Kelly Tanner1, Garey Noritz2, Lauren Ayala3, Rachel Byrne4, Darcy Fehlings5, Alison Gehred6, Lisa Letzkus7, Iona Novak8, Nathan Rosenberg2, Jilda Vargus-Adams9, Sarah Winter3, Nathalie L Maitre10. 1. Division of Clinical Therapies, Nationwide Children's Hospital, Columbus, Ohio. Electronic address: Kelly.Tanner@nationwidechildrens.org. 2. Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio. 3. Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah. 4. Cerebral Palsy Foundation, New York, New York. 5. Holland Bloorview Kids Rehabilitation Hospital, Department of Pediatrics, University of Toronto, Toronto, Canada. 6. Nationwide Children's Hospital, Grant Morrow III Library, The Ohio State University, Columbus, Ohio. 7. University of Virginia School of Medicine, Department of Pediatrics, Neurodevelopmental and Behavioral Pediatrics, UVA Children's, Charlottesville, Virginia. 8. Cerebral Palsy Alliance Research Institute, Discipline of Child & Adolescent Health, Faculty of Medicine & Health, The University of Sydney, Sydney, Australia. 9. Cincinnati Children's Hospital Medical Center, University of Cincinnati, Cincinnati, Ohio. 10. Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio; Center for Perinatal Research at Nationwide Children's Hospital, Columbus, Ohio.
Abstract
BACKGROUND: Children with cerebral palsy (CP) are five times more likely than typically developing children to have sleep problems, resulting in adverse outcomes for both children and their families. The purpose of this systematic review was to gather current evidence regarding assessments and interventions for sleep in children under age 2 years with or at high risk for CP and integrate these findings with parent preferences. METHODS: Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using preferred reporting items for systematic reviews and meta-analyses guidelines, and quality of the evidence was reviewed using best evidence tools by two independent reviewers at minimum. An online survey was conducted regarding parent preferences through social media channels. RESULTS: Eleven articles met inclusion criteria. Polysomnography emerged as the only high-quality assessment for the population. Three interventions (medical cannabis, surgical interventions, and auditory, tactile, visual, and vestibular stimulations) were identified; however, each only had one study of effectiveness. The quality of evidence for polysomnography was moderate, while the quality and quantity of the evidence regarding interventions was low. Survey respondents indicated that sleep assessments and interventions are highly valued, with caregiver-provided interventions ranked as the most preferable. CONCLUSIONS: Further research is needed to validate affordable and feasible sleep assessments compared to polysomnography as the reference standard. In the absence of diagnosis-specific evidence of safety and efficacy of sleep interventions specific to young children with CP, it is conditionally recommended that clinicians follow guidelines for safe sleep interventions for typically developing children.
BACKGROUND: Children with cerebral palsy (CP) are five times more likely than typically developing children to have sleep problems, resulting in adverse outcomes for both children and their families. The purpose of this systematic review was to gather current evidence regarding assessments and interventions for sleep in children under age 2 years with or at high risk for CP and integrate these findings with parent preferences. METHODS: Five databases (CINAHL, EMBASE, OVID/Medline, SCOPUS, and PsycINFO) were searched. Included articles were screened using preferred reporting items for systematic reviews and meta-analyses guidelines, and quality of the evidence was reviewed using best evidence tools by two independent reviewers at minimum. An online survey was conducted regarding parent preferences through social media channels. RESULTS: Eleven articles met inclusion criteria. Polysomnography emerged as the only high-quality assessment for the population. Three interventions (medical cannabis, surgical interventions, and auditory, tactile, visual, and vestibular stimulations) were identified; however, each only had one study of effectiveness. The quality of evidence for polysomnography was moderate, while the quality and quantity of the evidence regarding interventions was low. Survey respondents indicated that sleep assessments and interventions are highly valued, with caregiver-provided interventions ranked as the most preferable. CONCLUSIONS: Further research is needed to validate affordable and feasible sleep assessments compared to polysomnography as the reference standard. In the absence of diagnosis-specific evidence of safety and efficacy of sleep interventions specific to young children with CP, it is conditionally recommended that clinicians follow guidelines for safe sleep interventions for typically developing children.