Systematic review and meta-analysis of behavioral interventions for sleep disruption in pediatric neurodevelopmental and medical conditions

OBJECTIVE: To perform a systematic review and meta-analysis of randomized controlled trials (RCTs) of behavioral interventions for sleep disruption in children with neurodevelopmental and medical conditions. METHODS: A comprehensive literature search was designed and run for studies published between 1970 and July 1, 2023. Original, peer-reviewed RCTs of children ages birth to 18 years with/at risk for sleep disruption and a neurodevelopmental and/or medical condition were included. Interventions without behavioral components, lifestyle interventions, or pharmaceutical interventions were excluded. Primary outcomes included sleep health domains, and secondary outcomes were condition symptomatology and quality of life. RESULTS: Data from 15 RCTs were examined (1,374 participants, 78% male, 71% White). Sleep disruptions were predominantly insomnia symptoms. Intervention content included parent training, sleep hygiene education, and relaxation strategies. Adaptations to the interventions for use in children with neurodevelopmental and/or medical conditions included behavioral strategies commonly used in those conditions, sleep education specific to the condition, and/or use of case examples specific to the condition. No studies reported on adverse effects. Behavioral sleep interventions had a significant effect on sleep satisfaction, bedtime resistance, and ADHD symptoms at postintervention. At follow-up, effects were maintained only for sleep satisfaction. Parent rating of child sleep duration improved at follow-up but not postintervention. CONCLUSIONS: Despite being at high risk for comorbid sleep disruption, children with neurodevelopmental and/or medical conditions are underrepresented in the sleep intervention literature. Future research is needed with larger, more diverse samples and increased methodological rigor to address sleep disruption in these pediatric populations. PROTOCOL REGISTRATION: Open Science Framework Preregistration doi.org/10.17605/OSF.IO/KE58C, date of registration December 9, 2023.