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

Aim To describe existing evidence on non‐pharmacological interventions to manage sleep disturbance in children with neurodisabilities. Method We systematically reviewed non‐pharmacological interventions aimed at improving non‐respiratory sleep disturbance in children with neurodisability. Sixteen databases, grey literature, and reference lists of included papers were searched up to February 2017. Two researchers (B.B., C.M., G.S., A.S., A.P.) undertook screening, data extraction, and quality appraisal. Results Twenty‐five studies were included: 11 randomized controlled trials and 14 before‐and‐after studies. All studies were at high or unclear risk of bias. Parent‐directed interventions were categorized as comprehensive tailored interventions (n=9), comprehensive non‐tailored interventions (n=8), and non‐comprehensive interventions (n=2). Six ‘other’ non‐pharmacological interventions were included. Seventy‐one child and parent sleep‐related outcomes were measured across the included studies. We report the two most commonly measured outcomes: the Child Sleep Habits Questionnaire and sleep onset latency. Five studies reported significant improvements on at least one of these outcomes. Interpretation Various types of non‐pharmacological intervention for managing sleep disturbance have been evaluated. Clinical heterogeneity and poor study quality meant we could not draw definitive conclusions on the effectiveness of these interventions. Current clinical guidance recommends parent‐directed interventions as the first approach to managing sleep disturbance; prioritizing research in this area is recommended.