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Original Investigation
September 12, 2022

Nonpharmacological Interventions to Lengthen Sleep Duration in Healthy Children: A Systematic Review and Meta-analysis

Author Affiliations
  • 1Population Health Research Institute, St George’s, University of London, London, United Kingdom
  • 2Institute for Infection and Immunity, St George’s, University of London, London, United Kingdom
JAMA Pediatr. 2022;176(11):1084-1097. doi:10.1001/jamapediatrics.2022.3172
Key Points

Question  Are nonpharmacological interventions effective in lengthening sleep duration in healthy children, and if so, what are the key elements?

Findings  In this systematic review and meta-analysis of 45 trials, interventions to improve sleep in healthy children were associated with a small increase in sleep duration (by 10 minutes per night). Face-to-face delivery was an important component of interventions, but interventions that included earlier bedtimes were associated with 47 minutes longer sleep duration per night.

Meaning  Supporting children to go to bed earlier can increase sleep duration in healthy children, and interventions to encourage earlier bedtimes should be included.


Importance  Adequate sleep duration is necessary for many aspects of child health, development, and well-being, yet sleep durations for children are declining, and effective strategies to increase sleep in healthy children remain to be elucidated.

Objective  To determine whether nonpharmaceutical interventions to improve sleep duration in healthy children are effective and to identify the key components of these interventions.

Data Sources  CENTRAL, MEDLINE, Embase, PsycINFO, Web of Science Core collection, ClinicalTrials.gov, and WHO trials databases were searched from inception to November 15, 2021.

Study Selection  Randomized clinical trials of interventions to improve sleep duration in healthy children were independently screened by 2 researchers. A total of 28 478 studies were identified.

Data Extraction and Synthesis  Data were processed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) reporting guideline. Random-effects meta-analytic models were used to estimate pooled effect sizes.

Main Outcomes and Measures  Difference in sleep duration, measured in minutes.

Results  A total of 13 539 child participants from 45 randomized clinical trials were included. Of these, 6897 (50.9%) were in the intervention group and 6642 (49.1%) in the control group, and the mean age ranged from 18 months to 19 years. Pooled results indicate that sleep interventions were associated with 10.5 minutes (95% CI, 5.6-15.4) longer nocturnal sleep duration. There was substantial variation between trials. Sources of variation that were not associated with the study effect size included age group, whether the population was identified as having a sleep problem or being at a socioeconomic disadvantage (eg, coming from a low-income family or area), method of assessment of sleep duration (objective vs subjective), location of intervention delivery (home vs school), whether interventions were delivered in person or used parental involvement, whether behavioral theory was used, environmental change, or had greater or lower intensity. Interventions that included earlier bedtimes were associated with a 47-minute sleep extension (95% CI, 18.9-75.0; 3 trials) compared with remaining studies (7.4 minutes; 95% CI, 2.9-11.8; 42 trials) (P = .006 for group difference). Trials of shorter duration (6 months or less) had larger effects.

Conclusions and Relevance  Interventions focused on earlier bedtimes may offer a simple, pragmatic, effective way to meaningfully increase sleep duration that could have important benefits for child health.

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