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Somnologie

, Volume 23, Issue 4, pp 271–280 | Cite as

Melatonin in der Behandlung neuropsychiatrischer Störungsbilder im Kindes- und Jugendalter

  • Jan FrölichEmail author
  • Alfred Wiater
  • Gerd Lehmkuhl
Übersichten
  • 69 Downloads

Zusammenfassung

Hintergrund

Aufmerksamkeitsdefizit- und Hyperaktivitätsstörungen (ADHS), Autismus-Spektrum-Störungen (ASS) sowie verschiedene, selten auftretende neuropsychiatrische Störungsbilder mit einer Entwicklungsretardation werden in vielen Fällen begleitet von erheblich ausgeprägten Ein- und Durchschlafstörungen. Maßnahmen der Psychoedukation, der Schlafhygiene sowie verhaltenstherapeutische Maßnahmen stellen wichtige und primäre Bausteine der Behandlung dar, können aber bei nicht zureichender Wirksamkeit ergänzt werden durch eine Behandlung mit Melatonin.

Fragestellung und Methodik

Die vorliegende Arbeit gibt, basierend auf einer Medline-Recherche, in welche Metaanalysen, Übersichtsarbeiten wie auch kontrollierte Therapiestudien eingingen, eine Übersicht über die Behandlungsergebnisse mit Melatonin.

Ergebnisse

Zur Diskussion gestellt werden vor allen Dingen die Frage der Indikation und der Behandlungsdauer bei im Grundsatz chronisch vorliegenden Schlafstörungen. Berücksichtigt wurde zudem die Problematik, dass eine Mehrzahl der Kinder mit neuropsychiatrischen Erkrankungen bereits eine psychopharmakologische Behandlung wegen der Grunderkrankung erhält, deren Auswirkung auf den Schlaf und deren mögliche Interaktionen mit Melatonin zu berücksichtigen sind.

Schlussfolgerungen

Nach jetzigem Wissensstand kann vorläufig geschlussfolgert werden, dass Melatonin eine wichtige, wirksame und verträgliche Behandlungsoption bei Schlafstörungen im Kontext neuropsychiatrischer Krankheitsbilder darstellt, jedoch stets eingebunden in ein multimodales Behandlungskonzept und möglichst in Form einer intervallbezogenen Verabreichung.

Schlüsselwörter

Aufmerksamkeitsdefizit- Hyperaktivitätsstörung Autismus-Spektrum-Störung Kognitive Entwicklungsretardation Melatonin Psychostimulanzien 

Melatonin in the treatment of neuropsychiatric diseases in children and adolescents

Abstract

Background

Attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and diverse rare neuropsychiatric disorders with psychomental retardation are often accompanied by comorbid problems concerning sleep onset and sleep maintenance. Measures of psychoeducation, sleep hygiene, and behavioral treatment remain the primary treatment of choice. However if these approaches are not effective, medical treatment with melatonin may be an additional treatment alternative.

Objective and methods

Based on Medline research, this article presents melatonin treatment results from metaanalyses, controlled treatment studies, and reviews.

Results

In particular, we discuss the indication and duration of treatment regarding chronic sleep problems in neuropsychiatric disorders as well as the fact that in many cases the medical treatment of the primary disorder may influence the patient’s sleep. Additionally, possible interactions between melatonin and other medications may occur.

Conclusion

We conclude that melatonin is an effective and safe treatment option for sleep problems in neuropsychiatric diseases, if always implemented using a multimodal approach and, if possible, in an interval-related manner.

