Melatonin versus chloral hydrate for recording sleep EEG

Although behavioral training could be successful in promoting electroencephalogram (EEG) compliance without restraint or sedation, sleep EEG may increase the yield of seizure activity. Furthermore uncooperative children not amenable to behavioral training require sedation for EEG recording. Our aim was to assess the impact of melatonin on the sleep EEG recording in comparison with chloral hydrate. Three hundred and forty eight patients (aged 1 month to 6 years) that were uncooperative with the EEG setup or referred for sleep EEG were enrolled in the study. Patients, partially sleep-deprived the night before, were randomly divided in two groups of melatonin and chloral hydrate on an alternative day basis, 174 patients in each group. Sleep onset latency in the chloral hydrate and melatonin groups was similar (Mann– Whitney test, P ¼ 0.113). However, sleep duration and drowsiness time were significantly shorter in the group of melatonin compared to the group of chloral hydrate (Mann–Whitney test, P < 0.0001 and P < 0.0001 respectively). More patients in the melatonin group (20 versus six patients in the chloral hydrate group) required a second dose of sedative for sleep induction (chi square test, P value ¼ 0.004). Seizure activities appeared in the electroencephalograms of 53% and 46% of patients in the melatonin and chloral hydrate groups respectively that were significantly higher in the melatonin group (chi square test, P ¼ 0.005). Few adverse effects occurred in both groups (Fisher’s exact test, P ¼ 0.64). The shorter sleep duration and drowsiness period were the two advantages of melatonin over chloral hydrate. Furthermore higher yield of seizure activity detection in melatonin sedated patients was in favor of its prescription for sleep EEG recording in the pediatric population.