Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis

Abstract

Importance: Adequate 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.

Objective: To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.

Data sources: CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021.

Study selection: Randomized 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 synthesis: Data 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 measures: Difference in sleep duration, measured in minutes.

Results: A 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 relevance: Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.

Figure 1.. Study Selection Process

Figure 2.. Forest Plot Showing Mean Differences in Sleep Duration in 45 Studies, Comparing Sleep Intervention Groups With Control

Mean differences in sleep duration (in minutes) for each study, comparing duration in those receiving a sleep intervention vs control. Point estimates are shown by blue solid squares, with horizontal lines showing the 95% CI. The pooled estimate based on a random-effects model is shown with a blue diamond. In the risk of bias column, category A indicates random sequence generation (selection bias); category B, allocation concealment (selection bias); category C, blinding of participants and personnel (performance bias); category D, blinding of outcome assessment (detection bias); category E, incomplete outcome data (attrition bias); category F, selective reporting (reporting bias); and category G, other bias. Risk of bias criteria graded from low risk (green), unclear risk (yellow), or high risk (red).