NS) or race (42 = 12.6, NS) (see Table 8).
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DISCUSSION |
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TOPABSTRACTMETHODSRESULTSDISCUSSIONREFERENCES |
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This study is the first to examine the use of sleep medications in hospitalized children. Overall, 6% of all hospitalized children receive some type of sleep medication, with 3% of all medically hospitalized children (not including children with a psychiatric diagnosis) being prescribed a sleep-related medication. Thus,
1 of every 20 to 25 children are treated with a sleep medication while hospitalized. In terms of type of medication, prescription antihistamines were the most commonly prescribed sleep medications, given to 37% of all children prescribed a sleep-related medication. The next most common medications are benzodiazepines (19%), antipsychotic agents (16%), and alpha agonists (10%), with fewer children receiving antidepressants (6%), selective serotonin reuptake inhibitors (SSRIs; 5%), chloral hydrate (4%), and nonbenzodiazepine hypnotic agents (2%). Differences existed in type of medication prescribed by both hospital and by service. Across all 3 children's hospitals, antihistamines were most commonly prescribed; however, children at CCHMC were more likely to be given antipsychotic agents and alpha agonists, whereas benzodiazepines were almost 3 times as likely to be prescribed at CHOP and HCH.
As stated, differences in medication choice also differed by service and diagnosis. For example, critical care patients were much more likely to be given a benzodiazepine or hypnotic agent and less likely to be prescribed an antihistamine. Children with a psychiatric diagnosis were more likely to be prescribed an alpha agonist or antipsychotic agent, compared with higher use of benzodiazepines and chloral hydrate in children without a psychiatric diagnosis. More specifically, children with autism were much more likely to be prescribed an alpha agonist, an antidepressant, or an antipsychotic agent, whereas children with ADHD were more likely to be given an alpha agonist or an antipsychotic agent and much less likely to be prescribed a benzodiazepine. Furthermore, children with cancer were 15 times more likely to be prescribed a hypnotic agent and much less likely to be given an alpha agonist or chloral hydrate.
Thus, medication choice was quite varied across service and across hospital setting. Unfortunately there are no FDA-approved medications for pediatric insomnia, nor are there guidelines for medication choices,1,13 which is reflected in the wide range of medications actually given. In addition, there is vastly more information available regarding recommended guidelines for pharmacological management of adult insomnia, although less is known about appropriate treatment for hospitalized adults. For hospitalized adult patients, recent recommendations14 indicate using intermediate-acting benzodiazepines (eg, lorazepam, temazepam) as first-line agents, followed by nonbenzodiazepines (eg, zaleplon, zolpidem) as second-line agents because of their increased cost. Trazodone is also considered an appropriate choice. On the other hand, antihistamines, tricyclic antidepressants, barbiturates, and chloral hydrate are discouraged. These recommendations, albeit for adults, are quite counter to the use of specific agents prescribed to children, with antihistamines the most commonly used medications and nonbenzodiazepines the least used.
As indicated, a striking finding in this study was that children on a psychiatric service and/or with a psychiatric diagnosis are the ones most likely to receive such a medication. In this study, 22% of children on a psychiatric service received a sleep-related medication, and more specifically 30% of children with autism and 20% of children with ADHD received a sleep-related medication. This is in contrast to 7% of children in critical care and 3% of children in a general pediatric unit or surgical service. This finding is consistent with 1 study that found that adult psychiatric patients experienced worse sleep quality while hospitalized than surgical or medical patients.15
There are some difficulties interpreting our findings because those medications indicated to be sleep-related by using our proxy method are also those medications used to treat psychiatric diagnoses. Thus, secondary analyses were conducted on just those children hospitalized with medical diagnoses, excluding all psychiatric diagnoses. Of these patients, 3.2% were prescribed a medication for sleep. Antihistamines continued to be the most frequently prescribed medication (39.1%); however, benzodiazepines were also commonly prescribed (38.0%). Hypnotic agents continued to be the least prescribed class of medications (2.3%).
Another interesting finding was that no differences for sleep-related medication use were found between general pediatric services and surgical patients. This finding is in contrast to a study of hospitalized adults that found that medical patients received more sedative medications and reported less sleep problems than did surgical patients (note that no psychiatric patients were assessed in this study).16
There were also differences in medication use and medication chosen across hospital site. The differences in diagnosis accounted for much of the differences across hospital site, given that CCHMC has a large inpatient psychiatric unit, accounting for 25.3% of all of its hospitalized children, whereas CHOP and HCH do not have inpatient psychiatric units. However, even beyond this difference in each hospital's population, there were additional differences in what specific medications are more or less likely to be given to children in each setting. For example, after excluding all children with a psychiatric diagnosis, hypnotic agents were more commonly used at HCH, whereas selective serotonin reuptake inhibitors and antipsychotic agents were prescribed at CCHMC, medications that were chosen much less frequently at CHOP and HCH.
As expected, older children and adolescents are more likely to be prescribed a medication for sleep, as well as children with shorter hospital stays. Age differences, however, are confounded by diagnosis, with children with a psychiatric diagnosis having an average age of 12.5 years compared with 5.8 years for all other hospitalized children. However, even when excluding children with a psychiatric diagnosis, older children continue to be more likely to be prescribed a sleep-related medication. Also, children with a shorter hospital stay are more likely to be given a medication. This result is consistent with the concept that although nonpharmacological interventions for pediatric sleep disturbances are effective, they may not be appropriate for hospitalized children with sleep problems because of the length of time needed before behavioral treatments can be effective.
