1. In a systematic review and meta-analysis of 45 randomized controlled trials including healthy children, nonpharmaceutical sleep interventions were associated with a 10.5-minute increase in sleep duration.

2. Interventions involving an earlier bedtime were associated with an increase in sleep duration of 47 minutes.

Evidence Rating Level: 1 (Excellent)

Study Rundown: In the pediatric population, sleep duration is important not only for short-term health and quality of life but also for growth and development. This study aimed to review randomized controlled trials of nonpharmaceutical interventions for increasing sleep duration in healthy children in order to determine their relative and overall effectiveness. Across 45 trials including about 13,500 children, interventions were associated with a statistically significant increase in sleep duration of 10.5 minutes. Interventions involving earlier bedtimes were significantly more likely to increase sleep duration, with a 47-minute difference across three trials. Other interventions included family-based educational programs, physical activity programs, motivational interviewing, positive reinforcement, and structured bedtime routines. The included studies were heterogeneous, and factors including the continent where the study was performed and the reporting methods for sleep duration — though not subjects’ age group — were found to significantly affect outcomes. Studies with less than 6 months of follow-up reported significantly larger effects than those with longer follow-up. Still, this meta-analysis reflects a larger, more diverse population than previous reviews and provides compelling evidence that children’s sleep can be improved through structured, nonpharmaceutical intervention, particularly earlier bedtimes. This is highly relevant for both providers and parents given the wide-reaching benefits of adequate sleep duration.

Click to read the study in JAMA Pediatrics

Click to read an accompanying editorial in JAMA Pediatrics

Relevant Reading: Sleep health promotion interventions and their effectiveness: An umbrella review

In-Depth [systematic review and meta-analysis]: Individual and cluster randomized controlled trials implementing non-pharmacological interventions on children 1-18 years old without diagnosed sleep disorders were included. Self- and parent-reported as well as objectively measured sleep durations were included. The 95% confidence interval (CI) for the 10.5-minute increase in sleep duration across trials was 5.6-15.4 (p<0.001). The I2 statistic for the meta-analysis was 87.2%, indicating considerable heterogeneity. Interventions focused on sleep hygiene alone significantly increased sleep duration, while interventions with broader goals did not (p<0.001). Studies using sleep diaries to measure duration reported significantly larger increases in sleep duration at 26.4 minutes (95% CI 17.7-35.2) compared to 0.4 minutes (-3.4-4.3) and 7.8 minutes (-2.3-17.7) for parent reporting and child reporting, respectively. The 95% CI for the 47.0 minute increase in sleep duration with trials involving early bedtime was 18.9-75.0 minutes compared to 7.4 minutes (2.9-11.8) for all other trials (p=0.006).

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