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TOPLINE:

A comparison of morning and evening growth hormone injection schedules in children with growth disorders showed no significant differences in sleep-wake patterns, sleep duration, or daytime activity, indicating that flexible dosing schedules could enhance treatment compliance and patient comfort without compromising sleep quality.

METHODOLOGY:

• Physiologic growth hormone is secreted during slow-wave sleep, and although evening injections of growth hormone therapy better mimic natural secretion patterns, the discomfort and rigidity of bedtime injection schedules can lead to sleep disturbances and significant burdens for patients and their families.
• Researchers conducted an open-label, randomized crossover trial to evaluate the convenience of administering evening vs morning daily growth hormone injections in 20 children (11 boys) aged 5-14 years with isolated growth hormone deficiency (n = 12) and idiopathic short stature (n = 8).
• Participants were randomized to either evening injections for 2 weeks followed by 2 weeks of morning injections or vice versa; treatment schedules were standardized to 08:00-09:00 for morning injections and 20:00-21:00 for evening injections.
• Sleep-wake patterns and daytime activity were assessed using a 7-day actigraph during the second week of each treatment schedule.
• The primary outcomes were changes in activity index and the number of arousals per night.

TAKEAWAY:

• The number of arousals, total sleep time, sleep efficiency, sleep-onset latency, time in bed, and activity indices were similar between evening and morning injection treatment schedules, all falling within the normal pediatric range.
• No significant differences in sleep parameters were observed between growth hormone–deficient and idiopathic short stature groups.
• Both boys and girls showed comparable sleep parameters in response to injection timing.

IN PRACTICE:

“GH [growth hormone] therapy can allow for flexible dosing schedules without compromising sleep-wake pattern, potentially improving treatment compliance and patient comfort,” the authors wrote.

SOURCE:

This study was led by Aglaya Levshtein, HaEmek Medical Center, Afula, Israel. It was published online on in Frontiers in Endocrinology.

LIMITATIONS: 

This study had a modest sample size due to its focus on sleep-wake patterns and daytime activity as primary endpoints. Additionally, the short-term nature of the study, with only 2 weeks per dosing schedule, allowed for the examination of sleep and wakefulness parameters but not longer-term outcomes such as insulin-like growth factor 1 levels, growth rates, or bone maturation.

DISCLOSURES:

This study was supported by a grant from the Novo Nordisk Foundation. The authors declared no conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.