Non-pharmacological and melatonin interventions for pediatric sleep initiation and maintenance problems: A systematic review and network meta-analysis.
Study Goal
The researchers aimed to evaluate the efficacy of non-pharmacological treatments, including light therapy, compared to melatonin and psychological interventions for sleep initiation and maintenance problems in healthy pediatric populations.
Results Summary
Light therapy was more effective than psychological interventions alone for reducing sleep onset latency (SOL). Combined light therapy and psychological interventions showed the largest effect for improving total sleep time (TST). For wake after sleep onset (WASO), psychological interventions alone or combined with light therapy were most effective.
Population
Healthy pediatric populations with sleep initiation and maintenance problems.
Effective Dosage
Not available
Duration
Not available
Interactions
None mentioned
| Intervention | Direction | Endpoint | Population | Dosage | Impact | Claim # |
|---|---|---|---|---|---|---|
light therapy | decrease | sleep onset latency (SOL) | healthy pediatric populations | - | greater effectiveness | #1 |
melatonin | decrease | sleep onset latency (SOL) | healthy pediatric populations | - | greater effectiveness | #2 |
evidence-based psychological interventions | decrease | wake after sleep onset (WASO) | healthy pediatric populations | - | most efficacious | #3 |
evidence-based psychological interventions plus light treatment | decrease | wake after sleep onset (WASO) | healthy pediatric populations | - | most efficacious | #4 |
evidence-based psychological intervention with light therapy | increase | total sleep time (TST) | healthy pediatric populations | - | larger effect | #5 |
Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and maintenance problems in healthy pediatric populations. We included 30 studies in the systematic review and 15 in the meta-analysis. Three network meta-analyses were conducted for sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). For SOL variable, the results support greater effectiveness of light therapy and melatonin than evidence-based psychological interventions, whether implemented in combination with light therapy or not. Regarding WASO variable, evidence-based psychological interventions and a combination of those techniques plus light treatment were the most efficacious. Finally, for TST variable, a larger effect was shown for the combined treatment of evidence-based psychological intervention with light therapy in comparison to other interventions. In conclusion, we found a high variability between study protocols likely impacting the results of the meta-analysis. Future randomized control trials studies, stratified by pediatric age classes, are needed in order to provide clear suggestions in clinical settings.