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      Pilot study of an integrated model of sleep support for children: a before and after evaluation

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          Abstract

          Objective

          Despite the success of behavioural sleep support interventions in the third sector, sleep support is not universally available for families in the UK. The aim of the study was to provide evidence of efficacy and to propose a delivery model for integrated sleep support for families of vulnerable children.

          Design and setting

          A sleep support intervention was carried out in Sheffield Local Authority evaluated using a preintervention and postintervention study design by Sheffield Children’s National Health Service (NHS) Trust.

          Participants

          Fifty-six children aged 6–16 years with significant sleep problems were recruited; 39 completed the intervention and evaluation.

          Interventions

          Basic sleep education and an individualised programme was delivered by a sleep practitioner. Follow-on telephone support was provided to empower the parent (and/or young person) to carry out the sleep programme at home. An integrated NHS and Local Authority delivery model was designed and implemented.

          Results

          Parents’ ratings of their child’s ability to self-settle improved from 1.1/10 to 6.4/10 (p<0.05). Mean Warwick-Edinburgh Mental Well-being Scale scores improved significantly for parents/carers (MD 5.16, 95%CIs 2.62 to 7.69, p<0.05). Children who completed the intervention gained on average an extra 2.4 hours sleep a night. There was reduction in healthcare utilisation, illnesses and medication use.

          Conclusions

          The behavioural approach to sleep support for these vulnerable groups of children is highly effective. Follow-on individual support to empower parents is key to achieving success. Sleep support can be implemented in NHS and Local Authority services by integration into the existing workforce using a cross-agency model.

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          Most cited references11

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          The influence of sleep quality, sleep duration and sleepiness on school performance in children and adolescents: A meta-analytic review.

          Insufficient sleep, poor sleep quality and sleepiness are common problems in children and adolescents being related to learning, memory and school performance. The associations between sleep quality (k=16 studies, N=13,631), sleep duration (k=17 studies, N=15,199), sleepiness (k=17, N=19,530) and school performance were examined in three separate meta-analyses including influential factors (e.g., gender, age, parameter assessment) as moderators. All three sleep variables were significantly but modestly related to school performance. Sleepiness showed the strongest relation to school performance (r=-0.133), followed by sleep quality (r=0.096) and sleep duration (r=0.069). Effect sizes were larger for studies including younger participants which can be explained by dramatic prefrontal cortex changes during (early) adolescence. Concerning the relationship between sleep duration and school performance age effects were even larger in studies that included more boys than in studies that included more girls, demonstrating the importance of differential pubertal development of boys and girls. Longitudinal and experimental studies are recommended in order to gain more insight into the different relationships and to develop programs that can improve school performance by changing individuals' sleep patterns. Copyright 2009 Elsevier Ltd. All rights reserved.
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            Sleep problems of children with pervasive developmental disorders: correlation with parental stress.

            This study aimed to investigate the prevalence of sleep problems in Chinese children with pervasive developmental disorders (PDD) in Hong Kong and their relationship to parental stress. A cross-sectional survey was conducted in six child assessment centres. All parents of the children with PDD completed the Children's Sleep Habits Questionnaire, the Parenting Stress Index-Short Form, and questions on sleep practice. A total of 210 out of 250 questionnaires (response rate 84%) were returned. Mean age of the children was 3 years 6 months (SD 1 y 4 mo; range 2 y-7 y 7 mo; 168 males, 25 females). The prevalence of parent-defined sleep problems in various sleep domains ranged from 9.3 to 45.6%, with 67.9% of children having significant problems in at least one sleep domain. The most common problems reported were bedtime resistance and parasomnias. Similar sleep problems occurred in all the PDD subgroups. The factor most significantly associated with sleep problems was the occurrence of sleep problems before the age of 2 years. The parents of children with PDD with sleep problems experienced a higher level of stress than those whose children had no sleep problems. A high prevalence of significant sleep problems was reported in Chinese children in Hong Kong with PDD. A higher stress level among the parents of those children with PDD with sleep problems suggests the need for systematic early detection and management of sleep problems in children with PDD.
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              In a randomized case-control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program.

              We tested the hypothesis that sleep training would improve emotional, social and behavioural functioning in children with attention-deficit/hyperactivity disorder (ADHD) compared to children with ADHD without such intervention and to healthy controls.
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                Author and article information

                Journal
                BMJ Paediatr Open
                BMJ Paediatr Open
                bmjpo
                bmjpo
                BMJ Paediatrics Open
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2399-9772
                2019
                10 November 2019
                : 3
                : 1
                : e000551
                Affiliations
                [1 ] departmentDepartment of Respiratory and Sleep Medicine , Sheffield Children’s Hospital , Sheffield, UK
                [2 ] Sheffield City Council , Sheffield, UK
                [3 ] The Children’s Sleep Charity , Doncaster, UK
                Author notes
                [Correspondence to ] Heather E Elphick; h.elphick@ 123456nhs.net
                Author information
                http://orcid.org/0000-0001-8982-9250
                Article
                bmjpo-2019-000551
                10.1136/bmjpo-2019-000551
                6863653
                d1335f7e-22b6-4a3d-8104-6eca1a54ab24
                © Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

                This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:  http://creativecommons.org/licenses/by-nc/4.0/.

                History
                : 08 July 2019
                : 02 October 2019
                : 12 October 2019
                Categories
                Sleep
                1506
                Original research
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