Behavioral Interventions for Sleep Disturbances in Children with Neurological and Neurodevelopmental Disorders: A Systematic Review and Meta-analysis of Randomized Controlled Trials
Abstract
STUDY OBJECTIVES
Sleep disturbances are common and associated with negative functional and health consequences in children with neurological and neurodevelopmental disorders (NNDDs), and represent an important potential target for behavioral interventions. This systematic review examined the efficacy of behavioral sleep interventions (BSIs) for children with NNDDs and comorbid sleep disturbances.
METHODS
A systematic search of MEDLINE, EMBASE, PsychINFO, and CENTRAL was conducted in April 2019. Randomized controlled trials (RCTs) of BSI for children with NNDDS were included. Meta-analysis and GRADE quality ratings were performed on sleep and secondary functional outcomes (cognition, academics, behavior).
RESULTS
Nine RCTs were identified (n=690; Mage=8.39±2.64years; 71.11% male). Largely moderate level evidence for post-treatment improvements in sleep were found on (i) subjectively reported sleep disturbances (total sleep disturbance [SMD=0.89], night wakings [SMD=0.52], bedtime resistance [SMD=0.53], parasomnias [SMD=0.34], sleep anxiety [SMD=0.50]), subjectively reported sleep patterns (sleep duration [SMD=0.30], sleep onset duration [SMD=0.75]) and (ii) objectively measured actigraphic sleep patterns (total sleep time [MD=18.09 mins; SMD=0.32], sleep onset latency [MD=11.96 mins; SMD=0.41]). Improvements in sleep (subjective, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low quality evidence. Reduction in total…
How strong is the evidence?
Evidence Hub reads this as a meta-analysis, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 690 participants or records.
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