Pharmacological and non-pharmacological interventions for non-respiratory sleep disturbances in children with neurodevelopmental disorders: a systematic review

SPRU research team

• Professor Bryony Beresford (Principal Investigator)
• Gemma Spiers

External collaborators

• Dr Catriona McDaid, York Trials Unit, Department of Health Sciences, University of York
• Professor Catherine Hewitt, York Trials Unit, Department of Health Sciences, University of York
• Professor Heather Elphick, Sheffield Children’s NHS Foundation Trust
• Dr Megan Thomas, Blackpool Teaching Hospitals NHS Foundation Trust
• The Children’s Sleep Charity

Project summary

Everyone needs sleep: it is essential for our physical and mental health, growth and development. Sleep disturbances can therefore have a large impact on individuals and family members. There are three kinds of sleep disturbance: difficulty getting to sleep; difficulty falling back asleep if awoken in the night; and problems with when, in a 24 hour period, sleep takes place. Children with disabilities caused by some sort of damage or disorder of the brain (neurodisabilities (ND)) are more likely to have sleep difficulties compared to typically developing children. Such problems are also typically more severe. We know that sleep disturbances have a negative impact across a number of areas of children’s and parents’ lives. Help with their child’s sleep is a high priority for parents.

Sleep disturbance among children with ND has a number of causes. This means there need to be different types of treatments or interventions. Medicines (or pharmacology) are used act on the physiological processes of sleep and/or the timing of the sleep-wake cycle. Non-pharmacological approaches are wide-ranging and tackle different causes of sleep disturbance. Examples include training parents in sleep management, systematically changing bed-/rising-times to a more typical schedule, and removing stimulants from the diet.

At the moment our understanding of the effectiveness of some sleep management interventions for children with ND is quite limited. In addition, and crucial given that for many children with ND there is more than one cause to their sleep disturbance, no one has examined and brought together the evidence on pharmacological and non-pharmacological interventions. It is important that this piece of work is done so that health professionals are better informed about how to manage sleep disturbance in children with ND, and the areas where more research would be helpful can be identified.

This project will:

• evaluate evidence on the effectiveness of different sleep disturbance interventions for children with ND;
• examine whether the nature of the ND makes an intervention more or less effective;
• examine whether the way an intervention is delivered, or who delivers it, impacts on its effectiveness;
• review evidence on parents’ views on the acceptability of the intervention their child received;
• identify interventions where evidence is limited but promising, and which could feasibly be used in NHS settings.

To achieve these aims we will use an internationally recognised, and highly rigorous, research method known as ‘systematic reviewing’. It involves:

• searches of international electronic databases to identify potentially relevant research papers or reports;
• selection of papers relevant to the research question(s);
• extracting information on methods and results into a bespoke database;
• assessing the quality of the research;
• combining, or synthesising, findings and, where appropriate, conducting further statistical analyses;
• drawing conclusions.

A project report will document the research. We will also produce a research summary and A3 size poster: these will be widely distributed to paediatric, community and mental health services in electronic and hard copy formats.

Additional information