Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy.
Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy; Department of Psychology, University of Bologna, Bologna, Italy.
Sleep Med Rev. 2023 Aug;70:101806. doi: 10.1016/j.smrv.2023.101806. Epub 2023 Jun 16.
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.
睡眠启动和维持问题在儿科人群中很常见，虽然推荐了行为干预措施，但它们在临床试验中的疗效仍有待评估。我们进行了系统评价和网络荟萃分析，以评估非药物治疗和褪黑素对健康儿科人群睡眠启动和维持问题的疗效。我们在系统评价中纳入了 30 项研究，在荟萃分析中纳入了 15 项研究。进行了 3 项网络荟萃分析，用于评估睡眠潜伏期（SOL）、睡眠后觉醒（WASO）和总睡眠时间（TST）。对于 SOL 变量，结果支持光疗和褪黑素比循证心理干预更有效，无论是否与光疗联合使用。关于 WASO 变量，循证心理干预以及这些技术与光疗的联合应用是最有效的。最后，对于 TST 变量，与其他干预措施相比，证据为基础的心理干预与光疗联合治疗显示出更大的效果。总之，我们发现研究方案之间存在很大的差异，这可能会影响荟萃分析的结果。需要针对儿科年龄组进行分层的随机对照试验研究，以便在临床环境中提供明确的建议。
