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Interventions with a sleep outcome for children with cerebral palsy or a post-traumatic brain injury: a systematic
Barbara C Galland1, Dawn E Elder, Barry J Taylor
1Department of Women's & Children's Health, University of Otago, PO Box 913, Dunedin 9016, New Zealand. barbara.galland@otago.ac.nz
Insights
This review found no specific sleep interventions for children with cerebral palsy (CP) or traumatic brain injury (TBI). Melatonin showed some promise for CP sleep issues, but more research is needed for evidence-based treatments.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Rehabilitation Medicine
Background:
- Sleep disorders are prevalent in children with cerebral palsy (CP) and traumatic brain injury (TBI).
- Existing literature lacks targeted interventions for sleep problems in these pediatric populations.
Purpose of the Study:
- To systematically review interventions for sleep problems in children (0-12 years) with CP or TBI.
- To identify effective sleep interventions and assess their efficacy based on available evidence.
Main Methods:
- A systematic literature review was conducted across five databases (1990-2011).
- Search terms included age groups and keywords for CP and TBI.
- Inclusion criteria were expanded to include conditions where sleep was a measured outcome.
Main Results:
- Only 19 articles were relevant for CP and one for TBI; no interventions were specifically designed for CP or TBI sleep issues.
- For CP, interventions improving primary symptoms also improved sleep as a secondary outcome.
- Melatonin use in CP patients showed consistent improvements in sleep latency and night waking, but studies were not exclusive to CP.
Conclusions:
- There is a significant lack of well-designed studies and evidence-based treatments for sleep problems in children with CP and TBI.
- Further research, particularly randomized controlled trials with objective sleep measures, is crucial.
- Melatonin may offer potential benefits, but its exclusive use and efficacy in CP require further investigation.
Abstract:
The purpose of this study was to conduct a systematic literature review on interventions for sleep problems in children (aged 0-12 years) with cerebral palsy (CP) or traumatic brain injury (TBI). The literature describes sleep disorders as common in both conditions. Criteria were expanded to include interventions for other medical conditions where sleep was measured as an outcome. No interventions specifically designed to improve sleeping in children with CP or TBI were found. A literature search was conducted of five databases (Ovid MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Database) from January 1 1990, to June 2011. The search terms [infant (age 0-23 months) or child, preschool (age 2-5 years) or child (age 6-12 years)] were used, with key terms related to CP and TBI. The search yielded 491 articles; 19 were relevant for CP, one for TBI. For CP, if the intervention improved the symptom/s targeted as primary outcome/s, sleep (measured as a secondary outcome) also improved. Few studies used objective measures of sleep, so efficacy could not be assessed. Only four studies were randomized controlled trials. Interventions were diverse. Where melatonin was used for CP patients with sleep problems/disorders, several related to phase or sleep maintenance disorders, improvements in sleep latency and night waking were consistently found, and in some subjects, improvements in total sleep time. No studies using melatonin studied CP patients exclusively. The one study where sleep was measured as a secondary outcome for TBI was of limited value. In conclusion, more well-designed studies are necessary to advance evidence-based treatments in the area of sleep problems for these chronic pediatric conditions.
