Not enough research on sleep problems in kids with cerebral palsy

Polysomnography remains the only reliable method of measuring sleep parameters among children with cerebral palsy (CP), reports a recent systemic meta-analysis. However, there is a need for more feasible and affordable sleep assessments for this population, other than polysomnography. In addition, more studies on the safety and efficacy of interventions are needed.

Accessing five databases (CINAHL, Embase, Medline, PsycINFO, and SCOPUS), the researchers identified 11 articles eligible for inclusion. Most of the studies (n=8) dealt with sleep assessment, while three looked at potential interventions.

All eight studies on sleep assessment employed polysomnography or electroencephalography. Despite being mostly retrospective and observational in nature, synthesis of these studies suggested that either method was reliable for the measurement of sleep parameters in infants under 2 years of age with or at risk of CP.

The quality of evidence supporting the use of polysomnography for sleep assessment was moderate.

Notably, two randomized trials used self-developed assessment tools, which included parent numerical rating scale and coding of behavioural states by research assistants. While the coding system demonstrated good inter-rater reliability, the parent-answered scale was poorly defined.

In terms of interventions, three main types were examined in the literature: medical cannabis; surgical interventions; and auditory, tactile, visual, and vestibular stimulations.

However, each intervention type only had one study assessing its effectiveness, and the overall quality of evidence was low.

In a subsequent online survey, respondents noted that they highly valued sleep assessments and interventions, in particular those that are provided by caregivers.

“Like many of the treatments that are routinely administered to individuals with CP, there is a paucity of robust data for sleep interventions documenting their efficacy,” the researchers said. “No pharmacologic agent that safely and effectively improves sleep in this population was identified; any medication for sleep should be used cautiously.”