Cerebral palsy and sleep: nonpharmacological treatment and impact on the life of caregivers – an integrative review

Almeida, Marcela Fischer de; Mello, Suzane; Zonta, Marise Bueno; Crippa, Ana Chrystina

doi:10.1055/s-0044-1781464

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Arquivos de Neuro-Psiquiatria

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View and Review • Arq. Neuro-Psiquiatr. 82 (3) • 2024 • https://doi.org/10.1055/s-0044-1781464 copy

Cerebral palsy and sleep: nonpharmacological treatment and impact on the life of caregivers – an integrative review

Paralisia cerebral e sono: tratamento não farmacológico e impacto na vida dos cuidadores – uma revisão integrativa

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background

Children with cerebral palsy have a higher prevalence of sleep disorders, with numerous factors associated with a negative impact on the quality of life of caregivers.

Objective

To identify factors related to sleep disorders, nonpharmacological treatment, and the impact on the lives of caregivers.

Methods

The present literature review was carried out in the Latin American and Caribbean Center on Health Sciences Information (BIREME), the Cochrane Library, Scopus, PubMed, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycInfo, WorldCat, Web of Science, Latin American Literature on Health Sciences (LILACS), and Excerpta Medica Database (EMBASE), with the descriptors sleep, child, cerebral palsy, parents, and nursing. Studies available in Portuguese, English, or Spanish, published between 2010 and 2020, were our inclusion criteria. A total of 29 articles were included in the present review.

Results

We considered nonpharmacological interventions effective support measures to drug-based treatments. The main sleep disorders in children with cerebral palsy are insomnia, parasomnias, nightmares, sleep bruxism, sleepwalking, sleep talking, disorders of initiation and maintenance of sleep, and sleep hyperhidrosis. Most studies point to a reduction in the quality of life of caregivers whose children have sleep disorders.

Conclusion

Our review suggests the effectiveness of nonpharmacological treatments combined with the use of medications. Measures such as changes in sleep environment and routine are favorable strategies to improve sleep quality. In addition, children with sleep disorders negatively impact the quality of life of their caregivers.

Keywords
Cerebral Palsy; Caregivers; Sleep; Child

Study design	Sample	Results	Type of sleep disorder	Reference
Systematic review and meta-analysis	23 cross-sectional studies with samples ranging from 50 to 675 children	15.5% had sleep breathing disorders; 14.6% had disorders of excessive somnolence; and 34.9% had sleep hyperhidrosis	Parasomnias; insomnia; restless leg syndrome	Horwood et al.⁹9 HorwoodL, Li P,MokE, ShevellM,Constantin E.Asystematic review and meta-analysis of the prevalence of sleep problems in children with cerebral palsy: howdo childrenwith cerebral palsy differ from each other and from typically developing children? Sleep Health 2019;5(06):555–571. Doi: 10.1016/j.sleh.2019.08.006 https://doi.org/10.1016/j.sleh.2019.08.0...
Systematic review	66 studies	Delayed sleep phase syndrome; impaired sleep maintenance	Obstructive sleep apnea	Galland et al. ³⁶36 Galland BC, Elder DE, Taylor BJ. Interventions with a sleep outcome for children with cerebral palsy or a post-traumatic brain injury: a systematic review. Sleep Med Rev 2012;16(06): 561–573. Doi: 10.1016/j.smrv.2012.01.007 https://doi.org/10.1016/j.smrv.2012.01.0...
Integrative review	1,385 individuals in the totality of studies	50% had sleep-disordered breathing; 50% had nightmares; 12.5% regularly talked in their sleep; and 62.5% had excessive daytime	Restless leg syndrome; obstructive sleep apnea; sleep bruxism; insomnia	Lélis et al.⁷7 Lélis AL, Cardoso MV, Hall WA. Sleep disorders in children with cerebral palsy: An integrative review. Sleep Med Rev 2016; 30:63–71. Doi: 10.1016/j.smrv.2015.11.008 https://doi.org/10.1016/j.smrv.2015.11.0...
Systematic review	40 international medical data studies	62.5% had difficulty in the initiation of sleep; 55% had bedtime resistance; and 57.5% had night-waking	Insomnia	Rigney et al.⁴⁷47 Rigney G, Ali NS, Corkum PV, et al. A systematic review to explore the feasibility of a behavioural sleep intervention for insomnia in children with neurodevelopmental disorders: A transdiagnostic approach. Sleep Med Rev 2018;41:244–254. Doi: 10.1016/j.smrv.2018.03.008 https://doi.org/10.1016/j.smrv.2018.03.0...
Systematic review based on 2 randomized clinical trials	21 children	Not available	Obstructive sleep apnea	Blake et al.³⁰30 Blake SF, Logan S, Humphreys G, et al. Sleep positioning systems for children with cerebral palsy. Cochrane Database Syst Rev 2015; 2015(11):CD009257. Doi: 10.1002/14651858.CD009257.pub2 https://doi.org/10.1002/14651858.CD00925...
Literature review	Not available	50% had sleep-disorderd breathing; and 50% had nightmares	Insomnia; sleep bruxism	Dutt et al.²¹21 Dutt R, Roduta-Roberts M, Brown CA. Sleep and Children with Cerebral Palsy: A Review of Current Evidence and Environmental Non-Pharmacological Interventions. Children (Basel) 2015;2(01): 78–88. Doi: 10.3390/children2010078 https://doi.org/10.3390/children2010078...

