Management of Paediatric Sleep Problems in Primary Care: A Systematic Review

Problem

Sufficient sleep is important for the health and development of children across a range of behavioural, academic, cognitive, emotional and physiological domains. In particular, shorter sleep duration has been associated with higher risk of obesity and reduced grey matter volume. Sleep problems vary, but include difficulty initiating and maintaining sleep and may be caused by sleep disorders. Behavioural Insomnia (BI) is the commonest childhood sleep disorder. Literature supports behavioural and sleep hygiene interventions for BI, though there is little research into management within primary care. As a first point of contact for families, primary care is an important setting for enhancing the availability of treatment and addressing sleep problems at an early stage, reducing the possibility of persisting problems. Honaker and Meltzer (2016) suggested that limited professional training in sleep problems is currently provided and sleep problems are not often discussed in primary care. We aim to update their review which was conducted up to 2014 and focus on primary care professionals’ understanding, knowledge, perceptions of their role and current practice regarding children’s sleep problems.

Approach

Six databases were searched (MEDLINE, EMBASE, PsycINFO, CINAHL, Cochrane Library CENTRAL and Web of Science), using terms and subject headings for ‘sleep’, ‘child/paediatric’, ‘primary health care’, ‘general practitioner’ and ‘health visitor’. Selection criteria include quantitative and/or qualitative studies of either GPs (or similar) treating paediatric sleep problems or parents/ carers of children presenting in primary care. The primary outcomes and focus will be GP/health visitor attitudes, knowledge, understanding and practice regarding paediatric sleep management in Primary Care. Titles and abstracts will be screened for eligibility and full texts will then be considered. A second reviewer will screen 10% of initial results, and full texts. Data extraction of included studies will be conducted and checked by a second reviewer. Any discrepancies throughout the review will be discussed by the review team. A mixed-methods synthesis will be conducted, involving a thematic synthesis for qualitative papers and a narrative synthesis for quantitative papers. Quality appraisal of the included studies will be conducted using the Mixed Methods Appraisal Tool (MMAT).

Findings

Database searches resulted in approximately 4750 papers (before screening for duplicates). Screening is currently in progress and analysis will be complete by July 2019.

Consequences

Our findings will identify gaps in the literature and potential areas for improvement. This will inform further primary care focussed research to better support primary care professionals and families in managing children’s sleep problems and accessing appropriate resources at an early stage.