Interventions for sleep difficulties in adults with an intellectual disability: a systematic review.
P J Shanahan, S Palod, K J Smith and 2 others
PMID 30628125WHAT IT FOUND
Sleep interventions for adults with intellectual disability were too varied to compare, and only one study had low risk of bias.
Seven reported better sleep, but the review cannot say which intervention helped which patient.
Key findings
01The review included nine studies and 97 adults, and it found the interventions were not directly comparable.
02Melatonin evidence was mixed: in the one low-risk study, 5 mg melatonin shortened sleep onset latency more than placebo, while all three participants in another study stopped melatonin because of agitation.
03Behavioural packages that combined optimal scheduling, sleep hygiene, stimulus control, relaxation, light therapy and cognitive behaviour therapy, or team-decided activity, routine and sleep scheduling changes, reported improvements, but the effective component cannot be separated.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The nine studies used different interventions, sleep measures, populations and analyses, so the review could not combine them into a clear answer. Only one included study had low risk of bias, and the remaining studies had serious or critical risk. The studies were small, with 1 to 34 adults each and a mean of 10 adults per study. Five studies used verbal report from the person or carer, and only two studies with 37 adults used actigraphy. Some participants were taking other medications, and some had epilepsy, autism or visual impairment. The review excluded studies where sleep change was a secondary effect of mental health interventions, so indirect effects were not assessed. The review included only English-language papers, and the authors note risk of publication and language bias. The authors used ROBINS-I for the randomised study, which may underestimate its risk of bias.
Declared interests
The authors declared no conflicts of interest.
The easy way to misread this
Do not read the seven reports of improved sleep as proof that any sleep intervention works for adults with intellectual disability. The studies were too different to compare, and only one had low risk of bias.