Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children

Abstract

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.

Child Eveningness as a Predictor of Parental Sleep

“…Furthermore, parental knowledge of child sleep seems to be associated with earlier child bedtimes and wake times and more consistency between weekend and weekday sleep routines [ 57 ]. A recent meta-analysis also showed that interventions aimed at an earlier child bedtime resulted in 47 min more of child sleep a night [ 58 ]. Therefore, spreading knowledge about the different adverse outcomes of child eveningness may motivate parents and professionals to find the appropriate means to steer a child’s diurnal rhythm toward one that favors well-being.…”

Children’s Sleep and Our Power to Improve It

“…Kishan M. Thadikonda, MD; Katherine M. Gast, MD, MS There are an estimated 1.6 million transgender people in the United States, of which 300 000 are younger than 18 years. 1 Transgender, nonbinary, and gender expansive/ nonconforming (TNG) patients experience health disparities including increased levels of poverty, homelessness, and suicidality. 2 Among transgender youth, one-half consider suicide and over a third attempt it.…”

“…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 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.…”

“…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. Such trials would ideally also be designed to assess sleep quality (such as fragmentation) and hygiene—2 areas critical to understanding sleep that Magee et al could not examine due to heterogeneity. Furthermore, an understanding of who can affectively deliver such interventions (primary care physicians, nurses, trained parents or teenagers, teachers, etc) could pave the way for broad reach.…”

Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial

“…Prior research has shown that a 30 minute increase in sleep duration can lead to improvements in clinically relevant outcomes in children 7,8 . However, a meta-analysis reported that current sleep interventions for children increase average sleep duration by 10 minutes per night and most have been conducted in the school setting 9 .…”