0995 Brief Behavioral Intervention Enhances Children’s Sleep and Improves Weight Status

Hart, CN; Hawley, Nicola L.; Egleston, Brian L.; Raynor, Hollie A.; Jelalian, Elissa; Carskadon, MA; Owens, J.; Wing, RR

doi:10.1093/sleepj/zsx050.994

Cited by 2 publications

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“…The primary analysis found that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4; P < .001) longer nocturnal sleep duration compared with the control condition. Figure 2 shows the primary meta-analysis forest plot, with quality assessments . There was marked heterogeneity across study estimates ( I 2 = 87.2%).…”

Section: Resultsmentioning

confidence: 99%

“…While an overall 10-minute increase in sleep duration would have a modest effect in addressing declining sleep durations in children, a 47-minute increase associated with earlier bedtimes would substantially affect this population-level problem. However, while the difference in sleep duration among trials using earlier bedtimes was much larger, this was only based on 3 studies (1 trial in primary school–aged children and 2 trials in secondary school–aged children), largely in the US, and these findings need to be replicated in further studies and settings. If confirmed, earlier bedtimes are needed given wake-up times are less changeable, especially on schooldays.…”

Section: Discussionmentioning

confidence: 99%

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Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children

et al. 2022

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ImportanceAdequate 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.ObjectiveTo determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.Data SourcesCENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021.Study SelectionRandomized 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 SynthesisData 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 MeasuresDifference in sleep duration, measured in minutes.ResultsA 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 RelevanceInterventions 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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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children

et al. 2022

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“…3 Adolescent gender-affirming care is recognized by the American Academy of Pediatrics, Pediatric Endocrine Society, American Academy of Family Physicians, American Academy of Child and Adolescent Psychiatry, and American Medical Association as medically necessary and potentially lifesaving. 4 Puberty suppression is associated with significantly decreased depressive symptoms, behavioral and emotional problems, improved general functioning, and lower lifetime suicidal ideation.…”

Section: Role Of the Funder/sponsormentioning

confidence: 99%

“…While the size of effect and surrounding CIs (mean of 32 additional minutes of sleep; 95% CI, 17-48 minutes) were impressive, much remains to be done and learned. The key conclusionthat interventions to bring bedtimes forward result in longer sleep duration-rested on just 4 of the 45 trials reviewed, in total comprising only around 330 children (230 individuals aged 2 to 12 years 3,4 and 100 individuals aged 14 to 19 years 5,7 ). An excellent outcome of this systematic review would be to take this approach to scale in a suite of harmonized, large, population-based trials tailored to children in different age groups (preschoolers, elementary schoolers, and high schoolers) and with longer follow-up.…”

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confidence: 99%

“…Mindell et al simply gave parents 3 educational messages (bedtime before 11:00 pm , no caffeine, and keep electronics out of the bedroom) on 2 occasions to parents of 2- to 12-year old children living in disadvantage. Hart et al offered a 4-session behavioral intervention to 8- to 11-year-old children, using strategies, such as goal setting, stimulus control, and positive reinforcement that focused solely on changing sleep length by increasing time in bed by 1 to 1.5 hours per night. Van Dyk et al targeted 14- to 18-year adolescents who routinely slept 5 to 7 hours on school nights, focusing on increasing time in bed by 1.5 hours per school night via problem-solving ways to extend that sleep, using established behavioral principles, and working with the parent/adolescent dyad to prioritize and reorganize activities to allow an earlier bedtime.…”

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Children’s Sleep and Our Power to Improve It

Wake

Hiscock

2022

JAMA Pediatr

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Children's sleep duration matters and it is in our power to change it. This is 1 of 2 cut-through findings of the systematic review and meta-analysis by Magee et al 1 of interventions in this issue of JAMA Pediatrics, spanning 45 randomized clinical trials and nearly 14 000 children and adolescents aged 1 to 18 years. Specifically, sleep can be lengthened by around half an hour each night simply by encouraging earlier bedtimes.The other is what the study did not find. Once the 4 trials focusing on earlier bedtime were removed, all other approaches (including targeting physical activity, sleep improvement strategies, obesity reduction, and environmental change) had minimal impacts on sleep duration, with an overall mean increase of just 8 minutes (95% CI, 3-13) of additional sleep per night-probably a nonbeneficial increment. 2 Findings did not differ by age group (preschool, elementary school, or high school), baseline quartile of sleep duration, social disadvantage, intensity of intervention delivery, inclusion only of children with sleep problems, site of intervention (home, school), parental involvement, whether the intervention was delivered face to face, or whether the intervention was theoretically based or not. Trials that focused solely on sleep were more effective than those with complex interventions and a broad focus.This practical, focused message should be good news for clinicians and for families as well as those, such as teachers, who provide broader services for children. While the review does not specify any 1 approach to achieve the earlier bedtime, the 4 relevant trials offered a number of straightforward strategies that could readily be used in the office setting. Mindell et al 3 simply gave parents 3 educational messages (bedtime before 11:00 PM, no caffeine, and keep electronics out of the bedroom) on 2 occasions to parents of 2-to 12-year old children living in disadvantage. Hart et al 4 offered a 4-session behavioral intervention to 8-to 11-year-old children, using strategies, such as goal setting, stimulus control, and positive reinforcement that focused solely on changing sleep length by increasing time in bed by 1 to 1.5 hours per night. Van Dyk et al 5 targeted 14-to 18-year adolescents who routinely slept 5 to 7 hours on school nights, focusing on increasing time in bed by 1.5 hours per school night via problemsolving ways to extend that sleep, using established behavioral principles, 6 and working with the parent/adolescent dyad to prioritize and reorganize activities to allow an earlier bedtime. Dewald-Kaufmann et al 7 targeted 12-to 19-year-old adolescents with symptomatic chronic sleep reduction, instructing them to gradually advance their weekday bedtimes by 5 minutes each night, and also to prevent bedtime shifts on weekend nights.It is not new that children's sleep duration is mutable-at least in the opposite direction. Average duration has steadily

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0995 Brief Behavioral Intervention Enhances Children’s Sleep and Improves Weight Status

Cited by 2 publications

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Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children

Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children

Children’s Sleep and Our Power to Improve It

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