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Volume 14 No. 11
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Accepted Papers

Review Articles

Cognitive and Behavioral Interventions to Improve Sleep in School-Age Children and Adolescents: A Systematic Review and Meta-Analysis

Lie Åslund, MSc1,4; Filip Arnberg, PhD1,2; Marie Kanstrup, PhD1,3; Mats Lekander1,4
1Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; 2Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; 3Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden; 4Stress Research Institute, Stockholm University, Stockholm, Sweden

Study Objectives:

Sleep problems are common in children and adolescents and can aggravate comorbid disorders. This meta-analysis examined the effect of cognitive and behavioral sleep interventions (with four or more treatment sessions) from randomized controlled trials on school-age children and adolescents.


In a systematic literature search, six randomized controlled trials were identified (n = 528; mean age = 14.6 years; female = 63%) that reported total sleep time (TST), sleep onset latency (SOL), wake after sleep onset, and daytime sleepiness from ratings and actigraphy.


After intervention, no effect was seen on self-reported TST, but when measured with actigraphy, an effect favoring the intervention group was observed (+11.47 minutes, P = .05). SOL decreased in the intervention group compared to the control group after intervention as measured by both sleep diaries (−9.31 minutes, P = .007) and actigraphy (−19.48 minutes, P < .0001). Effect sizes ranged from small to large. No effect was found for wake after sleep onset or daytime sleepiness. Short-term (4 to 8 weeks) follow-up data from four studies indicated maintained positive effects on SOL: sleep diaries −15.85 minutes (P = .01) and actigraphy −23.67 minutes (P < .0001). At follow-up, the effects on wake after sleep onset from ratings (−14.41 minutes, P = .001) and actigraphy (−7.54 minutes, P = .01) were significant, favoring the intervention group (moderate to large effect sizes). No effect on TST was indicated.


Cognitive and behavioral sleep interventions are indicated to improve sleep in school-age children and adolescents. However, because treatment protocols were heterogeneous and risk of bias high, results should be interpreted with caution. Large and rigorous trials are needed.


Åslund L, Arnberg F, Kanstrup M, Lekander M. Cognitive and behavioral interventions to improve sleep in school-age children and adolescents: a systematic review and meta-analysis. J Clin Sleep Med. 2018;14(11):1937–1947.

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