Houston Area Pediatric Specialists

Independent pediatric specialists aim to serve our community. We want to share news and analysis regarding our specialties and our practices.

Saturday, September 7, 2013

Non-pharmacological sleep interventions for youth with chronic health conditions

In children with chronic health problems, sleep problems are common, UNRECOGNIZED by most professionals and have a negative IMPACT on recovery.

Many sleep problems can  treatable with non-pharmacologic means. 

Bottom line: If your child has a sleep problem, parents should seek the help of a SPECIALIST (e.g neurologist or pulmonologist) who is knowledgeable in sleep disorders to maximize treatment and recovery. 


Non-pharmacological sleep interventions for youth with chronic health conditions: A critical review of the methodological quality of the evidence
July 2013, Vol. 35, No. 15 , Pages 1221-1255 (doi:10.3109/09638288.2012.723788)

1Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton, Alberta
2Department of Public Health, Faculty of Professional Education, Concordia University College of Alberta
Correspondence: Cary A. Brown, FHEA, PhD, Associate Professor, Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta,
Edmonton, Alberta
Canada. T6G 2G4. Tel: (780) 492–9545. Fax: (780) 492–4628. E-mail: 

Purpose: Restorative sleep is clearly linked with well-being in youth with chronic health conditions. This review addresses the methodological quality of non-pharmacological sleep intervention (NPSI) research for youth with chronic health conditions. Method: The Guidelines for Critical Review (GCR) and the Effective Public Health Practice Project Quality Assessment Tool (EPHPP) were used in the review. Results: The search yielded 31 behavioural and 10 non-behavioural NPSI for review. Most studies had less than 10 participants. Autism spectrum disorders, attention deficit/hyperactivity disorders, down syndrome, intellectual disabilities, and visual impairments were the conditions that most studies focused upon. The global EPHPP scores indicated most reviewed studies were of weak quality. Only 7 studies were rated as moderate, none were strong. Studies rated as weak quality frequently had recruitment issues; non-blinded participants/parents and/or researchers; and used outcome measures without sound psychometric properties. Conclusions: Little conclusive evidence exists for NPSIs in this population. However, NPSIs are widely used and these preliminary studies demonstrate promising outcomes. There have not been any published reports of negative outcomes that would preclude application of the different NPSIs on a case-by-case basis guided by clinical judgement. These findings support the need for more rigorous, applied research.
Implications for Rehabilitation
  • Methodological Quality of Sleep Research
  • Disordered sleep (DS) in youth with chronic health conditions is pervasive and is important to rehabilitation therapists because DS contributes to significant functional problems across psychological, physical and emotional domains.
  • Rehabilitation therapists and other healthcare providers receive little education about disordered sleep and are largely unaware of the range of assessment and non-pharmacological intervention strategies that exist. 
    An evidence-based website of pediatric sleep resources can be found at http://www.SleepRight.ualberta.ca
The current research on non-pharmacological sleep interventions (NPSI) for youth with health conditions is methodologically weak. 

However, consistently positive outcomes reported in the literature demonstrate that pragmatic interventions such as:
  •  bright light therapy, 
  • activity, 
  • massage and 
  • behavioral interventions are promising areas. 

  • No studies found reasons that a trail of a NPSI matched to the youth’s context and condition should not attempted. More rigorous clinically relevant study of pragmatic non-pharmacological interventions appropriate for therapists’ and parents’ needs is required.

Read More: http://informahealthcare.com/doi/abs/10.3109/09638288.2012.723788

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