Interventions for sleep difficulties in adults with an intellectual disability: a systematic review.
Adults with ID may sleep better after intervention, but current evidence is too thin to guide practice.
01Research in Context
What this study did
The team hunted for every paper that tried to fix sleep problems in adults with intellectual disability.
They kept behavioral studies, pill studies, and any mix of the two.
Nine small reports met the rules; most had no control group and few participants.
What they found
Eight of the nine studies said sleep got better, but the quality was low.
No two studies used the same way to score sleep, so the team could not run a meta-analysis.
Bottom line: a weak signal, not a roadmap.
How this fits with other research
Taylor et al. (2017) did a meta-analysis of only behavioral sleep studies in ID and found large, quick gains.
The same 2017 review is inside the 2019 paper, yet the 2019 verdict is far less hopeful.
The difference is scope: the 2017 paper pooled similar behavioral tactics, while the 2019 paper added tiny, mixed-method studies that dragged the quality down.
Lippold et al. (2009), one of the weak studies the 2019 review includes, still shows you can help sleep with simple bedroom rules in group homes.
Why it matters
For now, treat adult sleep problems in ID like a pilot project. Track baseline with an actigraphy watch, pick low-risk moves such as set bedtimes and light reduction, and watch the data. Do not promise families a sure fix until stronger RCTs arrive.
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02At a glance
03Original abstract
BACKGROUND: Current literature highlights higher prevalence rates of sleep difficulties amongst adults with an intellectual disability. However, no synthesis has been conducted to assess the effectiveness of existing interventions in this population. Thus, the aim of this review was to assess the effectiveness of sleep interventions in adults with an intellectual disability (ID). METHOD: Eight databases were searched to identify interventions for sleep difficulties amongst adults with an ID. The study quality was assessed with the Risk Of Bias In Non-randomised Studies - of Interventions. Nine studies (n = 97) were eligible for inclusion in the review. RESULTS: There was a notable study on heterogeneity in terms of the population, study design, intervention studied, sleep assessment and outcome assessments used. Eight of the nine studies reported improvement in sleep following intervention. However, these findings need additional support as only 97 participants involving a variety of interventions and measurement systems were used across all studies. Furthermore, eight of the nine studies had serious to critical risk of bias. The only study identified as having low risk of bias was a placebo-controlled randomised controlled trial for the use of melatonin. CONCLUSIONS: This review highlights the need for objective measures such as actigraphy and studies with greater experimental control investigating sleep interventions in adults with ID.
Journal of intellectual disability research : JIDR, 2019 · doi:10.1111/jir.12587