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Decker JE, Morales KH, Fair MA, Vallecorsa G, Subramanyam S, Fiks AG, Mayne S, Williamson AA, Mitchell JA. Classifying intervention components used in sleep duration interventions for children: A systematic review and meta-analysis. Sleep Med Rev 2024; 78:101995. [PMID: 39216182 DOI: 10.1016/j.smrv.2024.101995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 08/13/2024] [Accepted: 08/20/2024] [Indexed: 09/04/2024]
Abstract
The Multiphase Optimization Strategy (MOST) is a three-phase iterative framework that could accelerate the development of behavioral interventions. This systematic review and meta-analysis was conducted within the MOST preparation phase and aimed to classify components included in pediatric sleep duration interventions, using the Behavior Change Technique (BCT) Taxonomy. Across 37 interventions, 46 out of 93 BCTs have been used, with an average of 8 techniques used per study. The most common BCTs used were instruction on how to perform the behavior (N = 29; code 4.1), practical social support (N = 22; code: 3.2), and behavioral practice/rehearsal (N = 22; code: 8.1). A latent class analysis identified two classes of interventions, distinguished by the presence of BCTs falling within the following behavior change groups: shaping knowledge, natural consequences, comparison of behavior, and repetition and substitution. Our meta-analysis revealed that interventions belonging to the latent class with these behavior change groups (N = 15) had a pooled positive intervention effect of 14 min (95 % CI: 8-21) versus 8 min (95 % CI: 1-15) for interventions without these behavior change groups (N = 19). This systematic review and meta-analysis will enhance the development of sleep promotion interventions and guide the selection of candidate intervention components for future optimization and randomized control trials.
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Affiliation(s)
- Jessica E Decker
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Maddy A Fair
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Giuliana Vallecorsa
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Sanjana Subramanyam
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Stephanie Mayne
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Ariel A Williamson
- The Ballmer Institute for Children's Behavioral Health, University of Oregon, Portland, OR, USA; Department of Psychology, College of Arts and Sciences, University of Oregon, Eugene, OR, USA
| | - Jonathan A Mitchell
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Kogon AJ, Maqsood AM, LoGuidice J, Amaral S, Meyers K, Mitchell JA. Sleep Duration and Blood Pressure in Youth Referred for Elevated Blood Pressure Evaluation. Pediatrics 2024; 154:e2023062940. [PMID: 38887814 DOI: 10.1542/peds.2023-062940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 04/15/2024] [Accepted: 04/18/2024] [Indexed: 06/20/2024] Open
Abstract
OBJECTIVES Sleep promotion is not specifically recommended as a target for hypertension management. We examined associations of sleep duration and timing with blood pressure parameters in patients referred to pediatric nephrology clinic for elevated blood pressure evaluation. METHODS This is a retrospective study of initial ambulatory blood pressure monitoring data and self-report sleep data collected from patients referred to nephrology clinic for the evaluation of elevated blood pressure. Linear and logistic regression modeling determined associations between sleep exposures (duration and timing) and continuous and dichotomous blood pressure outcomes, respectively, adjusted for age, sex, body mass index, and weekday versus weekend status. RESULTS The study sample included 539 patients with mean age 14.6 years and 56% meeting hypertension criteria. Sleep duration averaged 9.1 hours per night. Average timing of sleep onset and offset were 11:06 pm and 8:18 am, respectively. Longer sleep duration was associated with better daytime blood pressure parameters (eg, every extra hour of sleep duration was associated with a reduced odds of wake hypertension [odds ratio, 0.88; 95% CI, 0.79-0.99]). Later sleep onset was associated with worse daytime blood pressure parameters (eg, each additional hour of later sleep onset was associated with higher wake systolic blood pressure index [mean wake blood pressure/95th percentile]) (β = 0.07; 95% CI, 0.02-0.13). Associations were consistent across sex, age, body mass index, and weekday status. CONCLUSIONS Longer sleep duration and earlier sleep onset were associated with lower blood pressure. This suggests that sleep optimization may be an important target for intervention in hypertension management.
