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Assessments and Interventions for Sleep Disorders in Infants With or at High Risk for Cerebral Palsy: A Systematic
Kelly Tanner1, Garey Noritz2, Lauren Ayala3
1Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio.
Insights
Children with cerebral palsy (CP) experience frequent sleep problems. This review found limited evidence for interventions, highlighting the need for better sleep assessments and caregiver-led strategies for young children with CP.
Area of Science:
- Pediatrics
- Neurology
- Sleep Medicine
Background:
- Children with cerebral palsy (CP) have a fivefold higher risk of sleep problems compared to typically developing children.
- Sleep disturbances in children with CP negatively impact both the child and their family.
- Early identification and management of sleep issues in young children with CP are crucial.
Purpose of the Study:
- To systematically review current evidence on sleep assessments and interventions for children under two years with CP or at high risk.
- To integrate findings with parent preferences for sleep management strategies.
- To identify gaps in research for sleep in this population.
Main Methods:
- A systematic search was conducted across five major databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, PsycINFO).
- Article screening and quality assessment followed PRISMA guidelines and best evidence tools.
- An online survey gathered parent preferences for sleep assessments and interventions.
Main Results:
- Eleven studies met inclusion criteria. Polysomnography was the only high-quality sleep assessment identified.
- Three interventions (medical cannabis, surgical, and sensory stimulations) showed limited evidence from single studies.
- Moderate evidence supported polysomnography; intervention evidence was low quality and quantity.
- Parents highly value sleep assessments and interventions, preferring caregiver-led approaches.
Conclusions:
- Further research is required to validate cost-effective and practical sleep assessments for young children with CP.
- In the absence of specific evidence for interventions in this group, guidelines for typically developing children are conditionally recommended.
- Caregiver-provided interventions are preferred by parents and warrant further investigation.
Background:
Children with cerebral palsy (CP) are five times more likely than typically developing children to have sleep problems, resulting in adverse outcomes for both children and their families. The purpose of this systematic review was to gather current evidence regarding assessments and interventions for sleep in children under age 2 years with or at high risk for CP and integrate these findings with parent preferences.
Methods:
Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using preferred reporting items for systematic reviews and meta-analyses guidelines, and quality of the evidence was reviewed using best evidence tools by two independent reviewers at minimum. An online survey was conducted regarding parent preferences through social media channels.
Results:
Eleven articles met inclusion criteria. Polysomnography emerged as the only high-quality assessment for the population. Three interventions (medical cannabis, surgical interventions, and auditory, tactile, visual, and vestibular stimulations) were identified; however, each only had one study of effectiveness. The quality of evidence for polysomnography was moderate, while the quality and quantity of the evidence regarding interventions was low. Survey respondents indicated that sleep assessments and interventions are highly valued, with caregiver-provided interventions ranked as the most preferable.
Conclusions:
Further research is needed to validate affordable and feasible sleep assessments compared to polysomnography as the reference standard. In the absence of diagnosis-specific evidence of safety and efficacy of sleep interventions specific to young children with CP, it is conditionally recommended that clinicians follow guidelines for safe sleep interventions for typically developing children.
