Non-pharmacological interventions for sleep promotion in hospitalized children

This review assessed the effect of non‐pharmacological sleep promotion interventions in hospitalized children and adolescents on sleep quality and sleep duration, child or parent satisfaction, cost‐effectiveness, delirium incidence, length of mechanical ventilation, length of stay, and mortality.

The review authors included 10 studies with 528 participants aged 4 to 22 years old. Seven studies were conducted in the USA, two in Canada, and one in Brazil. Eight studies were funded by government, charity or foundation grants, and two studies provided no information on funding.

Eight studies investigated behavioural interventions (massage, touch therapy, and bedtime stories) and two investigated physical activity interventions. The studies varied greatly in terms of the duration and timing of interventions; the methods used to measure the quantity and quality of sleep and the way the results were analysed. Consequently, the authors were unable to perform a quantitative synthesis and provided a narrative summary of the results instead.

Behavioural interventions 

Studies that combined methods of relaxation found that these may make little or no difference on the amount or quality of sleep compared to usual care.

Touch therapy may improve TST and sleep quality in children with burns. Massage and bedtime stories may also improve sleep. However, the authors have little confidence in these results, because of differences in the study populations and the measurement methods used.

Children and parents may be satisfied with both massage and multicomponent relaxation methods for improving sleep. However, the authors are not confident in these results either, as the people in the studies knew which sleep‐improving method they received, and there were not enough studies to be certain about the results.

Physical activity interventions

One study showed that using a stationary (exercise) bicycle to improve sleep may not improve TST or quality of sleep compared to usual care. 

Another study assessed whether organized play improved subjective measures of sleep and found inconsistent results for boys and girls and for children in different age groups.

No study evaluated child or parent satisfaction for behavioral interventions, or cost‐effectiveness, delirium incidence or delirium‐free days at hospital discharge, length of mechanical ventilation, length of hospital stay, or mortality for either behavioral or physical activity intervention.

Due to the inconsistent, low to very low‐certainty evidence, the review authors concluded that, compared with usual care or other interventions, the effects of non‐pharmacological sleep promotion interventions on sleep quality or sleep duration are unclear. They advised that the evidence base should be strengthened through design and conduct of randomized trials, which use validated and highly reliable sleep assessment tools, including objective measures, such as polysomnography and actigraphy.

The search is current to December 2021.

Read the full review here on the Cochrane Library.