Non‐pharmacological interventions for non‐respiratory sleep disturbance in children with neurodisabilities: a systematic review

Scantlebury, Arabella; McDaid, Catriona; Dawson, Vicki; Elphick, Heather; Fairhurst, Caroline; Hewitt, Catherine; Parker, Adwoa; Spiers, Gemma; Thomas, Megan; Wright, Kath; Beresford, Bryony

doi:10.1111/dmcn.13972

Cited by 20 publications

(14 citation statements)

References 61 publications

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“…The results of the systematic review of effectiveness are available separately (www.journalslibrary.nihr.ac.uk/programmes/hta/1421202/#/). 9–11 The aim of this paper is to summarise the outcome measures used in the RCTs and other effectiveness studies evaluating pharmacological and non-pharmacological interventions for the management of non-respiratory sleep disturbances in children with neurodisabilities and make recommendations about whether a core outcome set is required.…”

Section: Introductionmentioning

confidence: 99%

Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review

et al. 2019

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ObjectivesTo assess whether a core outcome set is required for studies evaluating the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities.DesignSurvey of outcome measures used in primary studies identified by a systematic review.Data sourcesASSIA, CENTRAL, Cochrane Database of Systematic Reviews, Conference Proceedings Citation Index, CINAHL, DARE, Embase, HMIC, MEDLINE, MEDLINE In-Process, PsycINFO, Science Citation Index, Social Care Online, Social Policy & Practice, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform and the UK Clinical Trials Gateway were searched up to February 2017.Eligibility criteriaStudies evaluating pharmacological or non-pharmacological interventions for children (≤18 years old) with a neurodisability and experiencing non-respiratory sleep disturbance.Data extraction and synthesisOutcome measures were listed from each study and categorised into domains.ResultsThirty-nine studies assessed five core outcome areas: child sleep, other child outcomes, parent outcomes, adverse events and process measures. There were 54 different measures of child sleep across five domains: global measures; sleep initiation; maintenance; scheduling; and other outcomes. Fifteen non-pharmacological (58%) and four pharmacological studies (31%) reported child outcomes other than sleep using 29 different measures.One pharmacological and 14 non-pharmacological (54%) studies reported parent outcomes (17 different measures). Eleven melatonin studies (85%) recorded adverse events, with variation in how data were collected and reported. One non-pharmacological study reported an explicit method of collecting on adverse events. Several process measures were reported, related to adherence, feasibility of delivery, acceptability and experiences of receiving the intervention.ConclusionsThere is a lack of consistency between studies in the outcome measures used to assess the effectiveness of interventions for non-respiratory sleep disturbances in children with neurodisabilities. A minimum core outcome set, with international consensus, should be developed in consultation with parents, children and young people, and those involved in supporting families.PROSPERO registration numberCRD42016034067

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Section: Introductionmentioning

confidence: 99%

Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review

et al. 2019

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“…In this paper we focus on the effectiveness and safety of pharmacological interventions. Findings with respect to non‐pharmacological interventions are reported elsewhere …”

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confidence: 99%

“…Findings with respect to non-pharmacological interventions are reported elsewhere. 31,32 We aimed to evaluate and summarize the existing evidence about the effectiveness of pharmacological interventions on sleep disturbances for children with neurodisabilities. Where possible, we planned to undertake subgroup analyses to examine whether intervention effectiveness differed between different types of neurodisability, and whether it was administered in parallel or sequentially to another sleep management intervention.…”

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confidence: 99%

Oral melatonin for non‐respiratory sleep disturbance in children with neurodisabilities: systematic review and meta‐analyses

Parker

Beresford

Dawson³

et al. 2019

Develop Med Child Neuro

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Aim To evaluate the effectiveness of pharmacological interventions for managing non‐respiratory sleep disturbances in children with neurodisabilities. Method We performed a systematic review and meta‐analyses of randomized controlled trials ( RCT s). We searched 16 databases, grey literature, and reference lists of included papers up to February 2017. Data were extracted and assessed for quality by two researchers (B.B., C.M., G.S., A.S., A.P.). Results Thirteen trials were included, all evaluating oral melatonin. All except one were at high or unclear risk of bias. There was a statistically significant increase in diary‐reported total sleep time for melatonin compared with placebo (pooled mean difference 29.6min, 95% confidence interval [ CI ] 6.9–52.4, p =0.01). Statistical heterogeneity was high (97%). For the single RCT with low risk of bias, the unadjusted mean difference in total sleep time was 13.2 minutes (95% CI −13.3 to 39.7) favouring melatonin, while the mean difference adjusted for baseline total sleep time was statistically significant (22.4min, 95% CI 0.5–44.3, p =0.04). Adverse event profile suggested that melatonin was well‐tolerated. Interpretation There is a paucity of evidence on managing sleep disturbances in children with neurodisabilities, and it is mostly of limited scope and poor quality. There is evidence of the benefit and safety of melatonin compared with placebo, although the extent of this benefit is unclear. What this paper adds Melatonin for the management of non‐respiratory sleep disturbances in children with neurodisabilities was well tolerated with minimal adverse effects. The extent of benefit and which children might benefit most from melatonin use is uncertain. Benefit may be greatest in those with autism spectrum disorder; however, this finding should be interpreted with caution.

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“…The finding that a behavioural intervention for sleep support is effective is not novel. Previous projects have shown efficacy of behavioural sleep support delivered both by the third sector and in healthcare settings 12–14. Our study has shown that delivery and implementation of sleep support within existing local services is feasible for groups of vulnerable children in the community.…”

Section: Discussionmentioning

confidence: 66%

Pilot study of an integrated model of sleep support for children: a before and after evaluation

Elphick

Lawson

Ives

et al. 2019

bmjpo

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ObjectiveDespite the success of behavioural sleep support interventions in the third sector, sleep support is not universally available for families in the UK. The aim of the study was to provide evidence of efficacy and to propose a delivery model for integrated sleep support for families of vulnerable children.Design and settingA sleep support intervention was carried out in Sheffield Local Authority evaluated using a preintervention and postintervention study design by Sheffield Children’s National Health Service (NHS) Trust.ParticipantsFifty-six children aged 6–16 years with significant sleep problems were recruited; 39 completed the intervention and evaluation.InterventionsBasic sleep education and an individualised programme was delivered by a sleep practitioner. Follow-on telephone support was provided to empower the parent (and/or young person) to carry out the sleep programme at home. An integrated NHS and Local Authority delivery model was designed and implemented.ResultsParents’ ratings of their child’s ability to self-settle improved from 1.1/10 to 6.4/10 (p<0.05). Mean Warwick-Edinburgh Mental Well-being Scale scores improved significantly for parents/carers (MD 5.16, 95%CIs 2.62 to 7.69, p<0.05). Children who completed the intervention gained on average an extra 2.4 hours sleep a night. There was reduction in healthcare utilisation, illnesses and medication use.ConclusionsThe behavioural approach to sleep support for these vulnerable groups of children is highly effective. Follow-on individual support to empower parents is key to achieving success. Sleep support can be implemented in NHS and Local Authority services by integration into the existing workforce using a cross-agency model.

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Non‐pharmacological interventions for non‐respiratory sleep disturbance in children with neurodisabilities: a systematic review

Cited by 20 publications

References 61 publications

Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review

Outcome domains and outcome measures used in studies assessing the effectiveness of interventions to manage non-respiratory sleep disturbances in children with neurodisabilities: a systematic review

Oral melatonin for non‐respiratory sleep disturbance in children with neurodisabilities: systematic review and meta‐analyses

Pilot study of an integrated model of sleep support for children: a before and after evaluation

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