Abstract
Objective
We conducted an umbrella review of systematic reviews (SRs) - with or without meta-analysis (MA) - of randomized controlled trials (RCTs) assessing non-pharmacological sleep interventions for children and adolescents across various clinical populations.
Method
We searched multiple electronic databases up to 24/01/24. Meta-analyzable data from RCTs in the retrieved SRs/MAs were pooled using Metaumbrella. Primary outcomes were subjective/objective child sleep parameters. Additional outcomes included child health/functioning and parental sleep/health. The quality of the MAs/SRs was assessed with AMSTAR-2, and the certainty of evidence using GRADE.
Results
We included 93 SRs/MAs covering 393 RCTs, with 25 (17%, 39% and 30%: high, moderate, and low quality) providing data for quantitative synthesis. Behavioral interventions, usually multicomponent including parent training, psychoeducation, and/or specific sleep therapy/strategies, showed beneficial effects on night waking, sleep duration, overall sleep disturbance, mood/depression, and maternal sleep quality (standardized mean difference [SMD]: 0.10 to 0.80) in participants with sleep problems without a formal sleep disorder diagnosis. For those with a formal diagnosis (mainly insomnia), benefits were found for night waking, sleep efficiency (subjective/actigraphically measured), and sleep onset latency (mean SMD: 0.49 to 0.97). Those with ADHD improved in bedtime resistance, night waking, parasomnias, sleep anxiety, ADHD symptoms, sleep disturbance, and quality of life (mean SMD: 0.18 to 0.49). For those with autism, sleep disturbance improved (mean SMD: 0.70). However, all findings were of low to very low certainty of evidence.
Conclusion
Among non-pharmacological interventions for sleep difficulties in youth, only behavioral interventions are supported by meta-analytic evidence, yet with small to moderate effect sizes and limited certainty of evidence.