Table 2

Behavioural treatments for sleep disorders in Down’s syndrome

CitationStudy groupStudy type (level of evidence)OutcomeKey resultsComments
Ramchandani et al (2000)9 controlled trials, 132 children randomised to drug treatments, 235 children randomised to psychological treatments. All children aged 5 years and under with a sleeping problemSystematic review, narrative synthesis (level 1a)Parent report (number of night awakenings, time to settle, number of nights disturbed)Effect sizes not reported. Drug trials showed short term benefits, but no effects were seen at two months follow up. Behavioural treatments produced both short and long term (6–12 weeks), but the loss of control groups at follow up was notedConclusions are undermined by poor quality of trials
Drug trials were assessed as of better quality than non-drug trials
Mindell (1999)39 studies, 1697 children aged 5 years and under with bedtime refusal or night waking problemsReview, narrative synthesis (level 4)Parent report (sleep diaries, questionnaires)Effects sizes not reported. Interventions rated according to the number and quality of trials that showed effects. Extinction was considered “well established”. Graduated extinction and scheduled awakenings “probably efficacious”No studies were excluded due to poor study methodology
Lancioni et al (1999)21 studies, 258 young people aged 4–23 years with a range of developmental disabilities with sleeping problemsReview, narrative synthesis (level 4)Findings dichotomised into improvement or no improvement in sleep pattern100% of those treated using bedtime fading with or without response cost improvedDegree of sleep improvement not assessed. No assessment of study quality was used, nor were any studies excluded on the basis of their methodology
82% of those treated using bedtime routine plus gradual distancing of parents improved