Two-Stage Extraction of Clinical Course Information From Psychiatric Discharge Summaries Using Fine-Tuned Large Language Models: Cross-Validation Study.

Sleep disturbance is common in childhood (Krishna et al. ), and the prevalence is higher in children and young people (CYP) aged 5–17 years with psychiatric and neurodevelopmental disorders (El Halal and Nunes ). The prevalence is estimated to be 88% among CYP in mental health care in the United Kingdom (Halstead et al. ) and 65% in the Netherlands (van Tetering et al. ). The prevalence is also reported to be higher in Asian CYP with neurodevelopment disorders: 75%–80% in Thailand (Tippawanich et al. ) and 39.80%–50.4% in Japan (Kuki et al. ). In Australia, 42% of CYP have been reported as having a problem with their sleeping pattern (Rhodes et al. ). Sleep disturbances tend to persist over a long period and may lead to persistent insomnia (de Zambotti et al. ), which can cause clinically significant distress due to impairment in academic, behavioural, cognitive, educational or other areas of functioning (Arboledas et al. ). Persistent sleep disturbances are over‐represented in CYP experiencing emotional and behavioural problems, including depression, anxiety, mood, and emotional dysregulation (Liu et al. ), indicating the importance of non‐pharmacological strategies and the appropriate use of medication when the former is ineffective (Wei et al. ). Peer‐reviewed studies of the prevalence of prescribed sleep medication use among CYP are growing, with a reported prevalence rate ranging from 17% to 50%. For example, a Swedish nationwide registered study found that among people with different age groups, including CYP (5–17 years), with attention deficit hyperactivity disorder (ADHD), 47.5% had been prescribed sleep medication, with 12% in those without ADHD, indicating the increased prevalence of sleep medication use in this clinical population, including CYP (Ahlberg et al. ). Few studies in the US and New Zealand reported prevalence estimates of sleep medication use in CYP. A US study among youth with diagnosed insomnia reported a prevalence of 37% (Bushnell et al. ), while a New Zealand study among CYP with autism or ADHD reported a prevalence of 25% (McLay et al. ). Further, an increase in prescription prevalence of benzodiazepines and other medications for sleep is being reported, with Hong Kong reporting an increase from 1.88% to 5.69% between 2000 and 2020 for 4–24 year olds (Kwok et al. ). In Australia, rates of sleep medication prescribing for CYP in primary care increased from 1.7% in 2011% to 5.9% in 2014% to 11.8% in 2018 (Klau et al. ), with more recent data indicating higher rates of use, such as 22.47% reported in 2023 (Glass et al. ). Taken together, the evidence suggests that sleep medication use is substantially higher among CYP with mental health and sleep disorders compared to general populations, with increasing prescribing trends observed over time in several settings. However, the use of sleep medication raises legitimate concerns about its impact among CYP (Boafo et al. ). Many sleep medications, such as melatonin, benzodiazepines, and Z‐drugs, have limited information on their effects on CYP, including daytime drowsiness, dizziness, mood swings, irritability, hyperactivity, and decreased daytime functioning, which can negatively impact school performance and well‐being (Haendel et al. ). Moreover, sleep medications are often prescribed in the context of co‐occurring psychiatric conditions and in combination with other psychotropic medications, including antidepressants, antipsychotics, and stimulants (Bushnell et al. ). Such combinations may lead to polypharmacy that raises the risk of drug–drug interactions (Özbek et al. ), cumulative sedation, tolerance, dependence, and other adverse outcomes (e.g., cardiac arrhythmias and suicidal ideation) (Zito et al. ). Given these concerns, understanding the factors associated with sleep medication use among CYP is essential to guide appropriate prescribing, prioritise non‐pharmacological interventions when suitable, and adopt a targeted, risk‐informed approach.