Keywords

Attention deficit hyperactivity disorder  Autism spectrum disorder  Psychomental retardation Melatonin Psychostimulants 

Notes

Einhaltung ethischer Richtlinien

Interessenkonflikt

J. Frölich, A. Wiater und G. Lehmkuhl geben an, dass kein Interessenkonflikt im Zusammenhang mit der Erstellung des Manuskriptes besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

Literatur

  1. 1.
    Accardo JA, Marcus CL, Leonard MB et al (2012) Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder. J Dev Behav Pediatr 33(2):97–105.  https://doi.org/10.1097/DBP.0b013e31823f6853 CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Akinci G, Oztura I, Hiz S et al (2015) Sleep structure in children with attention-deficit/hyperactivity disorder. J Child Neurol 30(11):1520–1525PubMedCrossRefGoogle Scholar
  3. 3.
    Andersen IM, Kaczmarska J, McGrew SG, Malow BA (2008) Melatonin for insomnia in children with autism spectrum disorders. J Child Neurol 23(5):482–485.  https://doi.org/10.1177/0883073807309783 CrossRefPubMedGoogle Scholar
  4. 4.
    Boonstra AM, Kooij JJ, Oosterlaan J et al (2007) Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep 30(4):433–442PubMedCrossRefGoogle Scholar
  5. 5.
    Braam W, Didden R, Smits M, Curfs L (2008) Melatonin treatment in individuals with intellectual disability and chronic insomnia: a randomized placebo-controlled study. J Intellect Disabil Res 52:256–264.  https://doi.org/10.1111/j.1365-27882007.01016.x CrossRefPubMedGoogle Scholar
  6. 6.
    Bumb JM, Mier D, Noelte I et al (2016) Associations of pineal volume, chronotype and symptom severity in adults with attention deficit hyperactivity disorder and healthy controls. Eur Neuropsychopharmacol 26(7):1119–1126.  https://doi.org/10.1016/j.euroneuro.2016.03.016 CrossRefPubMedGoogle Scholar
  7. 7.
    Camfield P, Gordon G, Dooley J et al (1996) Melatonin appears ineffective in children with intellectual deficits and fragmented sleep: six “N of 1” trials. J Child Neurol 11:341–343PubMedCrossRefGoogle Scholar
  8. 8.
    Cao YL, Cui QT, Tang CH, Chang X (2012) Association of CLOCK gene T3111C polymorphism with attention deficit hyperactivity disorder and related sleep disturbances in children. Zhongguo Dang Dai Er Ke Za Zhi 14(4):285–288PubMedGoogle Scholar
  9. 9.
    Carrillo-Vico A, Reiter RJ, Lardone PJ et al (2006) The modulatory role of melatonin on immune responsiveness. Curr Opin Investig Drugs 7:423–431PubMedGoogle Scholar
  10. 10.
    Chaste P, Clement N, Botros HG et al (2011) Genetic variations of the melatonin pathway in patients with attention-deficit and hyperactivity disorders. J Pineal Res 51(4):394–399PubMedCrossRefGoogle Scholar
  11. 11.
    Coppola G, Iervolino G, Mastrosimone M et al (2004) Melatonin in wake-sleep disorders in children, adolescents, and young adults with mental retardation with or without epilepsy: a double-blind, cross-over, placebo-controlled trial. No To Hattatsu 26:373–376.  https://doi.org/10.1016/S0387-7604(03)00197-9 CrossRefGoogle Scholar
  12. 12.
    Corkum P, Davidson F, Macpherson M (2011) A framework for the assessment and treatment of sleep problems in children with attention-deficit/hyperactivity disorder. Pediatr Clin North Am 58:667–683.  https://doi.org/10.1016/j.pcl.2011.03.004 CrossRefPubMedGoogle Scholar
  13. 13.
    Corkum P, Tannock R, Moldofsky H (1998) Sleep disturbances in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 37(6):637–646PubMedCrossRefGoogle Scholar
  14. 14.
