Consistency of new research with a 2006 Sleep Medicine practice parameter for young children

Background: Clinical practice guidelines are systematic reviews and synthesis of the scientific literature for specific diagnoses and treatment modalities. They provide important guidance to practitioners and patients. However, if a practice guideline is not updated regularly, then readers may not be aware of changes and newer developments in best practices. We identified a practice guideline that had not been updated since 2006, the American Academy of Sleep Medicine’s Practice Parameters for Behavioral Treatment of Bedtime Problems and Night Wakings in Infants and Young Children. To determine whetherthe clinical trials and published research since 2006 remain consistent or conflict, we completed a systematic review.

Methods: We constructed research questions based on the guideline recommendations using the Participants, Intervention, Comparator, Outcome (PICO) format, developed search strings based on these questions, and searched ClinicalTrials.gov, the World Health Organization’s International Clinical Trials Registry Platform, and PubMed. Studies were screened for eligibility and exclusion criteria based on completion date and relevance. Retained studies were evaluated based on study type and design, stage of completion, and which recommendation they addressed.

Results: After the screening process, 36 studies were retained for review. Of these, 28 were completed with published results, including 19 randomized controlled trials, 8 non-randomized intervention studies, and 1 case report. The majority of studies addressed more than 1 recommendation of interest and supported the use of behavioral interventions.

Conclusions: Research over the past 15 years continues to support the general effectiveness of behavioral techniques. However, published research and registered clinical studies have not aligned with research gaps that were identified in the 2006 guidelines. To further advance knowledge for clinical care of infants and young children with bedtime and night-waking problems, future research should target the previously identified research gaps as opposed to continuing to replicate well-established practices.