Infant Sleep Interventions with Sleep Measurements Using Actigraphy: A Systematic Review.

AimThis review investigated the outcomes and methodological quality of infant sleep intervention studies utilizing actigraphy.BackgroundParents need appropriate support for infant sleep from nurses. There are few methodological reports of actigraphy in infant sleep intervention studies that objectively measure infant sleep in a natural setting.DesignThis was a systematic review study.Data SourcesOvid MEDLINE, Embase, Cochrane, CINAHL and PsycINFO were searched from database establishment to 30 December 2021.Review MethodsThis systematic review utilized the Cochrane Collaboration review guidelines.ResultsEleven sleep intervention studies were reviewed. Three used extinction-based behavioural interventions, and eight included parental education programs. The infant sleep interventions positively affected the sleep outcomes of both infants and parents. Fairly consistent effects were found on infants' number of awakenings and sleep onset latency. However, parental psychosocial outcomes were inconsistent. All studies reported device placement, the algorithm for analysis, the use of a sleep diary and number of days/nights, but external movements affecting infants' sleep records were insufficiently reported. Only two studies had a low risk of bias.ConclusionsThe infant sleep interventions had positive effects on both infants and their parents. Comprehensive methodological considerations are required for more standardized assessments using actigraphy for infant sleep evaluation. What is already known about this topic?Strong evidence exists that behavioural interventions improve infant sleep.Infant sleep interventions using actigraphy have gradually increased in paediatric sleep research.What this paper adds:Behavioural interventions were found to be fairly effective for infants' sleep onset latency and night-wakings.Parental education programs were inconsistent in their effectiveness on infant sleep outcomes, compared to extinction-based behavioural interventions. Infant behavioural sleep interventions also did not show consistent positive effects on parental variables.The use of actigraphy with infants is challenging in terms of comparability across studies due to the lack of standardized criteria for defining and scoring daytime and nighttime sleep data, and unexpected external movement detection due to variability of infants' sleep conditions.The implications of this paper:This study contributes to nursing knowledge and practice by increasing the feasibility of implementing infant behavioural sleep interventions using actigraphy and considering family contexts.Meta-analysis is needed to clarify the effectiveness of infant sleep interventions, and further studies should investigate the long-term effects of infant sleep interventions.In infant sleep intervention studies using actigraphy, it is necessary to use subjective and objective measures as complementary modalities. Follow-up studies are needed to establish standards in actigraphic measurement and reporting methodology.