Study design	Sample	Results	Sleep measure	Reference
Cross-sectional study	227 children (69 control group + 23 with CP + 106 with epilepsy + 29 with CP and epilepsy)	100% had sleep-disordered breathing; and 91% had excessive daytime sleepiness	Pediatric sleep questionnaire; sleep disordered breathing scale	Ming et al.²⁴24 Ming X, Pak J,MulveyMA, et al. Sleep complaints in cerebral palsy and/or epilepsy: A pediatric sleep questionnaire study. J Pediatr Neurol 2014;12:127–135. Doi: 10.3233/JPN-140652 https://doi.org/10.3233/JPN-140652...
Cross-sectional study	132 individuals (91 with CP + 41 control group)	7.3% had sleep-disordered breathing; 1.0% had excessive daytime sleepiness	Pediatric sleep questionnaire	Sandella et al.¹²12 Sandella DE, O’Brien LM, Shank LK, Warschausky SA. Sleep and quality of life in children with cerebral palsy. Sleep Med 2011;12 (03):252–256. Doi: 10.1016/j.sleep.2010.07.019 https://doi.org/10.1016/j.sleep.2010.07....
Cross-sectional study	100 individuals with CP	62.5% had excessive daytime sleepiness; 50% had sleep- disordered breathing; 50% had nightmares; and 12.5% had sleep talking	Sleep questionnaire	Elsayed et al.²⁵25 Elsayed RM, Hasanein BM, Sayyah HE, El-Auoty MM, Tharwat N, Belal TM. Sleep assessment of children with cerebral palsy: Using validated sleep questionnaire. Ann Indian Acad Neurol 2013;16 (01):62–65. Doi: 10.4103/0972-2327.107708 https://doi.org/10.4103/0972-2327.107708...
Cross-sectional study	165 children with CP	22% had disorders of initiating and maintaining sleep; 14% had sleep-breathing disorders; 15% had sleep–wake transition disorder; 10% had disorders of arousal; and 7% had sleep hyperhidrosis	Sleep Disturbance Scale for Children	Romeo et al.³3 Romeo DM, Brogna C, Quintiliani M,et al. Sleep disorders in children with cerebral palsy: neurodevelopmental and behavioral correlates. Sleep Med 2014;15(02):213–218.Doi: 10.1016/j.sleep.2013.08.793 https://doi.org/10.1016/j.sleep.2013.08....
Cross-sectional study	113 children with CP	45.1% had frequent twitching or jerking of legs/often changes position/kicks the covers off the bed; 39.8% had difficulty falling asleep at night; 32.7% had nighttime awakenings; and 34.5% awaked in the morning feeling tired	Sleep Disturbance Scale for Children	Horwood et al.¹⁷17 Horwood L, Mok E, Li P, Oskoui M, Shevell M, Constantin E. Prevalence of sleep problems and sleep-related characteristics in preschool- and school-aged children with cerebral palsy. Sleep Med 2018;50:1–6. Doi: 10.1016/j.sleep.2018.05.008a https://doi.org/10.1016/j.sleep.2018.05....

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[1] Address for correspondence Marcela Fischer de Almeida (email: marcela.fischer.almeida@gmail.com)