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Vol. 59. Núm. 3.
Páginas 239-245 (Septiembre 2003)
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Vol. 59. Núm. 3.
Páginas 239-245 (Septiembre 2003)
Acceso a texto completo
Tratamiento del insomnio en niños: aspectos farmacológicos
Treatment Of Insomnia In Children: Pharmacological Aspects
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M.a A. Idiazábal Alecha
Autor para correspondencia
mariannf@eresmas.com

Correspondencia: Clínica Nuestra Señora del Pilar. Balmes, 271. 08024 Barcelona. España
, E. Estivill Sancho
Unidad de Sueño. Institut Universitari Dexeus. Barcelona. España
Información del artículo
Resumen
Bibliografía
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En los últimos años se está produciendo un progresivo interés por los temas relacionados con el sueño en la infancia. La mayoría de fármacos utilizados para el tratamiento del insomnio en los adultos no se recomiendan en niños y, a pesar de ello, el 56 % de los pediatras utilizan medicación para tratar los problemas de sueño en la infancia. Este trabajo revisa las diferentes causas del insomnio en niños desde el nacimiento hasta la edad escolar y sus diferentes opciones terapéuticas, tanto farmacológicas como conductuales. Así mismo, se evalúan los métodos terapéuticos que se han mostrado más efectivos en los diferentes tipos de insomnio. Los hipnóticos más utilizados para el tratamiento del insomnio son las benzodiazepinas y los hipnóticos no benzodiacepínicos como la imidazopiridina, la pirazolopirimidina y la ciclopirrolona. Los estudios sobre el tratamiento del insomnio con melatonina son escasos, aunque diferentes trabajos sugieren que es útil y relativamente segura en el tratamiento del insomnio en niños en edad escolar

Ante un niño con insomnio, lo primero que debe hacerse es obtener información sobre las características de su insomnio y estudiar las circunstancias ambientales que rodean al niño y a su familia. Una vez descartada una causa orgánica, el tratamiento debería basarse en proporcionar información a los padres sobre la fisiología del sueño y en programas de entrenamiento a padres sobre la higiene de sueño y la adquisición del hábito del sueño. Cuando se deba recurrir al tratamiento farmacológico, éste deberá ser seleccionado de forma cuidadosa y utilizando las mínimas dosis efectivas. La melatonina parece presentar un futuro prometedor en el tratamiento del insomnio en niños sanos y en niños con trastornos neurológicos

Palabras clave:
Insomnio
Niños
Hipnóticos

In the last few years topics related to sleep in children have aroused increased interest. Most hypnotic drugs and sedatives used to treat adult insomnia are not recommended in children. Even so, 56 % of pediatricians use medication to treat childhood sleep disorders. We review the different causes of insomnia in children from birth to school age. The various therapeutic options are discussed and the therapeutic methods that have been demonstrated to be most effective in the various types of insomnia. The most frequent hypnotic drugs used in insomnia treatment are benzodiazepines and non-benzodiazepine hypnotics such as imidazopyridine, pyrazolopyrimidine and cyclopyrrolone. Few studies have been published on the use of melatonin in insomnia although several reports suggest that is useful and relatively safe in the treatment of insomnia in school-aged children

In children with insomnia, pediatricians should first of all obtain information about the characteristics of insomnia and the environmental characteristics surrounding the child and his/her family. Once an organic cause has been ruled out, treatment should be based on informing the parents about sleep physiology and on training them in sleep hygiene and the acquisition of sleep habits. When pharmacological treatment is required, it should be carefully selected using the smallest effective doses. Melatonin seems to have a promising future in insomnia treatment in healthy children and in those with neurological disorders

