Comparison between sleep-deprived, and melatonin-induced sleep electroencephalography in children of different ages: a randomized controlled trial.

Objective: To evaluate possible age-specific differences in the diagnostic yield of sleep-deprived, and melatonin-induced pediatric sleep EEGs. The multicenter study was performed prospectively. Methods: Children referred to sleep EEG (n = 169), were stratified into three age groups (2-5; 6-11; 12-17 years) and randomized to sleep induction by melatonin or partial sleep deprivation. Epileptiform activity, sleep, adverse effects, and technical recording quality were compared between study arms and age categories. Results: Epileptiform activity occurred in 36% of the children, without significant differences between melatonin and sleep-deprived EEGs. In 6-11-year-old children, epileptiform abnormalities occurred in 49%, significantly higher than in the other age groups independent of the sleep-inducing method. Sleep, but not the sleep induction method, was significantly associated with the presence of epileptiform activity (OR 9.16). The occurrence of sleep was significantly higher (97%) after melatonin induction compared to sleep deprivation (86%) without age differences. No serious adverse effects were registered. Conclusions: There were no differences concerning the occurrence of epileptiform activity in EEG after melatonin induction or sleep deprivation in children of any age category. Melatonin increased the likelihood of sleep. Significance: Melatonin as a premedication for sleep EEG should be considered safe and efficient in terms of diagnostic yield.