Enhancing waste management awareness in future nurses: a theory-based educational intervention and psychometric evaluation of a measurement tool.

Melatonin has become the most commonly used sleep supplement in children, with recent surveys indicating that up to 19% of school-age children have used melatonin in the past 30 days. In the US, melatonin is classified as a dietary supplement, is available without prescription, and is widely recommended as a pharmacologic option for pediatric insomnia, even though behavioral intervention remains the recommended first-line treatment. However, the evidence base for its effects on objective sleep architecture remains limited. Despite widespread use, little is known about how melatonin is associated with objective sleep architecture in children. The existing literature is dominated by small randomized clinical trials that relied on actigraphy or parent-reported outcomes rather than polysomnography (PSG), the criterion standard for assessing sleep stages. Malow et al conducted a dose-escalation trial of melatonin in 24 children with autism spectrum disorder (ASD) using actigraphy. A systematic review of melatonin in ASD identified 18 studies, none of which reported PSG sleep architecture outcomes. This evidence gap is clinically relevant. Rapid eye movement (REM) sleep is implicated in neurodevelopment, memory consolidation, and emotional regulation in children. Pharmacologic agents that suppress REM sleep, including serotonergic antidepressants and benzodiazepines, are used cautiously in pediatric populations. Melatonin’s interaction with serotonergic pathways raises questions about potential REM modulation, yet no adequately powered observational or randomized study has examined this possibility. Other domains of sleep architecture warrant the same scrutiny: slow-wave sleep is closely linked to growth hormone secretion and restorative function, and sleep-disordered breathing, arousal indices, and periodic limb movements are clinically relevant to any sleep-modifying agent yet remain unstudied at scale for melatonin. We used the Nationwide Children’s Hospital Sleep DataBank (NCHSDB), one of the largest publicly available pediatric PSG databases in North America, to compare 15 PSG parameters between propensity score–matched melatonin users and nonusers, with percentage of REM sleep prespecified as the primary outcome.