    Cortese S, Faraone SV, Konofal E, Lecendreux M (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 48:894–908PubMedGoogle Scholar
  15. 15.
    Cortesi F, Giannotti F, Ivanenko A, Johnson K (2010) Sleep in children with autistic spectrum disorder. Sleep Med 11:659–664PubMedCrossRefGoogle Scholar
  16. 16.
    Cox DJ, Moore M, Burket R et al (2008) Rebound effects with long-acting amphetamine or methylphenidate stimulant medication preparations among adolescent male drivers with attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 18(1):1–10.  https://doi.org/10.1089/cap.2006.0141 CrossRefPubMedGoogle Scholar
  17. 17.
    De Leersnyder H, Zisapel N, Laudon M (2011) Prolonged-release melatonin for children with neurodevelopmental disorders. Pediatr Neurol 45:23–26PubMedCrossRefGoogle Scholar
  18. 18.
    Díaz-Román A, Hita-Yáñez E, Buela-Casal G (2016) Sleep characteristics in children with attention deficit hyperactivity disorder: systematic review and meta-analyses. J Clin Sleep Med 12(5):747–756.  https://doi.org/10.5664/jcsm.5810 CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Dodge N, Wilson AG (2001) Melatonin for treatment of sleep disorders in children with developmental disabilities. J Child Neurol 16:581–584.  https://doi.org/10.1177/088307380101600808 CrossRefPubMedGoogle Scholar
  20. 20.
    Elia M, Ferri R, Musumeci SA et al (2000) Sleep in subjects with autistic disorder: a neurophysiological and psychological study. Brain Dev 22:88–92PubMedCrossRefGoogle Scholar
  21. 21.
    Fricke-Oerkermann L, Frölich J, Lehmkuhl G, Wiater A (2007) Schlafstörungen (Leitfaden Kinder- und Jugendpsychotherapie). Hogrefe, GöttingenGoogle Scholar
  22. 22.
    Frölich J (2018) Aufmerksamkeitsdefizit-Hyperaktivitätsstörung. In: Peter H, Penzel T, Peter JH (Hrsg) Enzyklopädie der Schlafmedizin. Springer, HeidelbergGoogle Scholar
  23. 23.
    Furster C, Hallerbäck MU (2015) The use of melatonin in Swedish children and adolescents—a register-based study according to age, gender, and medication of ADHDCrossRefGoogle Scholar
  24. 24.
    Williams GP, Sears LL, Allard A (2004) Sleep problems in children with autism. J Sleep Res 13:265–268CrossRefGoogle Scholar
  25. 25.
    Garstang J, Wallis M (2006) Randomized controlled trial of melatonin for children with autistic spectrum disorders and sleep problems. Child Care Health Dev 32(5):585–589PubMedCrossRefGoogle Scholar
  26. 26.
    Gringras P, Gamble C, Jones AP et al (2012) Melatonin for sleep problems in children with neurodevelopmental disorders: randomised double masked placebo controlled trial. BMJ 345:e6664.  https://doi.org/10.1136/bmj.e6664 CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Gringras P, Nir T, Breddy J et al (2017) Efficacy and safety of pediatric prolonged-release melatonin for insomnia in children with autism spectrum disorder. J Am Acad Child Adolesc Psychiatry 56(11):948–957e4.  https://doi.org/10.1016/j.jaac.2017.09.414 CrossRefPubMedGoogle Scholar
  28. 28.
    Gruber R, Fontil L, Bergmame L et al (2012) Contributions of circadian tendencies and behavioral problems to sleep onset problems of children with ADHD. BMC Psychiatry 12:212.  https://doi.org/10.1186/1471-244X-12-212 CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Gruber R, Sadeh A, Raviv A (2000) Instability of sleep patterns in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 39(4):495–501PubMedCrossRefGoogle Scholar
  30. 30.
