Key points Are non-pharmacological interventions effective in prolonging sleep duration in healthy children and, if so, what are the key elements? Findings In this systematic review and meta-analysis of 45 trials, interventions to improve sleep in healthy children were associated with a small increase in sleep duration (by 10 minutes per night). Face-to-face delivery was an important component of the interventions, but interventions that included earlier bedtimes were associated with 47 minutes more sleep per night. Which means that helping children go to bed earlier can increase sleep duration in healthy children, and interventions should be included to encourage earlier going to bed. |
Importance
Adequate sleep duration is necessary for many aspects of children’s health, development, and well-being; However, children’s sleep duration is decreasing and effective strategies to increase sleep in healthy children remain to be elucidated.
Aim
To determine whether non-pharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.
The data sources CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov and WHO trials databases were searched from inception to 15 November 2021.
Study selection
Randomized clinical trials of interventions to improve sleep duration in healthy children were evaluated independently by 2 investigators. A total of 28,478 studies were identified.
Data extraction and synthesis
Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Meta-analytic random effects models were used to estimate pooled effect sizes.
Main results and measures
Difference in sleep duration, measured in minutes.
Results
A total of 13,539 children participating in 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 nighttime 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 was socioeconomically disadvantaged (e.g., came from a family or area low-income), sleep duration assessment method (objective vs. subjective), location of intervention delivery (home vs. school), whether interventions were delivered in person or used parent involvement, whether behavioral theory was used, environmental change, or whether it had greater or lesser intensity.
Interventions that included earlier bedtime were associated with a sleep extension of 47 minutes (95% CI, 18.9 to 75.0; 3 trials) compared with the remaining studies (7.4 minutes; 95% CI). , 2.9 to 11.8; 42 trials) (p = 0.006 for group difference). Trials of shorter duration (6 months or less) had larger effects.
Conclusions and relevance
Interventions focused on earlier bedtime may offer a simple, pragmatic and effective way to significantly increase sleep duration that could have important benefits for children’s health.
