Can behavioural interventions delivered using digital technologies influence infant sleep? A systematic review and meta-analysis

Sleep disturbances in early childhood are common, and some individuals are already affected in infancy. We aimed to conduct a systematic review and meta-analysis of randomised controlled trials (RCTs) on the effect of behavioural interventions delivered using digital technologies on infant sleep. A literature search was performed in Medline, Embase, and Cochrane Database of Systematic Reviews. Two reviewers independently screened records and extracted data. Inclusion criteria were: Published RCTs studying the effect of behavioural sleep interventions delivered using digital technologies with no restriction on the comparator group on longest continuous sleep period and total night-time sleep as primary outcomes, as well as any sleep-related outcomes among infants, encompassing any measure of sleep duration, quality, timing and/or related disturbances as explorative outcomes. Forest plots were performed using random effect inverse variance model. Risk of bias assessment was based on Cochrane Risk of Bias tool 2. PROSPERO reg. no. CRD42022371851. We identified 4 eligible RCTs. The results from the meta-analyses suggested a clinically relevant effect on longest continuous sleep period (mean difference (MD): 0.76 h (95 % CI: 0.25, 1.27)), but not on total night-time sleep MD: 0.10 h (95 % CI: 0.27, 0.48) (both primary outcomes). Our results suggested that behavioural sleep interventions delivered using digital technologies improved child's mood in morning and how well the child sleep (both explorative outcomes). The included studies were all rated as high risk of bias, due to risk of misclassification, missing outcome data, and risk of selective reporting, and there was risk of imprecision, therefore the certainty of the effect estimates for all outcomes was low. In conclusion, our meta-analyses suggested a beneficial and clinically relevant effect of sleep recommendations delivered using digital technologies on infant prolonging continuous sleep periods, but not on total night-time sleep. Although, due to few studies that have a high risk of bias evidence-based conclusions are hampered, and large well conducted trials are urgently needed, our results suggest that behavioural interventions delivered using digital technologies are showing great promise in improving infant sleep.