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Affiliation(s)
- Amy J Kogon
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Anam M Maqsood
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jill LoGuidice
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Sandra Amaral
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Kevin Meyers
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Nephrology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jonathan A Mitchell
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
- Division of Gastroenterology, Hepatology, and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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3
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Bushnell G, Ivanenko A, Horton DB, Lunsford-Avery JR, Posner J, Gerhard T, Suarez E, Olfson M. Psychiatric comorbidities and prescribing tendencies of sleep medications and related medications in young people with insomnia: a United States commercial claims-based analysis. Sleep 2024; 47:zsae057. [PMID: 38430553 PMCID: PMC11082474 DOI: 10.1093/sleep/zsae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 02/05/2024] [Indexed: 03/04/2024] Open
Abstract
STUDY OBJECTIVES To characterize children and youth newly diagnosed with insomnia and to describe their use of sleep and other related prescription medications. METHODS Within a commercial claims database (January 1, 2016-December 31, 2021), we identified children and youth (2-24 years) with a newly recorded insomnia diagnosis (G47.0x; F51.0x) and examined psychiatric diagnoses in the prior 6 months. We evaluated sleep and related prescription medications dispensed in the week after new insomnia diagnoses (i.e. trazodone, other antidepressants, hydroxyzine, alpha-agonists, benzodiazepines, non-benzodiazepine hypnotics "z-drugs," antipsychotics, and others). Analyses were stratified by age and psychiatric comorbidities. RESULTS Among 68 698 children and 108 118 older youth (18-24 years) with a new insomnia diagnosis, three-quarters had a diagnosed comorbid psychiatric condition; anxiety disorders, depression, and ADHD were the most common. Among those without comorbid psychiatric diagnoses, 20.2% of children and 37.4% of older youth had a sleep or related medication dispensed in the following week. In children without a comorbid psychiatric diagnosis, alpha-agonists, hydroxyzine, and trazodone were the most common medications; in older youth, trazodone was the most common medication followed by hydroxyzine, z-drugs, and SSRIs. Sleep and related prescription medications were more commonly dispensed to those with psychiatric comorbidities. From 2017 to 2021, there was an increase in hydroxyzine prescriptions following a new insomnia diagnosis and decline in z-drug and benzodiazepine prescriptions. CONCLUSIONS Our findings from a nationwide sample of young people with insomnia highlight the high prevalence of psychiatric comorbidities and variety of sleep and related medications they receive. Characterizing prescribing tendencies informs guideline development and future research.
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Affiliation(s)
- Greta Bushnell
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Anna Ivanenko
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine; Chicago, IL, USA
| | - Daniel B Horton
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Department of Pediatrics, Rutgers Robert Wood Johnson Medical School; New Brunswick, NJ, USA
| | - Jessica R Lunsford-Avery
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine; Durham, NC, USA
| | - Tobias Gerhard
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
- Pharmacy Practice and Administration, Ernest Mario School of Pharmacy, Rutgers University; New Brunswick, NJ, USA
| | - Elizabeth Suarez
- Center for Pharmacoepidemiology and Treatment Sciences, Institute for Health, Health Care Policy and Aging Research; Rutgers University; New Brunswick, NJ, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Piscataway, NJ, USA
| | - Mark Olfson
- Department of Psychiatry, Columbia University Irving Medical Center; New York, NY, USA
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Lecuelle F, Leslie W, Gustin MP, Franco P, Putois B. Treatment for behavioral insomnia in young children with neurotypical development under 6 years of age: A systematic review. Sleep Med Rev 2024; 74:101909. [PMID: 38394890 DOI: 10.1016/j.smrv.2024.101909] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Revised: 01/30/2024] [Accepted: 02/12/2024] [Indexed: 02/25/2024]
Abstract
This literature review examines all treatments for behavioral insomnia in children under 6 years of age to determine which treatments have empirically demonstrated efficacy. Following PRISMA guidelines, three databases were investigated (Pubmed, Cochrane and Psychinfo) to select randomized controlled trials (RCTs) which assess treatments for behavioral insomnia in children under 6 years of age, all with neurotypical development. A total of 908 articles met the search criteria. 21 articles were selected and analyzed in their entirety for a total of 2363 children (ranging from 2 months to 6 years of age). Based on these studies, treatment of behavioral insomnia in young children under 6 years of age is primarily based on behavioral therapy. There is no evidence that pharmacological treatments are effective in the long term for neurotypical children. This review highlights the lack of RCTs in this field: new RCTs should be carried out among young children to refine and optimize the therapeutic approach and to address the risk of therapeutic abuse through the use of non-scientifically validated methods.
