Sleep-Wake Disorders

Studies of Childhood Insomnia Lack Diversity, Outcomes for Families, and Non-Sleep Phenotypes

Jessica Nye, PhD
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Previous reviews of behavioral interventions for pediatric insomnia have primarily focused on a single age group, a specific population, and/or only randomized controlled trials. Few reviews have considered the non-sleep outcomes of both children and their parents. This scoping review provides a broader context, including studies regardless of research design or population, along with sleep and non-sleep study outcomes.

Although pediatric insomnia has been identified as a relatively common problem, further research by studies with more complete designs were needed, according to results from a scoping review, published in Sleep Medicine Reviews.

Publication databases were searched from January 1970 through October 2019 for papers about pediatric insomnia. A total of 120 studies were included in this review. The studies were of typically developing children (n=80), young children (n=47), school-age children (n=9), and adolescents (n=10). The total sample size was 9587 children, most (66.7%) were participating in randomized clinical trials.

The participants were 54.1% boys, aged average 6.4 years, and 80.9% were White.

The most commonly tested intervention was bedtime/positive routines (51.7%), followed by parental education (36.7%), sleep hygiene (34.2%), graduated extinction (30.8%), positive reinforcement (28.3%), standard extinction (24.2%), and cognitive strategies (16.7%).

Sleep assessment was most commonly dependent on parent- or child-reported questionnaires (82.5%). Actigraphy (30.0%) was limitedly used and polysomnography was rare (2.5%).

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Sleep was quantified by night waking (49.2%), total sleep time (46.7%), and sleep onset latency (45.0%).

Non-sleep assessments were missing from most study designs. Of the studies that did include some non-sleep component, daytime behavior (22.5%) was most the frequent measurement.

Few studies incorporated the resultant impact on parental sleep patterns (10.8%) or parental non-sleep outcomes (33.3%). The included non-sleep outcomes were depression (13.3%), stress (10.0%), anxiety (7.5%), and mood (6.7%).

This scoping review found that although multiple behavioral interventions have been studied to address adolescent insomnia, further research is still needed. Additional studies should address how effective behavioral therapies were at preventing pediatric insomnia and addressing how youth with medical or psychiatric disorders differed.

There was an overall lack of diversity among studied children. Non-White participants should be recruited for future studies. Children and both their parents should be assessed for sleep and non-sleep phenotypes for a holistic approach to addressing childhood insomnia and its impact on the family unit.

Reference

Meltzer LJ, Wainer A, Engstrom E, Pepa L, Mindell JA. Seeing the whole elephant: A scoping review of behavioral treatments for pediatric insomnia. Sleep Med Rev. Volume 56, 2021. doi:10.1016/j.smrv.2020.101410