1138 Use of Z-Drugs and Trazodone for Sleep Problems in Children and Youth with ADHD

Abstract Introduction Up to 70% of children and youth with ADHD suffer from sleep problems, and sleep problems are also a frequent side effect of stimulants, the first-line ADHD treatment. Z-drugs and trazodone are often prescribed for sleep problems; yet little is known on the clinical characteristics of children and youth who initiate these medications and how long they remain on treatment. We therefore aimed to characterize children and youth with ADHD who start z-drugs or trazodone and estimate their treatment duration. Methods Using MarketScan (2008-2023) administrative claims data for privately-insured US individuals, we identified children (5-11y), adolescents (12-17y), and young adults (18-29y) with ADHD initiating a z-drug or trazodone for a sleep problem, following 1+ year without prior dispensed prescription for that medication. Trazodone initiators also needed a recent (0-30 days) sleep problem diagnosis. We described ADHD treatment history, comorbid psychiatric diagnoses, and medication use. Treatment duration was estimated with Kaplan-Meier analysis, stratified by age, censoring at treatment end, disenrollment, or data end. Results We identified 27,597 children and youth with ADHD initiating a z-drug (mean age=22y, 47% male) and 15,129 initiating trazodone for a sleep problem (mean age=20y, 49% male). Stimulants were frequently prescribed in the year before starting treatment (z-drug: 77-82%; trazodone: 70-81%, across age groups). Alpha-agonists were also commonly dispensed before z-drug and trazodone initiation, respectively, to children (61%, 71%) and adolescents (23%, 30%). Clinical characteristics varied by age; anxiety disorders were the most frequent comorbidity followed by depression. Continuation of trazodone for 6+ months occurred in 44% of children, 26% of adolescents, and 19% of young adults. For z-drug initiators, continuation for 6+ months was lower than trazodone for children (11%) and adolescents (14%) but similar for young adults (15%). Few z-drug initiators (5-7%) continued treatment for 1+ year, with trazodone use for 1+ year varying by age (children=30%, adolescents=13%, young adults=9%). Conclusion Z-drug and trazodone are commonly used by children and youth with ADHD for sleep problems. Understanding these use patterns can inform efforts to improve cautious treatment utilization as well as future research on treatment effectiveness and safety. Support (if any) The work was funded by the NIMH (R01MH135875, PI: Bushnell).