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Affiliation(s)
- Florian Lecuelle
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France.
| | | | - Marie-Paule Gustin
- Institute of Pharmaceutic and Biological Sciences, University Claude Bernard Lyon 1, Villeurbanne, France; Emerging Pathogens Laboratory-Fondation Merieux, International Center for Infectiology Research (CIRI), Inserm U1111, CNRS UMR5308, ENS de Lyon, Lyon, France
| | - Patricia Franco
- Pediatric Sleep Unit, Hospital for Women Mothers & Children, Lyon 1 University, France; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
| | - Benjamin Putois
- Swiss Distance Learning University, Faculty of Psychology, Brig, Switzerland; Research Laboratory on the Physiology of the Brain Arousal System, CRNL, INSERM-U1028, CNRS UMR5292, Lyon, France
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Lönn M, Svedberg P, Nygren J, Jarbin H, Aili K, Larsson I. The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder-A randomized controlled crossover trial. J Sleep Res 2024; 33:e13990. [PMID: 37452697 DOI: 10.1111/jsr.13990] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 06/19/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. -2.79 min, p = 0.015, Cohen's d = -0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11-14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions.
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Affiliation(s)
- Maria Lönn
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
- Psychiatry Halland, Region Halland, Halmstad, Sweden
| | - Petra Svedberg
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Jens Nygren
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Håkan Jarbin
- Department of Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden
- Faculty of Medicine, Department of Clinical Sciences Lund, Child and Adolescent Psychiatry, Lund University, Lund, Sweden
| | - Katarina Aili
- Department of Health and Sport, School of Health and Welfare, Halmstad University, Halmstad, Sweden
| | - Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, Halmstad, Sweden
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Drozd F, Pettersen Sandtrø H, Leksbø TS, Haga SM, Jacobsen H, Størksen HT. Identifying and developing strategies for implementation of a guided internet- and mobile-based infant sleep intervention in well-baby and community mental health clinics using group concept mapping. BMC Health Serv Res 2024; 24:175. [PMID: 38326797 PMCID: PMC10851561 DOI: 10.1186/s12913-024-10632-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 01/23/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND This study aimed to identify strategies for the implementation of a guided internet- and mobile-based intervention (IMI) for infant sleep problems ("Sleep Well, Little Sweetheart") in well-baby and community mental health clinics. STUDY DESIGN We used group concept mapping, a two-phased mixed methods approach, conducted as a two-day workshop in each clinic. We recruited 20 participants from four clinics and collected sorting and rating data for implementation strategies based on the Expert Recommendations for Implementing Change taxonomy and brainstorming sessions. Data were analyzed using descriptive statistics, multidimensional scaling, and hierarchical cluster analysis to create cluster maps, laddergrams, and Go-Zone graphs. Participants were presented with the results and discussed and interpreted the findings at each of the clinics in spring 2022. RESULTS Participants identified 10 clusters of strategies, of which Training, Embedding and Coherence, User Involvement and Participation, and Clinician Support and Implementation Counseling were rated as most important and feasible. Economy and Funding and Interactive and Interdisciplinary Collaboration were rated significantly lower on importance and feasibility compared to many of the clusters (all ps < 0.05). There was a correlation between the importance and feasibility ratings (r =.62, p =.004). CONCLUSIONS The use of group concept mapping made it possible to efficiently examine well-baby and community clinics' perspectives on complex issues, and to acquire specific knowledge to allow for the planning and prioritization of strategies for implementation. These results suggest areas of priority for the implementation of IMIs related to infant sleep problems. TRIAL REGISTRATION The study was pre-registered at Open Science Framework ( www.osf.io/emct8 ).
