Data Demonstrates the Best Intervention for Pediatric Sleep Health is Earlier Bedtime

Lucia Magee, MBChB

According to new research, nonpharmacological sleep interventions that focused on earlier sleep schedules can serve as a “simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.”

The study addressed the necessity of proper sleep duration in healthy children as sleep durations in this population are declining. Sleep plays multiple roles in a child’s health, development, and well-being.

Because of the lack of existing strategies to promote healthy sleep in children, a team of investigators, including Lucia Magee, MBChB, PopulationHealth Research Institute,St George’s, University of London, aimed to determine if nonpharmacological interventions would be effective at improving the duration of time health children spend sleeping. They also sought to identify the key components of the studied interventions.

The Systematic Review of Sleep Studies

A pair of investigators independently screened 28,478 randomized clinical trials that evaluated interventions to improve sleep duration in healthy children. A total of 45 studies were included and assessed by the team. Then, the data was processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline.

A difference of sleep duration, measured by minutes, was the main outcome. Of the included trials, a total of 13,539 participating children were included in the analyses. The intervention group consisted of 6897 (50.9%) and 6642 (49.1%) children in the control group, with a mean age range of 18 months-19 years.

Substantial variations between trials were addressed in the results.

“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,” investigators wrote.

Determining Effective Sleep Interventions

An increase of 10.5 minutes of nocturnal sleep duration with sleep interventions was observed when results were pooled. Many intervention components revealed small impacts on sleep, while shorter trials with a duration of 6 months or less had more substantial effects.

Considerable increases were observed within the subcategory of trials with earlier bedtimes as the cornerstone. After objective measurements, an increase of 47 minutes was associated with these studies.

Studies with broader interventions, such as those focusing on obesity, demonstrated to be ineffective at increasing sleep duration compared with those focusing specifically on sleep. The research focused only on sleep revealed a 16-minute extension of sleep duration compared with 1.2 minutes when broader areas were studied.

“In this systematic review and meta-analysis of 45 trials, interventions to improve sleep in healthy children were associated with a small increase in sleep duration (by 10 minutes per night). Face-to-face delivery was an important component of interventions, but interventions that included earlier bedtimes were associated with 47 minutes longer sleep duration per night,” the team stated.

“Supporting children to go to bed earlier can increase sleep duration in healthy children, and interventions to encourage earlier bedtimes should be included,” the study concluded.

The study, “Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children” was published in JAMA Pediatrics.