Blake Sharon F, Logan Stuart, Humphreys Ginny, Matthews Justin, Rogers Morwenna, Thompson-Coon Joanna, Wyatt Katrina, Morris Christopher
Peninsula Cerebra Research Unit (PenCRU), University of Exeter Medical School, Room 008, Veysey Building, Salmon Pool Lane, Exeter, Devon, UK, EX2 4SG.
Cochrane Database Syst Rev. 2015;2015(11):CD009257. doi: 10.1002/14651858.CD009257.pub2. Epub 2015 Nov 2.
Sleep positioning systems can be prescribed for children with cerebral palsy to help reduce or prevent hip migration, provide comfort to ease pain and/or improve sleep. As sleep disturbance is common in children with developmental disabilities, with impact on their carers' sleep, and as sleep positioning systems can be expensive, guidance is needed to support decisions as to their use.
To determine whether commercially-available sleep positioning systems, compared with usual care, reduce or prevent hip migration in children with cerebral palsy. Any negative effect of sleep positioning systems on hip migration will be considered within this objective.Secondary objectives were to determine the effect of sleep positioning systems on: (1) number or frequency of hip problems; (2) sleep patterns and quality; (3) quality of life of the child and family; (4) pain; and (5) physical functioning. We also sought to identify any adverse effects from using sleep positioning systems.
In December 2014, we searched CENTRAL, Ovid MEDLINE, Embase, and 13 other databases. We also searched two trials registers. We applied no restrictions on date of publication, language, publication status or study design. We checked references and contacted manufacturers and authors for potentially relevant literature, and searched the internet using Google.
We included all randomised controlled trials (RCTs) evaluating whole body sleep positioning systems for children and adolescents (up to 18 years of age) with cerebral palsy.
Two review authors independently screened reports retrieved from the search against pre-determined inclusion criteria and assessed the quality of eligible studies.Members of the public (parent carers of children with neurodisability) contributed to this review by suggesting the topic, refining the research objectives, interpreting the findings, and reviewing the plain language summary.
We did not identify any randomised controlled trials that evaluated the effectiveness of sleep positioning systems on hip migration.We did find two randomised cross-over trials that met the inclusion criteria in respect of secondary objectives relating to sleep quality and pain. Neither study reported any important difference between sleeping in sleep positioning systems and not for sleep patterns or sleep quality (two studies, 21 children, very low quality evidence) and pain (one study, 11 children, very low quality evidence). These were small studies with established users of sleep positioning systems and were judged to have high risk of bias.We found no eligible trials that explored the other secondary objectives (number or frequency of hip problems, quality of life of the child and family, physical functioning, and adverse effects).
AUTHORS' CONCLUSIONS: We found no randomised trials that evaluated the effectiveness of sleep positioning systems to reduce or prevent hip migration in children with cerebral palsy. Nor did we find any randomised trials that evaluated the effect of sleep positioning systems on the number or frequency of hip problems, quality of life of the child and family or on physical functioning.Limited data from two randomised trials, which evaluated the effectiveness of sleep positioning systems on sleep quality and pain for children with cerebral palsy, showed no significant differences in these aspects of health when children were using and not using a sleep positioning system.In order to inform clinical decision-making and the prescription of sleep positioning systems, more rigorous research is needed to determine effectiveness, cost-effectiveness, and the likelihood of adverse effects.
可为脑瘫患儿开具睡眠定位系统，以帮助减少或预防髋关节移位，提供舒适感以缓解疼痛和/或改善睡眠。由于睡眠障碍在发育障碍儿童中很常见，会影响其照料者的睡眠，且睡眠定位系统可能价格昂贵，因此需要相关指导来支持关于其使用的决策。
确定与常规护理相比，市售睡眠定位系统能否减少或预防脑瘫患儿的髋关节移位。在此目标范围内，将考虑睡眠定位系统对髋关节移位的任何负面影响。次要目标是确定睡眠定位系统对以下方面的影响：（1）髋关节问题的数量或频率；（2）睡眠模式和质量；（3）儿童及其家庭的生活质量；（4）疼痛；（5）身体功能。我们还试图确定使用睡眠定位系统的任何不良影响。
2014年12月，我们检索了Cochrane系统评价数据库、Ovid MEDLINE、Embase以及其他13个数据库。我们还检索了两个试验注册库。我们对发表日期、语言、发表状态或研究设计均无限制。我们检查了参考文献，并联系了制造商和作者以获取潜在相关文献，还使用谷歌在互联网上进行了搜索。
我们纳入了所有评估针对脑瘫儿童和青少年（至18岁）的全身睡眠定位系统的随机对照试验（RCT）。
两位综述作者独立根据预先确定的纳入标准筛选检索到的报告，并评估符合条件的研究的质量。公众（神经残疾儿童的家长照料者）通过提出主题、完善研究目标、解释研究结果以及审查通俗易懂的总结，对本综述做出了贡献。
我们未找到任何评估睡眠定位系统对髋关节移位有效性的随机对照试验。我们确实找到了两项随机交叉试验，它们在与睡眠质量和疼痛相关的次要目标方面符合纳入标准。两项研究均未报告在使用睡眠定位系统睡眠和不使用睡眠定位系统睡眠之间，在睡眠模式或睡眠质量（两项研究，21名儿童，极低质量证据）以及疼痛方面（一项研究，11名儿童，极低质量证据）有任何重要差异。这些是针对睡眠定位系统现有使用者的小型研究，被判定存在高偏倚风险。我们未找到探索其他次要目标（髋关节问题的数量或频率、儿童及其家庭的生活质量、身体功能以及不良影响）的符合条件的试验。
我们未找到评估睡眠定位系统减少或预防脑瘫患儿髋关节移位有效性 的随机试验。我们也未找到评估睡眠定位系统对髋关节问题的数量或频率、儿童及其家庭的生活质量或身体功能影响的随机试验。两项随机试验的有限数据评估了睡眠定位系统对脑瘫患儿睡眠质量和疼痛的有效性，结果显示在儿童使用和不使用睡眠定位系统时，这些健康方面无显著差异。为了为临床决策和睡眠定位系统的开具提供信息，需要更严格的研究来确定其有效性、成本效益以及不良影响的可能性。