Key words:
Insomnia
Children
Hypnotics
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Bibliografía
[1.]
Y. Navelet.
Insomnia in the Child and Adolescent.
Sleep, 19 (1996), pp. 23-28
[2.]
F.N. Bamford, R.P. Banister, C.M. Benjamín, V.F. Hillier, B.S. Ward, W.M. Moore.
Sleep in the first year of life.
Dev Med Child Neurol, 32 (1990), pp. 718-724
[3.]
K. Tomioka, F. Toioka.
Development of circadian sleep wakefulness rhytmicity of three infants.
J Interdiscipl Cycle Res, 22 (1991), pp. 71-80
[4.]
S. Coons, C. Guilleminault.
Development of consolidated sleep and wakeful periods in relation to the day/night cycle in infancy.
Dev Med Child Neurol, 26 (1984), pp. 169-176
[5.]
T.F. Anders, L.F. Halpem, J. Hua.
Sleeping through the night: A developmental perspective.
Pediatrics, 90 (1992), pp. 554-560
[6.]
G. Klackemberg.
Incidence of parasomnias in children in general population.
Sleep and its disorders in Children, pp. 100-103
[7.]
J.R. Valdizán, J.M. Vergara, J.P. Rodríguez Arrondo, A. Saénz de Cabezón.
Encuestas de opiniones del sueño realizadas a padres de niños escolarizados de 4 a 14 años de la provincia de Zaragoza.
Rev Esp Neurofisiol Clin, 3 (1990), pp. 72-73
[8.]
N.J. Alí, D.J. Pitson, J.R. Stradling.
Snoring, sleep disturbance and behaviour in 4-5 year olds.
Arch Dis Child, 68 (1993), pp. 360-366
[9.]
T. Gislason, B. Benediktsdottir.
Snoring, apneic episodes, and nocturnal hypoxaemia among children 6 months to 6 years: An epidemiological study of lower limit of prevalence.
Chest, 107 (1995), pp. 963-966
[10.]
L. Brunetti, S. Rana, M.L. Lospalluti, A. Pietrafesa, R. Francavilla, M. Fanelli, et al.
Prevalence of obstructive sleep apnea syndrome in a cohort of 1,207 children of southerm italy.
Chest, 120 (2001), pp. 1930-1935
[11.]
R.A. Ferber.
Sleeplessness in the child.
Principles and Practice of Sleep Medicine, pp. 633-639
[12.]
A. Kahn, M.J. Mozin, E. Rebufffal, M. Sottiaux, M.F. Muller.
Milk Intolerance in children with persistent sleeplessness a prospective double-blind crossover evaluation.
Pediatrics, 84 (1989), pp. 595-603
[13.]
O.S. Ipsiroglu, A. Fatemi, I. Werner, M. Tiefenthaler, M.S. Urschitz, B. Schwarz.
Prevalence of sleep disorders in school children between 11 and 15 years of age.
Wien Klin Wochenschr, 113 (2001), pp. 235-244
[14.]
J.C. Blader, H.S. Koplewicz, H. Abikoff, C. Foley.
Sleep problems of elementary school children. A community survey.
Arch Pediatr Adolesc Med, 151 (1997), pp. 473-480
[15.]
W.J. Feikema.
Headache and chronic sleep deprivation: An often missed relationship in children and also in adults.
Ned Tijdschr Geneeskd, 143 (1999), pp. 1897-1900
[16.]
L. Quine.
Sleep problems in children with mental handicap.
J Mental Def Res, 35 (1991), pp. 269-290
[17.]
C.C. Piazza, W. Fisher, K. Kiesewetter, L. Bowman, H. Moser.
Aberrant sleep patterns in children with the Rett syndrome.
Brain Dev, 12 (1990), pp. 488-493
[18.]
A.L. Richdale.
Sleep problem in autism: Prevalence, cause and intervention.
Dev Med Child Neurol, 41 (1999), pp. 60-66
[19.]
M. Taira, M. Takase, H. Sasaki.
Sleep disorder in children with autism.
Psychiatry Clin Neurosci, 52 (1998), pp. 182-183
[20.]
A.M. Holbrook, R. Crowther, A. Lotter, C. Cheng, D. King.
Meta-analysis of benzodiacepina use in the treatment of insomnia.
Cmaj, 162 (2000), pp. 225-233
[21.]
H. Ashton.
Guidelines for the rational use of benzodiacepines: When and what to use.
Drugs, 48 (1994), pp. 25-40
[22.]
A.N. Vgontzas, A. Kales, E.O. Bixler.
Benzodiacepine side effects: Role of pharmacokinetics and pharmacodynamics.
Pharmacology, 51 (1995), pp. 205-223
[23.]
P.M. Hartmann.
Drug treatment of insomnia: Indications and newer agents.
Am Fam Physician, 51 (1995), pp. 191-194
[24.]
K.W. Weitzel, J.M. Wickman, S.G. Augustin, J.G. Strom.
