Salivary melatonin rhythm as a marker of the circadian system in healthy children and those with attention-deficit/hyperactivity disorder.

Attention-deficit/hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood. Problems with sleep structure, efficiency, and timing have been reported in some, but not all, studies on ADHD children. As the sleep-wake cycle belongs to circadian rhythms, the timekeeping circadian system might be involved in ADHD. To assess whether the circadian system of ADHD children differs from that of controls, the rhythm of the pineal hormone melatonin was used as a reliable marker of the system. Saliva from 34 ADHD and 43 control 6- to 12-yr-old children was sampled at 2-h intervals throughout the entire 24-h cycle, and the melatonin profiles of the ADHD and control children were compared. The nocturnal melatonin peaks of the ADHD and control group did not differ significantly. The high nocturnal interindividual variability of the peaks seen in adulthood was present already in the studied children. The 24-h melatonin profiles of all the ADHD subjects did not differ significantly from those of the control subjects. Categorization of subjects according to age, into groups of 6- to 7-yr-old (9 ADHD, 5 control), 8- to 9-yr-old (16 ADHD, 26 control), and 10- to 12-yr-old (9 ADHD, 12 control) children, revealed significant differences between the ADHD and control group in the melatonin rhythm waveform, but not in nocturnal melatonin peaks; the peaks were about the same in both groups and did not change significantly with increasing age. In the oldest, but not in the younger, children, the melatonin signal duration in the ADHD group was shorter than in the control group. The difference might be due to the fact that whereas in the control group both the evening melatonin onset and the morning offset phase delayed in the oldest children relative to those in the youngest children, in the ADHD group only the onset, but not the offset, phase delayed with increasing age. The data may indicate subtle differences between the circadian system of ADHD and control children during development.

Circadian rhythm in salivary melatonin in narcoleptic patients.

Narcolepsy is characterized, beside other features, by excessive daytime sleepiness and disturbed sleep at night. The pineal hormone melatonin may affect the sleep characteristics. The aim of the study was to compare the circadian rhythm in salivary melatonin in narcoleptic patients with that in control healthy subjects; 18 patients and 21 age- and gender-matched controls were involved. Narcoleptic patients exhibited a nocturnal increase in salivary melatonin similar to the one in control subjects. The morning melatonin decline in the narcoleptic group, as opposed to the control group was, however, not significant, as 8 out of 18 patients exhibited elevated melatonin levels also during the day. In these patients, the mean daytime value of the multiple sleep latency test (MSLT) was decreased when compared with that in patients with undetectable daytime melatonin levels. The results suggest that in some narcoleptic patients the circadian rhythm might be disturbed.