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Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and

Lucia Magee¹, Lucy P Goldsmith^1,2, Umar A R Chaudhry¹

¹Population Health Research Institute, St George's, University of London, London, United Kingdom.

JAMA Pediatrics

|September 12, 2022

Insights

Nonpharmaceutical interventions can increase children's sleep duration. Earlier bedtimes showed the most significant sleep extension, offering a practical approach to improving child health.

Area of Science:

Pediatrics
Sleep Medicine
Public Health

Background:

Adequate sleep is crucial for child health, development, and well-being.
Declining sleep durations in children necessitate effective intervention strategies.
Evidence-based methods to increase sleep in healthy children require elucidation.

Purpose of the Study:

To evaluate the efficacy of nonpharmaceutical interventions for improving sleep duration in healthy children.
To identify key components of effective sleep interventions for pediatric populations.

Main Methods:

Systematic review and meta-analysis of randomized clinical trials (RCTs).
Searched multiple databases (CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science, clinical trial registries) up to November 2021.
Included 45 RCTs with 13,539 child participants, analyzing data per PRISMA guidelines.

Main Results:

Sleep interventions were associated with an average increase of 10.5 minutes in nocturnal sleep duration.
Significant heterogeneity was observed across trials; no specific intervention component consistently explained variations.
Interventions incorporating earlier bedtimes resulted in a substantial sleep extension of 47 minutes compared to other interventions.

Conclusions:

Nonpharmaceutical interventions, particularly those focusing on earlier bedtimes, can effectively increase children's sleep duration.
Earlier bedtime strategies offer a pragmatic and beneficial approach to enhancing child health.
Further research may explore optimizing intervention components for broader applicability.

Read full analysis

Abstract

Importance:

Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated.

Objective:

To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.

Data Sources:

CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021.

Study Selection:

Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified.

Data Extraction And Synthesis:

Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes.

Main Outcomes And Measures:

Difference in sleep duration, measured in minutes.

Results:

A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects.

Conclusions And Relevance:

Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.

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