Systematic review and meta-analysis of behavioral interventions for pediatric insomnia

Abstract

Objective: To evaluate and quantify the evidence for behavioral interventions for pediatric insomnia.

Methods: Meta-analysis of 16 controlled trials and qualitative analysis of 12 within-subject studies were conducted (total n = 2,560).

Results: Meta-analysis found significant effects for four specified sleep outcomes: sleep-onset latency, number of night wakings, and duration of night wakings, and sleep efficiency, with small to large effect sizes across the controlled clinical trials involving typical children. No significant effects were found for the two studies conducted with special needs populations. Finally, within-subjects studies demonstrated significant effects for all sleep outcomes with large effect sizes. Risk of bias assessment and GRADE ratings of the quality of the evidence are described.

Conclusion: Moderate-level evidence supports behavioral interventions for pediatric insomnia in young children. However, low evidence for children, adolescents, and those with special needs (due to a lack of studies that met inclusion criteria) highlights the need for future research.

Keywords: bedtime problems; behavioral insomnia of childhood; behavioral treatment; insomnia; night wakings; pediatric insomnia; treatment.