    Guénolé F, Baleyte JM (2012) Effects of melatonin should be studied separately in each neurodevelopmental disorder and with specific sleep diagnoses. Comment on: Prolonged-release melatonin for children with neurodevelopmental disorders (Pediatric Neurology 2011). Pediatr Neurol 46:60–61PubMedCrossRefGoogle Scholar
  31. 31.
    Hancock E, O’Callaghan F, English J, Osborne J (2005) Melatonin excretion in normal children and in tuberous sclerosis complex with sleep disorder responsive to melatonin. J Child Neurol 20(1):21–25PubMedCrossRefGoogle Scholar
  32. 32.
    Hoebert M, van der Heijden KB, van Geijlswijk IM, Smits MG (2009) Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. J Pineal Res 47(1):1–7.  https://doi.org/10.1111/j.1600-079X.2009.00681.x CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Hvolby A, Jørgensen J, Bilenberg N (2008) Actigraphic and parental reports of sleep difficulties in children with attention-deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 162(4):323–329PubMedCrossRefGoogle Scholar
  34. 34.
    Imeraj L, Antrop I, Roeyers H et al (2011) Diurnal variations in arousal: a naturalistic heart rate study in children with ADHD. Eur Child Adolesc Psychiatry 20(8):381–392.  https://doi.org/10.1007/s00787-011-0188-y CrossRefPubMedGoogle Scholar
  35. 35.
    Ironside S, Davidson F, Corkum P (2010) Circadian motor activity affected by stimulant medication in children with attention-deficit/hyperactivity disorder. J Sleep Res 19(4):546–551PubMedCrossRefGoogle Scholar
  36. 36.
    Jeong SH, Yu JC, Lee CH et al (2014) Human CLOCK gene-associated attention deficit hyperactivity disorder-related features in healthy adults: quantitative association study using Wender Utah Rating Scale. Eur Arch Psychiatry Clin Neurosci 264(1):71–81PubMedCrossRefGoogle Scholar
  37. 37.
    Kidwell KM, Van Dyk TR, Lundahl A, Nelson TD (2015) Stimulant medications and sleep for youth with ADHD: a meta-analysis. Pediatr Electron Pages 136(6):1144–1153.  https://doi.org/10.1542/peds.2015-1708 CrossRefGoogle Scholar
  38. 38.
    Kirchhoff F, Paditz E, Erler T et al (2018) Einsatz von Melatonin bei Kindern mit Schlafstörungen – Stellungnahme der Arbeitsgruppe Pädiatrie der Deutschen Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM). In: Aktuelle Kinderschlafmedizin, S 68–82Google Scholar
  39. 39.
    Kissling C, Retz W, Wiemann S et al (2008) A polymorphism at the 3′-untranslated region of the CLOCK gene is associated with adult attention-deficit hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 147(3):333–338PubMedCrossRefGoogle Scholar
  40. 40.
    Kooij JJ, Bijlenga D (2014) The circadian rhythm in attention-deficit/hyperactivity disorder and health. The ADHD report, 22, special issue: focus on sleep and ADHD, S 1–6Google Scholar
  41. 41.
    Krakowiak P, Goodlin-Jones B, Hertz-Picciotto I et al (2008) Sleep problems in children with autism spectrum disorders, developmental delays, and typical development: A population-based study. J Sleep Res 17:197–206PubMedPubMedCentralCrossRefGoogle Scholar
  42. 42.
    Lecendreux M, Lavault S, Lopez R et al (2015) Attention-deficit/hyperactivity disorder (ADHD) symptoms in pediatric narcolepsy: a cross-sectional study. Sleep 38(8):1285–1295.  https://doi.org/10.5665/sleep.4910 CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Liu X, Hubbard JA, Fabes RA, Adam JB (2006) Sleep disturbances and correlates of children with autism spectrum disorders. Child Psychiatry Hum Dev 37:179–191PubMedCrossRefGoogle Scholar
  44. 44.