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Affiliation(s)
- Filip Drozd
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway.
| | - Hege Pettersen Sandtrø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Turid Skjerve Leksbø
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Silje Marie Haga
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
| | - Heidi Jacobsen
- Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, N-0405, Nydalen, Oslo, PO Box 4623, Norway
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7
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Edemann-Callesen H, Andersen HK, Ussing A, Virring A, Jennum P, Debes NM, Laursen T, Baandrup L, Gade C, Dettmann J, Holm J, Krogh C, Birkefoss K, Tarp S, Händel MN. Use of melatonin for children and adolescents with chronic insomnia attributable to disorders beyond indication: a systematic review, meta-analysis and clinical recommendation. EClinicalMedicine 2023; 61:102049. [PMID: 37457114 PMCID: PMC10339185 DOI: 10.1016/j.eclinm.2023.102049] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background Melatonin has become a widely used sleeping aid for young individuals currently not included in existing guidelines. The aim was to develop a recommendation on the use of melatonin in children and adolescents aged 2-20 years, with chronic insomnia due to disorders beyond indication. Methods We performed a systematic search for guidelines, systematic reviews, and randomised trials (RCTs) in Medline, Embase, Cochrane Library, PsycInfo, Cinahl, Guidelines International Network, Trip Database, Canadian Agency for Drugs and Technologies in Health, American Academy of Sleep Medicine, European Sleep Research Society and Scandinavian Health Authorities databases. A separate search for adverse events was also performed. The latest search for guidelines, systematic reviews, and adverse events was performed on March 17, 2023. The latest search for RCTs was performed on to February 6, 2023. The language was restricted to English, Danish, Norwegian, and Swedish. Eligible participants were children and adolescents (2-20 years of age) with chronic insomnia due to underlying disorders, in whom sleep hygiene practices have been inadequate and melatonin was tested. Studies exclusively on autism spectrum disorders or attention deficit hyperactive disorder were excluded. There were no restrictions on dosage, duration of treatment, time of consumption or release formula. Primary outcomes were quality of sleep, daytime functioning and serious adverse events, assessed at 2-4 weeks post-treatment. Secondary outcomes included total sleep time, sleep latency, awakenings, drowsiness, quality of life, non-serious adverse events, and all-cause dropouts (assessed at 2-4 weeks post-treatment), plus quality of sleep and daytime functioning (assessed at 3-6 months post-treatment). Pooled estimates were calculated using inverse variance random effects model. Statistical heterogeneity was calculated using I2 statistics. Risk of bias was assessed using Cochrane risk of bias tool. Publication bias was assessed using funnel plots. A multidisciplinary guideline panel constructed the recommendation using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). The certainty of evidence was considered either high, moderate, low or very low depending on the extent of risk of bias, inconsistency, imprecision, indirectness, or publication bias. The evidence-to-decision framework was used to discuss the feasibility and acceptance of the constructed recommendation and its impact on resources and equity. The protocol is registered with the Danish Health Authority. Findings We identified 13 RCTs, including 403 patients with a wide range of conditions. Melatonin reduced sleep latency by 14.88 min (95% CI 23.42-6.34, 9 studies, I2 = 60%) and increased total sleep time by 18.97 min (95% CI 0.37-37.57, 10 studies, I2 = 57%). The funnel plot for total sleep time showed no apparent indication of publication bias. No other clinical benefits were found. The number of patients experiencing adverse events was not statistically increased however, safety data was scarce. Certainty of evidence was low. Interpretation Low certainty evidence supports a moderate effect of melatonin in treating sleep continuity parameters in children and adolescents with chronic insomnia due to primarily medical disorders beyond indication. The off-label use of melatonin for these patients should never be the first choice of treatment, but may be considered by medical specialists with knowledge of the underlying disorder and if non-pharmacological interventions are inadequate. If treatment with melatonin is initiated, adequate follow-up to evaluate treatment effect and adverse events is essential. Funding The Danish Health Authority. The Parker Institute, Bispebjerg and Frederiksberg Hospital, supported by the Oak Foundation.
