Exploring Occupation-Based Interventions for Sleep Within OTPF: A Systematic Review

Sleep is a critical occupation that affects health and daily functioning, yet occupation-based approaches to addressing sleep have not been clearly defined within occupational therapy. To clarify current practice, this systematic review examined existing literature and classified occupation-based interventions (OBIs) for sleep according to the Occupational Therapy Practice Framework (OTPF).

Searches were conducted in PubMed, Web of Science, and CINAHL for articles published from January 1, 2013, to December 31, 2023, with an updated search performed up to October 27, 2024. Studies were included if they examined OBIs for sleep delivered by occupational therapists, incorporated occupation-based approaches or theoretical frameworks, and reported outcomes related to sleep quality, sleep participation, or occupational performance. Studies of any design were considered, while review articles, dissertations, conference proceedings, and non-English or inaccessible publications were excluded. Results were synthesized by classifying OBIs for sleep according to the OTPF.

A total of 7510 studies were identified. After removing duplicates, 6729 studies were screened by title and abstract, and 99 articles underwent full-text review. Ten studies met all inclusion criteria. The included studies involved diverse populations, regardless of the presence or absence of sleep-related problems. OTPF-based classification showed that most interventions primarily focused on sleep preparation, suggesting that current occupational therapy approaches may not fully address broader sleep-related needs. A multidisciplinary approach may therefore be necessary to address the complexity of sleep problems.

These findings highlight the value of OBIs as theoretically grounded and clinically relevant strategies, while underscoring the need for further development of interventions that integrate both sleep preparation and participation. However, evidence was limited by heterogeneous outcome measures, which precluded meta-analysis, and by the exclusive focus on occupational therapy interventions, which may not fully reflect the multidisciplinary approaches to sleep.