    Malow BA, Adkins KW, McGrew SG et al (2012) Melatonin for sleep in children with autism: A controlled trial examining dose, tolerability, and outcomes. J Autism Dev Disord 42:1729–1737PubMedPubMedCentralCrossRefGoogle Scholar
  45. 45.
    Malow BA, Marzec ML, McGrew SG et al (2006) Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep 29:1563–1571PubMedCrossRefGoogle Scholar
  46. 46.
    Maski K, Holbrook H, Manoach D et al (2013) Sleep architecture and neurobehavioral and cognitive functioning in children with autistic spectrum disorders. Neurology 80(7 Supplement)Google Scholar
  47. 47.
    McArthur AJ, Budden SS (1998) Sleep dysfunction in Rett syndrome: a trial of exogenous melatonin treatment. Dev Med Child Neurol 40(3):186–192PubMedCrossRefGoogle Scholar
  48. 48.
    McCauley JL, Olson LM, Delahanty R et al (2004) A linkage disequilibrium map of the 1‑Mb 15q12 GABA (A) receptor subunit cluster and association to autism. Am J Med Genet B Neuropsychiatr Genet 131B:51–59PubMedCrossRefGoogle Scholar
  49. 49.
    Melke J, Goubran Botros H, Chaste P et al (2008) Abnormal melatonin synthesis in autism spectrum disorders. Mol Psychiatry 13:90–98PubMedCrossRefGoogle Scholar
  50. 50.
    Miano S, Donfrancesco R, Bruni O (2006) NREM sleep instability is reduced in children with attention-deficit/hyperactivity disorder. Sleep 29(6):797–803PubMedGoogle Scholar
  51. 51.
    Mohammadi MR, Mostafavi SA, Keshavarz SA et al (2012) Melatonin effects in methylphenidate treated children with attention deficit hyperactivity disorder: a randomized double blind clinical trial. Iran J Psychiatry 7(2):87–92PubMedPubMedCentralGoogle Scholar
  52. 52.
    O’Callaghan FJ, Clarke AA, Hancock E et al (1999) Use of melatonin to treat sleep disorders in the tuberous sclerosis complex. Dev Med Child Neurol 41:123–126PubMedCrossRefGoogle Scholar
  53. 53.
    Paavonen EJ, Nieminen-von Wendt T, Vanhala R et al (2003) Effectiveness of melatonin in the treatment of sleep disturbances in children with Aspergr disorder. J Child Adolesc Psychopharmacol 13(1):83–95PubMedCrossRefGoogle Scholar
  54. 54.
    Porfirio MC, Gomes de Almeida JP, Stornelli M et al (2017) Can melatonin prevent or improve metabolic side effects during antipsychotic treatments? Neuropsychiatr Dis Treat 13:2167–2174.  https://doi.org/10.2147/NDT.S127564 CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Prehn-Kristensen A, Goder R, Fischer J et al (2011) Reduced sleep-associated consolidation of declarative memory in attention-deficit/hyperactivity disorder. Sleep Med 12:672–679PubMedCrossRefGoogle Scholar
  56. 56.
    Rossignol DA, Frye RE (2011) Melatonin in autism spectrum disorders: a systematic review and meta-analysis. Dev Med Child Neurol 53(9):783–792.  https://doi.org/10.1111/j.1469-8749.2011.03980.x CrossRefPubMedGoogle Scholar
  57. 57.
    Rybak YE, McNeely HE, Mackenzie BE et al (2007) Seasonality and circadian preference in adult attention-deficit/hyperactivity disorder: clinical and neuropsychological correlates. Compr Psychiatry 48:562–571.  https://doi.org/10.1016/j.comppsych.2007.05.008 CrossRefPubMedGoogle Scholar
  58. 58.
    Sadeh A, Pergamin L, Bar-Haim Y (2006) Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies. Sleep Med Rev 10:381–398.  https://doi.org/10.1016/j.smrv.2006.03.004 CrossRefPubMedGoogle Scholar
  59. 59.
    Sangal RB, Owens J, Allen AJ et al (2006) Effects of atomoxetine and methylphenidate on sleep in children with ADHD. Sleep 29:1573–1585PubMedCrossRefGoogle Scholar
  60. 60.