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Affiliation(s)
- Henriette Edemann-Callesen
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Center for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200, Slagelse, Denmark
| | | | - Anja Ussing
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Anne Virring
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Poul Jennum
- Danish Center for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Torben Laursen
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Bispebjerg and Gentofte Departments, Mental Health Centre Copenhagen, Copenhagen University Hospital – the Mental Health Services of the Capital Region in Denmark, Denmark
| | - Christina Gade
- Department of Clinical Pharmacology and Clinical Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Denmark
| | - Jette Dettmann
- Department of Pediatrics, Copenhagen University Hospital – NOH, Hillerød, Denmark
| | - Jonas Holm
- The Occupational Therapist Association, Denmark
| | - Camilla Krogh
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | | | - Simon Tarp
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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8
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Edemann-Callesen H, Andersen HK, Ussing A, Virring A, Jennum P, Debes NM, Laursen T, Baandrup L, Gade C, Dettmann J, Holm J, Krogh C, Birkefoss K, Tarp S, Händel MN. Use of melatonin in children and adolescents with idiopathic chronic insomnia: a systematic review, meta-analysis, and clinical recommendation. EClinicalMedicine 2023; 61:102048. [PMID: 37457117 PMCID: PMC10339205 DOI: 10.1016/j.eclinm.2023.102048] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 05/22/2023] [Accepted: 06/01/2023] [Indexed: 07/18/2023] Open
Abstract
Background Melatonin prescriptions for children and adolescents have increased substantially during the last decade. Existing clinical recommendations focus on melatonin as a treatment for insomnia related to neurodevelopmental disorders. To help guide clinical decision-making, we aimed to construct a recommendation on the use of melatonin in children and adolescents aged 5-20 years with idiopathic chronic insomnia. Methods A systematic search for guidelines, systematic reviews and randomised controlled trials (RCT) were performed in Medline, Embase, Cochrane Library, PsycInfo, Cinahl, Guidelines International Network, Trip Database, Canadian Agency for Drugs and Technologies in Health, American Academy of Sleep Medicine, European Sleep Research Society and Scandinavian Health Authorities databases. A search for adverse events in otherwise healthy children and adolescents was also performed. The latest search for guidelines, systematic reviews, and adverse events was performed on March 18, 2023. The latest search for RCTs was performed on to February 6, 2023. The language was restricted to English, Danish, Norwegian, and Swedish. Eligible participants were children and adolescents (5-20 years of age) with idiopathic chronic insomnia, in whom sleep hygiene practices have been inadequate and melatonin was tested. There were no restrictions on dosage, duration of treatment, time of consumption, or release formula. Primary outcomes were quality of sleep, daytime functioning and serious adverse events. Secondary outcomes included total sleep time, sleep latency, awakenings, drowsiness, quality of life, all-cause dropouts, and non-serious adverse events. Outcomes were assessed at different time points to assess short-term and long-term effects. Meta-analysis was performed using inverse variance random-effects model and risk of bias was assessed using Cochrane risk of bias tool. If possible, funnel plots would be constructed to investigate publication bias. Heterogeneity was calculated via I2 statistics. A multidisciplinary guideline panel formulated the recommendation according to Grading of Recommendations Assessment, Development and Evaluation (GRADE). The certainty of evidence was considered either high, moderate, low or very low depending on the extent of risk of bias, inconsistency, imprecision, indirectness, or publication bias. The evidence-to-decision framework was subsequently used to discuss the feasibility and acceptance of the constructed recommendation alongside the impact on resources and equity. The protocol is registered with the Danish Health Authority. Findings We included eight RCTs with 419 children and adolescents with idiopathic chronic insomnia. Melatonin led to a moderate increase in total sleep time by 30.33 min (95% confidence interval (CI) 18.96-41.70, 4 studies, I2 = 0%) and a moderate reduction in sleep latency by 18.03 min (95% CI -26.61 to -9.44, 3 studies, I2 = 0%), both as assessed by sleep diary. No other beneficial effects were found. None of the studies provided information on serious adverse events, yet the number of participants experiencing non-serious adverse events was increased (Relative risk 3.44, 95% CI 1.25-9.42, 4 studies, I2 = 0%). Funnel plots were not constructed due to the low number of studies. The certainty of evidence was very low on the quality of sleep and low for daytime functioning. Interpretation Evidence of very low certainty shows that benefits are limited and unwanted events are likely when melatonin is used to treat otherwise healthy children and adolescents with chronic insomnia. Melatonin should never be the first choice of treatment for this particular population, yet carefully monitored short-term use may be considered if sleep hygiene practices and non-pharmacological interventions have proven inadequate, and only if daytime function is compromised. Funding The Danish Health Authority and the Parker Institute, Bispebjerg and Frederiksberg Hospital supported by the Oak Foundation.
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Affiliation(s)
- Henriette Edemann-Callesen
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Centre for Evidence-Based Psychiatry, Psychiatric Research Unit, Psychiatry Region Zealand, 4200, Slagelse, Denmark
| | | | - Anja Ussing
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Anne Virring
- Department of Child and Adolescent Psychiatry, Aarhus University Hospital, Psychiatry, Aarhus, Denmark
| | - Poul Jennum
- Danish Centre for Sleep Medicine, Department of Clinical Neurophysiology, Rigshospitalet, Copenhagen, Denmark
| | - Nanette Mol Debes
- Department of Pediatrics, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Torben Laursen
- Department of Clinical Pharmacology, Aarhus University Hospital, Denmark
| | - Lone Baandrup
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Bispebjerg and Gentofte Departments, Mental Health Centre Copenhagen, Copenhagen University Hospital – the Mental Health Services of the Capital Region in Denmark, Denmark
| | - Christina Gade
- Departments of Clinical Pharmacology and Clinical Medicine, Copenhagen University Hospital, Bispebjerg and Frederiksberg, University of Copenhagen, Denmark
| | - Jette Dettmann
- Department of Pediatrics, Copenhagen University Hospital – NOH, Hillerød, Denmark
| | - Jonas Holm
- The Occupational Therapist Association, Denmark
| | - Camilla Krogh
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | | | - Simon Tarp
- The Danish Health Authority, 2300, Copenhagen, Denmark
| | - Mina Nicole Händel
- The Danish Health Authority, 2300, Copenhagen, Denmark
- Research Unit OPEN, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- The Parker Institute, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
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9
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Chen SJ, Li SX, Zhang JH, Lam SP, Yu MWM, Tsang CC, Kong APS, Chan KCC, Li AM, Wing YK, Chan NY. School-Based Sleep Education Program for Children: A Cluster Randomized Controlled Trial. Healthcare (Basel) 2023; 11:1853. [PMID: 37444687 DOI: 10.3390/healthcare11131853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 06/03/2023] [Accepted: 06/14/2023] [Indexed: 07/15/2023] Open
Abstract
Insufficient sleep contributes negatively to child developmental processes and neurocognitive abilities, which argues the need for implementing interventions to promote sleep health in children. In this study, we evaluated the effectiveness of a multimodal and multilevel school-based sleep education program in primary school children using a cluster randomized controlled design. Twelve schools were randomly assigned to either the sleep education or nonactive control groups. The sleep education group included a town hall seminar, small class teaching, leaflets, brochures, and a painting competition for children. Parents and teachers were invited to participate in a one-off sleep health workshop. Parental/caregiver-reported questionnaires were collected at baseline and 1-month follow-up. A total of 3769 children were included in the final analysis. There were no significant improvements observed in the sleep-wake patterns, daytime functioning, and insomnia symptoms between the two groups at follow-up, whereas the intervention group had significantly improved parental sleep knowledge than the controls (paternal: adjusted mean difference: 0.95 [95% confidence interval (CI): 0.18 to 1.71]; maternal: adjusted mean difference: 0.87 [95% CI: 0.17 to 1.57]). In addition, children receiving the intervention had a lower persistence rate of excessive beverage intake (adjusted odds ratio: 0.49 [95% CI: 0.33 to 0.73]), and experienced greater reductions in conduct problems (adjusted mean difference: 0.12 [95% CI: 0.01 to 0.24]) compared with the controls at 1-month of follow-up. Moreover, a marginally significant reduction for emotional problems in the intervention group was also observed (adjusted mean difference: 0.16 [95% CI: -0.00 to 0.32]). These findings demonstrated that school-based sleep education was effective in enhancing parental sleep knowledge and improving behavioral outcomes in children, but not sufficient in altering the children's sleep-wake patterns and sleep problems.
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Affiliation(s)
- Si-Jing Chen
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, The University of Hong Kong, Hong Kong SAR, China
- The State Key Laboratory of Brain and Cognitive Sciences, The University of Hong Kong, Hong Kong SAR, China
| | - Ji-Hui Zhang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Center for Sleep and Circadian Medicine, The Affiliated Brain Hospital of Guangzhou Medical University, Guangzhou 510370, China
- Key Laboratory of Neurogenetics and Channelopathies of Guangdong Province and the Ministry of Education of China, Guangzhou Medical University, Guangzhou 510260, China
| | - Siu Ping Lam
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Mandy Wai Man Yu
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Chi Ching Tsang
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Alice Pik Shan Kong
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Kate Ching Ching Chan
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Laboratory for Paediatric Respiratory Research, Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
- Hong Kong Hub of Paediatric Excellence, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yun Kwok Wing
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Ngan Yin Chan
- Li Chiu Kong Family Sleep Assessment Unit, Department of Psychiatry, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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10
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Mitchell JA, Morales KH, Williamson AA, Jawahar A, Juste L, Vajravelu ME, Zemel BS, Dinges DF, Fiks AG. Promoting Sleep Duration in the Pediatric Setting Using a Mobile Health Platform: A Randomized Optimization Trial. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2023:2023.01.04.23284151. [PMID: 36711634 PMCID: PMC9882437 DOI: 10.1101/2023.01.04.23284151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Objective Determine the optimal combination of digital health intervention component settings that increase average sleep duration by ≥30 minutes per weeknight. Methods Optimization trial using a 25 factorial design. The trial included 2 week run-in, 7 week intervention, and 2 week follow-up periods. Typically developing children aged 9-12y, with weeknight sleep duration <8.5 hours were enrolled (N=97). All received sleep monitoring and performance feedback. The five candidate intervention components (with their settings to which participants were randomized) were: 1) sleep goal (guideline-based or personalized); 2) screen time reduction messaging (inactive or active); 3) daily routine establishing messaging (inactive or active); 4) child-directed loss-framed financial incentive (inactive or active); and 5) caregiver-directed loss-framed financial incentive (inactive or active). The primary outcome was weeknight sleep duration (hours per night). The optimization criterion was: ≥30 minutes average increase in sleep duration on weeknights. Results Average baseline sleep duration was 7.7 hours per night. The highest ranked combination included the core intervention plus the following intervention components: sleep goal (either setting was effective), caregiver-directed loss-framed incentive, messaging to reduce screen time, and messaging to establish daily routines. This combination increased weeknight sleep duration by an average of 39.6 (95% CI: 36.0, 43.1) minutes during the intervention period and by 33.2 (95% CI: 28.9, 37.4) minutes during the follow-up period. Conclusions Optimal combinations of digital health intervention component settings were identified that effectively increased weeknight sleep duration. This could be a valuable remote patient monitoring approach to treat insufficient sleep in the pediatric setting.
