Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials

Natalie L Phillips; Teleri Moore; Arthur Teng; Naomi Brookes; Tonya M Palermo; Suncica Lah

doi:10.1093/sleep/zsaa040

Behavioral interventions for sleep disturbances in children with neurological and neurodevelopmental disorders: a systematic review and meta-analysis of randomized controlled trials

Sleep. 2020 Sep 14;43(9):zsaa040. doi: 10.1093/sleep/zsaa040.

Authors

Natalie L Phillips¹, Teleri Moore¹, Arthur Teng^{2

3}, Naomi Brookes⁴, Tonya M Palermo^{5

6}, Suncica Lah¹

Affiliations

¹ School of Psychology, University of Sydney, Sydney, New South Wales, Australia.
² Department of Sleep Medicine, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia.
³ Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.
⁴ Brain Injury Rehabilitation Program, Sydney Children's Hospital (Randwick), Sydney, New South Wales, Australia.
⁵ Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA.
⁶ Department of Anesthesiology and Pain Medicine, University of Washington School of Medicine, Seattle, WA.

PMID: 32163581
DOI: 10.1093/sleep/zsaa040

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, and behavior).

Results: Nine RCTs were identified (n = 690; Mage = 8.39 ± 2.64years; 71.11% male). The quality of the evidence was predominantly rated as moderate. Posttreatment improvements in sleep were found on self-reported sleep disturbances (total sleep disturbance [standardized mean difference, i.e. SMD = 0.89], night wakings [SMD = 0.52], bedtime resistance [SMD = 0.53], parasomnias [SMD = 0.34], sleep anxiety [SMD = 0.50]) and self-reported sleep patterns (sleep duration [SMD = 0.30], sleep onset duration [SMD = 0.75]) and (2) objectively measured actigraphic sleep patterns (total sleep time [MD = 18.09 min; SMD = 0.32], sleep onset latency [MD = 11.96 min; SMD = 0.41]). Improvements in sleep (self-reported, not actigraphy) were maintained at follow-up, but few studies conducted follow-up assessments resulting in low-quality evidence. Reduction in total behavioral problems (SMD = 0.48) posttreatment and attention/hyperactivity (SMD = 0.28) at follow-up was found. Changes in cognition and academic skills were not examined in any studies.

Conclusions: BSIs improve sleep, at least in the short term, in children with NNDDs. Benefits may extend to functional improvements in behavior. More rigorous RCTs involving placebo controls, blinded outcome assessment, longer follow-up durations, and assessment of functional outcomes are required.

Keywords: behavioral treatment; insomnia; meta-analysis; pediatric; sleep disturbance.

Publication types

Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

MeSH terms

Anxiety
Child
Female
Humans
Male
Neurodevelopmental Disorders* / complications
Neurodevelopmental Disorders* / therapy
Randomized Controlled Trials as Topic
Sleep
Sleep Wake Disorders* / complications
Sleep Wake Disorders* / therapy