Exploring Occupation-Based Interventions for Sleep Within OTPF: A Systematic Review.
Ji-Yea Kim, Si-An Lee, Seong-A Lee and 1 others
Most occupation-based sleep interventions focus on getting ready for sleep: routines, education, and adjusting the sleep environment.
Sustaining sleep and handling nighttime needs are largely absent from the literature. Eight of ten included studies reported a positive effect.
Key findings
1Across the ten included studies, most interventions targeted sleep preparation (routines, education, environmental modification) while the two sleep-participation components of sustaining a sleep state and meeting nighttime toileting and hydration needs had no corresponding intervention content in any study.
2Eight of the ten included studies reported their intervention as effective; two (a CO-OP protocol for burn patients and a compression garment for children with autism) reported no effect.
3Three studies used an explicit theoretical model (PEOP, CO-OP, or occupational balance). These addressed sleep preparation more comprehensively and were the only ones that extended into sleep-participation components.
Still to come
How it was doneWhat they foundWhat it means for OTs
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What it does not show
Only ten studies were included, and most are small (sample sizes of 4, 8, 10, 15, 20, 30, 42) with a single larger secondary analysis (N=217). The included studies used different outcome tools (PSQI, ISI, COPM, PROMIS, wristband data, CSHQ, and others), so no statistical synthesis of effect size was possible. Study designs varied widely: RCTs, quasi-experimental, single-subject ABA/ABAB, pilot, and single-group mixed-methods, making direct comparison difficult. Some studies provided only general descriptions of their intervention components, which prevented precise classification under the OTPF categories; these were marked as 'not specified.' The review is limited to interventions delivered by occupational therapists and does not capture multidisciplinary sleep approaches that may be relevant in clinical settings. The search was restricted to English-language, freely accessible articles published between 2013 and 2023.
Declared interests
Funded by the National Research Foundation of Korea (grant 2021R1I1A3041487) and Soonchunhyang University. The authors declare no conflicts of interest. ChatGPT was used for grammar review and linguistic refinement of the manuscript.
The easy way to misread this
Do not read the 8-of-10 effectiveness rate as evidence that occupation-based sleep interventions work across populations and conditions. The included studies are small, use different outcome tools, and no statistical synthesis was possible. Two studies, including one in children with autism using a compression garment, found no effect, and the review itself notes that the heterogeneity of measures prevented a meta-analysis.
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