    Schwichtenberg AJ, Malow B (2015) Melatonin treatment in children with developmental disabilities. Sleep Med Clin 10(2):181–187PubMedPubMedCentralCrossRefGoogle Scholar
  61. 61.
    Srinivasan V, Spence WD, Pandi-Perumal SR et al (2009) Melatonin and human reproduction: shedding light on the darkness hormone. Gynecol Endocrinol 25(12):779–785PubMedCrossRefGoogle Scholar
  62. 62.
    Susman EJ, Dockray S, Schiefelbein VL et al (2007) Morningness/eveningness, morning-to-afternoon cortisol ratio, and antisocial behavior problems during puberty. Dev Psychol 43:811–822PubMedCrossRefGoogle Scholar
  63. 63.
    Thirumalai SS, Shubin RA, Robinson R (2002) Rapid eye movement sleep behavior disorder in children with autism. J Child Neurol 17:173–178PubMedCrossRefGoogle Scholar
  64. 64.
    Tjon Pian gi CV, Broeren JP, Starreveld JS, Versteegh FG (2003) Melatonin for treatment of sleeping disorders in children with attention deficit/hyperactivity disorder: a preliminary open label study. Eur J Pediatr 162(7):554–555.  https://doi.org/10.1007/s00431-003-1207-x CrossRefPubMedGoogle Scholar
  65. 65.
    Van der Heijden KB, Smits MG, Van Someren EJ, Boudewijn Gunning W (2005) Prediction of melatonin efficacy by pretreatment dim light melatonin onset in children with idiopathic chronic sleep onset insomnia. J Sleep Res 14(2):187–194CrossRefPubMedPubMedCentralGoogle Scholar
  66. 66.
    Van der Heijden KB, Smits MG, Van Someren EJ et al (2007) Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry 46:233–241PubMedCrossRefGoogle Scholar
  67. 67.
    Vogel SW, Bijlenga D, Tanke M et al (2015) Circadian rhythm disruption as a link between Attention-Deficit/Hyperactivity Disorder and obesity? J Psychosom Res 79(5):443–450.  https://doi.org/10.1016/j.jpsychores.2015.10.002 CrossRefPubMedGoogle Scholar
  68. 68.
    Wasdell MB, Jan JE, Bomben MM et al (2008) A randomized, placebo-controlled trail of controlled release melatonin treatment of delayed sleep phase syndrome and impaired sleep maintenance in children with neurodevelopmental disabilities. J Pineal Res 44(1):57–64.  https://doi.org/10.1111/j.1600-079X.2007.00528.x CrossRefPubMedGoogle Scholar
  69. 69.
    Weiss MD, Wasdell MB, Bomben MM et al (2006) Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry 45(5):512–519PubMedCrossRefGoogle Scholar
  70. 70.
    Wirojanan J, Jacquemont S, Diaz R et al (2009) The efficacy of melatonin for sleep problems in children with autism, fragile X syndrome, or autism and fragile X syndrome. J Clin Sleep Med 5(2):145–150PubMedPubMedCentralGoogle Scholar
  71. 71.
    Xu X, Breen G, Chen CK et al (2010) Association study between a polymorphism at the 3′-untranslated region of CLOCK gene and attention deficit hyperactivity disorder. Behav Brain Funct 6:48PubMedPubMedCentralCrossRefGoogle Scholar
  72. 72.
    Zhdanova IV, Wurtman RJ, Wagstaff J (1999) Effects of a low dose of melatonin on sleep in children with Angelman syndrome. J Pediatr Endocrinol Metab 12(1):57–67PubMedCrossRefGoogle Scholar

Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie des Kindes und JugendaltersZentralinstitut für Seelische GesundheitMannheimDeutschland
  2. 2.Praxis für Kinder- und Jugendpsychiatrie, -psychotherapieStuttgartDeutschland
  3. 3.KölnDeutschland
  4. 4.Deutsche Gesellschaft für Schlafforschung und Schlafmedizin e. V. (DGSM)SchwalmstadtDeutschland
  5. 5.Klinik und Poliklinik für Psychiatrie und Psychotherapie des Kindes- und JugendaltersKlinikum der Universität zu KölnKölnDeutschland

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