Interventions with a sleep outcome for children with cerebral palsy or a post-traumatic brain injury: a systematic review.

The purpose of this study was to conduct a systematic literature review on interventions for sleep problems in children (aged 0-12 years) with cerebral palsy (CP) or traumatic brain injury (TBI). The literature describes sleep disorders as common in both conditions. Criteria were expanded to include interventions for other medical conditions where sleep was measured as an outcome. No interventions specifically designed to improve sleeping in children with CP or TBI were found. A literature search was conducted of five databases (Ovid MEDLINE, EMBASE, PsychINFO, CINAHL, and the Cochrane Database) from January 1 1990, to June 2011. The search terms [infant (age 0-23 months) or child, preschool (age 2-5 years) or child (age 6-12 years)] were used, with key terms related to CP and TBI. The search yielded 491 articles; 19 were relevant for CP, one for TBI. For CP, if the intervention improved the symptom/s targeted as primary outcome/s, sleep (measured as a secondary outcome) also improved. Few studies used objective measures of sleep, so efficacy could not be assessed. Only four studies were randomized controlled trials. Interventions were diverse. Where melatonin was used for CP patients with sleep problems/disorders, several related to phase or sleep maintenance disorders, improvements in sleep latency and night waking were consistently found, and in some subjects, improvements in total sleep time. No studies using melatonin studied CP patients exclusively. The one study where sleep was measured as a secondary outcome for TBI was of limited value. In conclusion, more well-designed studies are necessary to advance evidence-based treatments in the area of sleep problems for these chronic pediatric conditions.