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Affiliation(s)
- Jonathan A Mitchell
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia
| | - Knashawn H Morales
- Department of Biostatistics, Epidemiology and Informatics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Ariel A Williamson
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- The Center for Pediatric Clinical Effectiveness, Children's Hospital of Philadelphia, Philadelphia
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia
| | - Abigail Jawahar
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - Lionola Juste
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - Mary Ellen Vajravelu
- Division of Pediatric Endocrinology, Diabetes and Metabolism, UPMC Children's Hospital of Pittsburgh, Pittsburgh
| | - Babette S Zemel
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia
| | - David F Dinges
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | - Alexander G Fiks
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children's Hospital of Philadelphia, Philadelphia
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11
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Rönnlund H, Elovainio M, Virtanen I, Heikkilä AR, Raaska H, Lapinleimu H. Child Eveningness as a Predictor of Parental Sleep. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121968. [PMID: 36553411 PMCID: PMC9777097 DOI: 10.3390/children9121968] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/12/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
Child eveningness has been associated with many adverse outcomes for children. The aim of this study was to assess whether child eveningness poses a risk to parental sleep quality in follow-up. A total of 146 children (57% adopted, 47% boys, mean age at follow-up 5.1 years [standard deviation 1.7]) completed a 1-week actigraph recording to analyze their sleep twice, 1 year apart. The parents completed the Child ChronoType Questionnaire for their child and a short version of the Morningness-Eveningness Questionnaire for themselves and the Jenkins Sleep Scale for their sleep quality. Linear regression analyses showed that subjective parental sleeping problems at baseline were associated with subjective parental sleeping problems at follow-up. A morning-type child decreased the risk of parental sleeping problems at the 1-year follow-up compared to the child evening chronotype. Additionally, the child intermediate chronotype decreased the risk of maternal sleeping problems at the 1-year follow-up compared to the evening chronotype of the child. Parents of evening-type children experienced more sleeping problems in the follow-up, compared to parents of morning-type children. This finding encourages parents and professionals to steer the diurnal rhythm of evening-type children toward an earlier daily routine.
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Affiliation(s)
- Hanni Rönnlund
- Department of Paediatrics and Adolescent Medicine, University of Turku, 20014 Turku, Finland
- Kaarina Health Center, 20780 Kaarina, Finland
- Correspondence:
| | - Marko Elovainio
- Department of Psychology and Logopedics, University of Helsinki, 00014 Helsinki, Finland
- National Institute for Health and Welfare, 00271 Helsinki, Finland
| | - Irina Virtanen
- Department of Clinical Neurophysiology, Turku University Hospital, 20521 Turku, Finland
- Department of Clinical Neurophysiology, University of Turku, 20521 Turku, Finland
| | - Anna-Riitta Heikkilä
- Department of Pediatrics, University of Helsinki, 00014 Helsinki, Finland
- Department of Pediatrics, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Hanna Raaska
- Department of Child Psychiatry, Helsinki University Hospital, 00029 Helsinki, Finland
| | - Helena Lapinleimu
- Department of Paediatrics and Adolescent Medicine, University of Turku, 20014 Turku, Finland
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital, 20521 Turku, Finland
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12
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Errors in Supplement. JAMA Pediatr 2022; 177:213. [PMID: 36469351 PMCID: PMC9857530 DOI: 10.1001/jamapediatrics.2022.5042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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13
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Wake M, Hiscock H. Children's Sleep and Our Power to Improve It. JAMA Pediatr 2022; 176:1070-1071. [PMID: 36094560 DOI: 10.1001/jamapediatrics.2022.3169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Melissa Wake
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia.,Department of Paediatrics, The University of Melbourne, Parkville, Victoria, Australia.,The Royal Children's Hospital, Parkville, Victoria, Australia
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