A randomized controlled trial of an intervention for infants’ behavioral sleep problems

Abstract

BackgroundInfant behavioral sleep problems are common, with potential negative consequences. We conducted a randomized controlled trial to assess effects of a sleep intervention comprising a two-hour group teaching session and four support calls over 2 weeks. Our primary outcomes were reduced numbers of nightly wakes or parent report of sleep problem severity. Secondary outcomes included improvement in parental depression, fatigue, sleep, and parent cognitions about infant sleep.MethodsTwo hundred thirty five families of six-to-eight month-old infants were randomly allocated to intervention (n = 117) or to control teaching sessions (n = 118) where parents received instruction on infant safety. Outcome measures were observed at baseline and at 6 weeks post intervention. Nightly observation was based on actigraphy and sleep diaries over six days. Secondary outcomes were derived from the Multidimensional Assessment of Fatigue Scale, Center for Epidemiologic Studies Depression Measure, Pittsburgh Sleep Quality Index, and Maternal (parental) Cognitions about Infant Sleep Questionnaire.ResultsOne hundred eight intervention and 107 control families provided six-week follow-up information with complete actigraphy data for 96 in each group: 96.9 % of intervention and 97.9 % of control infants had an average of 2 or more nightly wakes, a risk difference of −0.2 % (95 % CI: −1.32, 0.91). 4 % of intervention and 14 % of control infants had parent-assessed severe sleep problems: relative risk 0.3, a risk difference of −10 % (CI: 0.11, 0.84-16.8 to −2.2). Relative to controls, intervention parents reported improved baseline-adjusted parental depression (CI: −3.7 to −0.4), fatigue (CI: −5.74 to −1.68), sleep quality (CI: −1.5 to −0.2), and sleep cognitions: doubts (CI: −2.0 to −0.6), feeding (CI: − 2.1 to - 0.7), anger (CI: − 1.8 to - 0.4) and setting limits (CI: −3.5 to −1.5).ConclusionsThe intervention improved caregivers' assessments of infant sleep problem severity and parental depression, fatigue, sleep, and sleep cognitions compared with controls.Trial registrationISRCTN42169337, NCT00877162

INSIGHT Responsive Parenting Intervention and Infant Sleep

“…3,39 Parental mental health is also adversely affected among infants who have difficult bedtimes or do not sleep well. 7,8 …”

“…3–6 Furthermore, infant sleep-related behaviors are associated with maternal sensitivity, relationship quality, parental emotional health, and parenting practices. 7, 8 Inadequate sleep has also emerged as an important risk factor for obesity 9, 10 with links between sleep and weight beginning in infancy. 11–16 Short sleep duration during infancy is also associated with inadequate sleep later in childhood, 17 and therefore improving sleep-related behaviors and extending infant sleep duration has the potential to influence the long-term well-being of children and families.…”

Mother-Infant Room-Sharing and Sleep Outcomes in the INSIGHT Study

“…Infant sleep also affects parental sleep, which can affect other outcomes, including maternal sensitivity, relationship quality, parental emotional health, and parenting practices. 16,17 Fatigue is related to somatic complaints, anxiety, depression, paranoia, and crashes or unintentional injuries involving motor vehicles among healthy adults 39,40 and has been associated with postpartum depression, 41 abusive head trauma, and child abuse. 42 At a time when family-centered guidance is strongly encouraged, parent fatigue should be considered in any guideline related to infant sleep.…”

Treatment of Psychiatric Symptoms Among Offspring of Parents With Bipolar Disorder

“…Another RCT in children (5–12 years) with ADHD who were randomized into two different groups (sleep hygiene practices and standardized behavioral strategies vs usual clinical care which routinely did not involve assessment and management of sleep problems) found that the active treatment group noted benefit in both sleep and behavioral issues, including ADHD symptoms [40]. Another sleep intervention study targeting infant offspring of parents with depression, found improvement in parental depression, limit setting, sleep quality, and fatigue [41]. Together, these studies provide a reasonable level of evidence that youth offspring of parents with Bipolar Disorder could benefit from sleep-related interventions.…”