Zaleplon: A pyrazolopyrimidine sedative-hypnotic agent for the treatment of insomnia.
Clin Ther, 22 (2000), pp. 1254-1267
[25.]
M. Dooley, G.L. Plosker.
Zaleplon. A review of its use in the treatment of insomnia.
Drugs, 60 (2000), pp. 413-445
[26.]
K.W. Weitzel, J.M. Wickman, S.G. Augustin, J.G. Strom.
Zaleplon: A pyrazolopyrimidine sedative-hypnotic agent for the treatment of insomnia.
Clin Ther, 22 (2000), pp. 1254-1267
[27.]
D.K. Hilton, C.A. Martin, W.M. Heffron, B.D. Hall, G.L. Johnson.
Imipramine treatment of ADHD in a fragile × child.
J Am Acad Child Adolesc Psychiatry, 3 (1991), pp. 831-834
[28.]
J. Furusho, K. Matsuzaki, I. Ichihashi, H. Satoh, K. Yamaguchi, K. Kumagai.
Alleviation of sleep disturbance and repetitive behavior by a selective serotonin reuptake inhibidor in a boy with Asperer's sundrome.
Brain Dev, 33 (2001), pp. 135-137
[29.]
J.E. Nagtegaal, G.A. Kerkhof, M.G. Smits, A.C. Swart, Y.G. Van Der Meer.
Delayed sleepphase syndrome: A placebo-controlled cross-over study on the effects of melatonin administered five hours before the individual dim light melatonin onset.
J Sleep Res, 7 (1998), pp. 135-143
[30.]
O. Lapierre, M. Dumont.
Melatonin treatment of non 24 hour sep wake cycle in a blind retarded child.
Biol Psychiatry, 38 (1995), pp. 119-122
[31.]
J.E. Jan, M.E. Donnell.
Use of melatonin in the treatment of paediatric sleep disorders.
J Pineal Res, 21 (1996), pp. 193-199
[32.]
C. Camfield, K. Gordon, J. Dooley.
Melatonin appears ineffective in children with intellectual deficits and fragmented sleep. Six "N of 1" trials.
J Child Neurol, 11 (1996), pp. 341-343
[33.]
M.G. Smits, J.E. Nagtegaal, J. Heijden, A.M. Coenen, G.A. Kerkhof.
Melatonin for chronic sleep onset insomnia in children: A randomised placebo-controlled trial.
J Child Neurol, 16 (2001), pp. 86-92
[34.]
A.S. Attele, J.T. Xie, C.S. Yuan.
Treatment of insomnia: An alternative approach.
Altern Med Rev, 5 (2000), pp. 249-259
[35.]
D.P. Jones, C.M. Verduyn.
Behavioral Management of Sleep Problems.
Arch Dis Child, 58 (1983), pp. 442-444
[36.]
E. Estivill, R. Civelti, A. Barraquer, E. Chimeno, C. Martínez.
Ferber's progressive aproach: Results when applied to 47 children with sep onset association disorder.
Sleep Research, 20 (1991), pp. 310
[37.]
E. Estivill.
Uso de fármacos hipnóticos en los lactantes y en los niños de corta edad.
An Esp Pediatr, 43 (1995), pp. 335-338
[38.]
A. Pelissolo, M. Lecendreux, M.C. Mouren-Simeoni.
Use of Hypnotics in children: Description and analisis.
Arch Pediatr, 6 (1999), pp. 625-630
[39.]
I.V. Zhdanova, R.J. Wurtman, J. Wagstaff.
Effects of a low dose of melatonin on sleep in children with Angelman syndrome.
J Pediatr Endocrinol Metab, 12 (1999), pp. 57-67
[40.]
Y. Yamashita, T. Matsuishi, Y. Murakami, H. Kato.
Sleep disorder in Rett syndrome and melatonin treatment.
Brain Dev, 21 (1999), pp. 59-62
[41.]
A.J. McArthur, S.S. Budden.
Sleep dysfunction in Rett syndrome: A trial of exogenous melatonin treatment.
Dev Med Child Neurol, 40 (1998), pp. 186-192
[42.]
E. Hayashi.
Effect of melatonin on sleep-wake rhythm: The sleep diary of an autistic male.
Psychiatry Clin Neurosci, 54 (2000), pp. 383-384
[43.]
N. Gordon.
The therapeutics of melatonin: A paediatric perspective.
Brain Dev, 22 (2000), pp. 213-217
[44.]
J.E. Jan, M.B. Connolly, D. Hamilton, R.D. Freeman, M. Laudon.
Melatonin treatment of non-epilpetic myoclonus in children.
Dev Med Child Neurol, 41 (1999), pp. 255-259
[45.]
C.C. Piazza, W. Fisher, H. Moser.
Behavioral treatment of sleep dysfunction in patients with the Rett syndrome.
Brain Dev, 13 (1991), pp. 232-237
[46.]
E. Estivill, V. De la Fuente, A. Barraquer.
Tratamiento farmacológico del insomnio en los niños con alteraciones neurológicas.
Rev Neurol, 25 (1997), pp. 1617-1620
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