Which interventions work to improve sleep duration in children? A Systematic Review of the literature.

Problem

Adequate sleep duration in childhood has important implications for social, mental, and physical health. With declining sleep durations in children, effective approaches to increase time asleep are needed. However, strategies to encourage sleep have been inconclusive. A limited number of trials appear to suggest that multi-behavioural interventions that promote bed-time routines might work. However, the effectiveness of such interventions has not been adequately quantified. Moreover, specific themes and strategies which increase sleep duration, and by how much, have not been formally quantified.

Approach

We have carried out a systematic review and meta-analysis to understand and quantify the effectiveness of sleep interventions to improve sleep duration and quality in children within community settings (PROSPERO ID CRD42019160089).

We screened 11621 randomised control trials (RCT), after carrying out a search using combined text words and MeSH criteria in CENTRAL, MEDLINE, EMBASE, PSYCHINFO, Web of science, clinicaltrials.gov, and WHO trials databases.

Studies involving infants under 1 year, trials using medications, and targeting children with behavioural / sleep problems were excluded. Full text screening of 341 studies identified 46 studies for data extraction. All screening was carried out independently by two reviewers using a web-based platform for systematic reviews (Covidence).

Findings

The selected studies were carried out nearly proportionally across the age ranges: 20% in >1 to 5 years age group, 26% >5 to 10 years, 30% >10 to 15 years, 24% >15 years.

The mode of delivery of the majority of interventions was face to face (70%). The intervention setting was most commonly school based in just over half of the studies (52%), with 19% based in the home environment. Intervention duration was less than one month in most studies (48% of studies), with a third (33%) of studies having a duration between one to six months; the maximum duration was 3 years in one study.

There was significant heterogeneity in reporting of sleep duration, with different analytic methods being employed. A summary of the findings from these studies on the impact of the intervention on sleep duration (including an overview of the behavioural strategies employed and effectiveness) will be outlined.

Consequences

This review will enhance our understanding of interventions to improve sleep duration in children and provide a platform from which to explore population level health interventions to improve sleep. Given challenges assimilating data, an overarching aim is to develop approaches that could be used to homogenise reporting in future RCTs in order that evidence can be summarised more easily.