Prescription Trends of Medications Used to Treat Sleep Disturbances in School-Aged Children: An Interrupted Time-Series Analysis in France, 2016-2023

Abstract

Objective

To assess rates and trends of hypnotic medication prescriptions for children and adolescents.

Study design

Cross-sectional study of national dispensing data between January 1, 2016, and December 31, 2023, in France. Prescriptions of hypnotic medications (hydroxyzine, alimemazine, melatonin, and Z-drugs) dispensed to children aged 6-17 years were analyzed. Monthly rates of hypnotic prescriptions per 1000 children were modeled before and after the pandemic onset (March 2020) to assess rate and trend changes. Rate ratios (RRs) were calculated between estimated and expected prescription rates.

Results

Overall, 2 675 142 prescriptions were dispensed to an average yearly population of 9 963 497 children. In January 2016, prescription rate of hypnotic medications was estimated at 1.9 per 1000 and at 6.8 per 1000 in December 2023, with postpandemic onset rates exceeding the expected by 131% (RR: 2.31, 95% CI: 2.08; 2.54). Prescription trends increased for all medications from −0.1% (95% CI: −0.2; 0.1%) per month prepandemic to +1.4% (95% CI: 1.2; 1.6%) after the pandemic onset for hydroxyzine; +0.1% (95% CI: 0.0; 0.2%) to +0.9% (95% CI: 0.7; 1.0%) for alimemazine; +2.2% (95% CI: 2.0; 2.3%) to +4.4% (95% CI: 3.9; 4.9%) for melatonin; and −3.2% (95% CI: −3.6;−2.8%) to +1.8% (95% CI: 1.4; 2.2%) for Z-drugs. Monthly prescription rates exceeded the expected by 38% (RR: 1.38, 95% CI: 1.31; 1.46) for hydroxyzine; 19% (RR: 1.19, 95% CI: 1.15; 1.22) for alimemazine; 344% (RR: 4.44, 95% CI: 4.07; 4.80) for melatonin; and 419% (RR: 5.19, 95% CI: 4.24; 6.14) for Z-drugs.

Conclusions

Recent substantial increases in hypnotic medication prescribing for children are possibly related to their persistently deteriorating mental health, changes in prescribing strategies, and/or unmet pre-existing needs.