過敏兒難入睡 褪黑激素催眠 2015-12-25 記者林惠琴／台北報導 孩子罹患異位性皮膚炎常常東癢西癢、東抓西抓，平均大約要花45分鐘時間才能入睡，是一般兒童入睡時間的2倍，讓許多家長傷透腦筋。不過，台大醫院與台北市立聯合醫院合作的研究發現，原本多用於調整時差、幫助睡眠的褪黑激素有助於改善類似情況，讓病童快快進入夢鄉！ 「晚上一躺下去就開始抓，很久都睡不著…」、「他不睡，我也都不用睡了！」這是異位性皮膚炎病童父母的心聲，此症屬於「濕疹」，是過敏性皮膚病的一種，會反覆發作搔癢症狀，兒童盛行率約15%至30%，夜間難以入眠，讓不少家長也跟著受罪。台北市立聯合醫院仁愛院區小兒科醫師張詠森指出，異位性皮膚炎的兒童若睡不好，不只影響個人與家人的生活品質，而且可能出現注意力不集中、過動、行為異常或學業表現較差的情形，德國就有研究證實，引起情緒或行為問題的機率是同齡其他兒童的2倍至3倍。台大醫院與台北市立聯合醫院合作，針對48名1歲至18歲的異位性皮膚炎病童，讓他們每晚睡前服用3毫克褪黑激素，連續4週下來，入睡時間從平均44.9分鐘降為21.6分鐘，並且病情嚴重程度也從49.1分降為40.2分，簡直一舉兩得，相關研究成果已刊登於國際排名第一位的小兒科醫學期刊《JAMA Pediatrics》。除了縮短病童入睡時間，可能減少搔抓患部的機會，因此降低病情嚴重程度外，台大醫院副院長江伯倫表示，褪黑激素也有抗發炎、調控免疫機能的成效，推估有利於緩解病情，但具體機轉尚在研究中。張詠森強調，褪黑激素是人體也會自然產生的荷爾蒙，參與該研究的兒童均未出現不良反應，沒有依賴性或成癮性的問題，家長可以放心。
Melatonin Supplementation for Children With Atopic Dermatitis and Sleep Disturbance A Randomized Clinical Trial JAMA Pediatr. Published online November 16, 2015. Importance Sleep disturbance is common in children with atopic dermatitis (AD), but effective clinical management for this problem is lacking. Reduced levels of nocturnal melatonin were found to be associated with sleep disturbance and increased disease severity in children with AD. Melatonin also has sleep-inducing and anti-inflammatory properties and therefore might be useful for the management of AD. Objective To evaluate the effectiveness of melatonin supplementation for improving the sleep disturbance and severity of disease in children with AD. Design, Setting, and Participants This randomized clinical trial used a double-blind, placebo-controlled crossover design to study 73 children and adolescents aged 1 to 18 years with physician-diagnosed AD involving at least 5% of the total body surface area. The study was conducted at the pediatric department of a large tertiary care hospital in Taiwan from August 1, 2012, through January 31, 2013. Forty-eight children were randomized 1:1 to melatonin or placebo treatment, and 38 of these (79%) completed the cross-over period of the trial. Final follow-up occurred on April 13, 2013, and data were analyzed from January 27 to April 25, 2014. Analyses were based on intention to treat. Interventions Melatonin, 3 mg/d, or placebo for 4 weeks followed by a 2-week washout period and then crossover to the alternate treatment for 4 weeks. Main Outcomes and Measures The primary outcome was AD severity evaluated using the Scoring Atopic Dermatitis (SCORAD) index, with scores ranging from 0 to 103 and greater scores indicating worse symptoms. Secondary outcomes included sleep variables measured by actigraphy, subjective change in sleep and dermatitis, sleep variables measured by polysomnography, nocturnal urinary levels of 6-sulfatoxymelatonin, and serum IgE levels. Results After melatonin treatment among the 48 children included in the study, the SCORAD index decreased by 9.1 compared with after placebo (95% CI, −13.7 to −4.6; P < .001), from a mean (SD) of 49.1 (24.3) to 40.2 (20.9). Moreover, the sleep-onset latency shortened by 21.4 minutes after melatonin treatment compared with after placebo (95% CI, −38.6 to −4.2; P = .02). The improvement in the SCORAD index did not correlate significantly with the change in sleep-onset latency (r = −0.04; P = .85). No patient withdrew owing to adverse events, and no adverse event was reported throughout the study. Conclusions and Relevance Melatonin supplementation is a safe and effective way to improve the sleep-onset latency and disease severity in children with AD.
童濕疹好癢難睡 褪黑激素助好眠 發稿時間：2015/12/24 20:38 最新更新：2015/12/24 20:38 中央社記者魏紜鈴傳真 104年3月3日 台大醫院副院長江伯倫帶領兒童過敏免疫研究團隊、睡眠中心醫師李佩玲，與台北市立聯合醫院仁愛院區小兒科醫師張詠森合作，研究兒童異位性皮膚炎的睡眠問題，台大下午召開成果發表記者會。江伯倫說，俗稱濕疹的異位性皮膚炎是慢性反覆發作、搔癢難耐的過敏性皮膚病，兒童盛行率高達15%至30%，而且逐年增加，癢到孩子一直抓，晚上也睡不好，家人也常因此也睡不好。張詠森表示，研究團隊收案48名異位性皮膚炎兒童，除使用原來的藥物外，每晚睡前服用3毫克褪黑激素連續4週，有助於改善皮膚炎嚴重度。她說，異位性皮膚炎嚴重度分數平均由49.1分降到40.2分，和安慰劑相比平均降低9.1分；同時也有效縮短入睡時間，入睡時間由平均44.9分鐘降到21.6分鐘，和安慰劑相比平均縮短21.4分鐘。褪黑激素為人體自然荷爾蒙，原來多用於調整時差及幫助睡眠，因為安全性高，沒有依賴性或成癮性的問題，參與這項研究兒童都沒有發生任何不良反應。研究成果已在11月16日發表在國際排名第一的小兒科醫學期刊「JAMA Pediatrics」，目前已申請美國專利，醫療團隊建議有此問題小朋友可尋求兒童睡眠障礙特別門診。（記者龍珮寧報導）
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