Unfortunately, no studies to date have been conducted on the percentage of hospitalized children who experience sleep problems. Thus, it is difficult to assess whether hospitalized children and adolescents are getting medicated appropriately for sleep issues. An early adult study conducted in 1990, indicated that a large percentage of medical and surgical patients (range: 31%–88%) were prescribed a sedative hypnotic drug.17 A more recent study of elderly hospitalized patients found that 29% had a hypnotic-agent prescription initiated while hospitalized and an additional 31% continued a preadmission hypnotic-agent prescription while hospitalized.18 These findings are in strong contrast to the 3% to 6% found in this study.
There are several reasons why a lower rate of prescriptions for sleep problems were found in this study compared with previous chart reviews and community surveys. First, the community surveys reflected the prescribing practices for outpatient settings (both general pediatricians and pediatric psychiatrists), where sleep medications are typically prescribed for long-standing sleep problems, particularly for psychiatric patients, or acute needs (eg, travel, sleep disruption because of death in the family), which is not the case for hospitalized patients. Second, while children are at home, they are generally expected to sleep well, with only those sleep disruptions seen as "problematic" reported to pediatricians, resulting in the high prevalence of practitioners prescribing medications. However, most people expect that sleep during a hospitalization will be poor, because of pain, discomfort, being in a strange environment, or external noises (alarms, conversations in the hallway). Thus, sleep disruptions may not be seen as "problematic," resulting in the lower rates of medications prescribed. Finally, the difference in medication profiles between the current study and previous studies is likely due to the rates of over-the-counter medications prescribed in outpatient settings. Because this chart review relied on pharmacy records, and over-the-counter medications for sleep are not recorded, this may also explain these differences in prescription practices.
There are several limitations to this study that may impact on the generalizability of these results. First, there are some concerns about the proxy method used. By using a proxy method endorsed by other studies on medication use for pediatric sleep problems,3 6% of all hospitalized children were classified as being prescribed a sleep medication. However, a more in-depth chart review at 1 of the study sites (HCH) found 39 (4.8%) of 804 children were administered a potential sleep medication from the list,19 but that a specific sleep indication could be subsequently definitively identified in only about half (n = 18; 46%) of those charts (alternative indications included pain, seizures, agitation, nausea, allergic reaction). Thus, the proxy method may somewhat overestimate the rate of sleep-medication prescriptions. However, the secondary chart review method may have underestimated the number of patients with specific sleep indications, because it is not always possible to assess exactly why a specific medication is given, and some of the medications may have been given for dual purposes (eg, a sedating antidepressant for depression and sleep [J.A.O., C. L. Rosen, MD, J.A.M., and L. H. Kirchner, MD, unpublished data, 2006] but only recorded for 1 reason, for example, depression).
A second limitation is that all 3 hospitals included in this study are academic institutions, thus they may not reflect prescription practices in community-based hospitals. A strength of this study was the inclusion of 3 hospitals, especially given that we found prescribing differences across the 3 hospitals that would not have been reflected if only 1 hospital was included. In addition to individual regional differences, the census of each hospital and the services provided had a clear impact on medication use. A study of other types of hospitals, especially community-based ones, would provide additional information on prescribing practices across a broader array of inpatient settings.
Overall, results from this study and other studies on prescription prevalence for sleep-related medications in children and adolescents indicate that prescribing medication for sleep in pediatric inpatients is somewhat common, although more so for children with psychiatric diagnoses and pediatric patients seen in outpatients settings. However, no FDA-approved medications exist, nor are there clinical consensus guidelines about type/specific medicines that should be used. Although our results indicate variability in the types of medications prescribed, antihistamines and benzodiazepines are the most common ones currently used for hospitalized pediatric patients. In addition, the best predictors of a prescription for a sleep-related medication in a hospital setting are a psychiatric diagnosis, older age, and shorter hospital stay. The results of this study suggest the need for additional examination of and physician training focusing on sleep problems and potential interventions for hospitalized children. Furthermore, clinical trials and consensus on safe and efficacious medications for pediatric populations, including hospitalized children, are needed. Finally, more broad-based prevalence studies of pediatric insomnia in hospitalized children are necessary to more truly understand what is the need for pharmacological and behavioral treatments for these children.
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ACKNOWLEDGMENTS |
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We thank Raymond Morris, Christine Gould, Juhee Lee, and Frank Baker for assistance with data collection.
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FOOTNOTES |
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Accepted Jan 22, 2007.
Address correspondence to Lisa J. Meltzer, PhD, Children's Hospital of Philadelphia, 3535 Market St, 14th Floor, Philadelphia, PA 19104. E-mail: meltzerl{at}email.chop.edu
Dr Meltzer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Financial Disclosure: This study was supported by an investigator-initiated grant from Sepracor. Dr Mindell served as a consultant for Pfizer, Wyeth, and Johnson & Johnson and was a member of the Speakers Bureau for King, Sepracor, and Johnson & Johnson. Dr Owens served as a consultant for Sepracor, Cephalon, Johnson & Johnson, and Sanofi-Aventis; was a member of the Speakers Bureau for Johnson & Johnson, Eli Lilly, and Sanofi-Aventis; was on the Advisory Board of Select Comfort, Eli Lilly, Cephalon, and Pfizer; and has received grants from Eli Lilly and Cephalon. Drs Meltzer and Byars have indicated they have no financial relationships relevant to this article to disclose.
Dr Meltzer had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
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PEDIATRICS (ISSN 1098-4275). ©2007 by the American Academy of Pediatrics
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