1139 An evidence-based clinical guidance designed for managing children and adolescents with sleep problems and associated neurodevelopmental disorders

Abstract

<h3>Background</h3> There is a paucity of national evidence-based guidelines that emphasises holistic care of children and adolescents with neurodevelopmental disorders, who are highly vulnerable to significant sleep disorders. In addition, clinical practice varies widely about melatonin use with enormous financial implications. There is an urgent need for implementation of safe and effective cost-saving measures to ensure sustainable provision of essential NHS services to the entire UK population. Sleep problems are common in children and adolescents, especially among those who have recognisable neurodevelopmental, emotional, behavioural or intellectual disorders (NDEBID). 50% to 80% of children and adolescents with NDEBID experience various types of insomnias. There is a complex relationship between sleep disorders and childhood neurodevelopmental disorders. Chronic sleep deprivation is known to significantly aggravate externalising and internalising bhaviour disorders, including depression, suicide and self-harm behaviors, impaired cognitive development and learning abilities. It can also cause disorders of the cardiovascular, immune and metabolic systems, including growth disorders. It negatively impacts on the child’s academic performance, personal and wider family emotional and social wellbeing. <h3>Objectives</h3> To review the most recent published research literature and develop a practical guidance on managing sleep disorders in children and adolescents with NDEBID along with a flowchart. <h3>Methods</h3> We carried out a literature review of the latest research on the use of cognitive-behavioural strategies and pharmacotherapy in the management of sleep problems among children with neurodevelopmental disorders such as ADHD, ASD, Epilepsy and Learning disorders using several databases including the OVID, EMBASE, CINHAL and Cochrane’s Databases. <h3>Results</h3> Treatment options for paediatric sleep insomnias include parent psychoeducation/training, sleep hygiene (modifiable daytime, bedtime, and night-time practices), behavioural strategies and pharmacological treatment for selected cases. Cognitive behavioural therapy (CBT) is also effective for adolescents. We provide an outline of evidence-based clinical guideline for clinicians managing CYP with diverse NDEBIDs in 4 sections, including overview of sleep disorders, special circumstances, transition to adult care, shared care and appendix of definitions, online resources and easy-to-use flowchart. Every CYP with sleep difficulties should have detailed medical and sleep history, including any possible underlying sleep apnoea, other physical explanations for insomnia including obesity, emotional problems or sources of discomfort, complemented by use of screening questionnaires, sleep diary and actigraphy (if available). This should lead to identification of specific sleep disorder type, consideration of differential diagnosis and formulation of a sleep plan with the parents or carers. Stepwise introduction of behavioural and pharmacological treatment options are outlined, including mandatory follow-up for effectiveness, side-effects and trial of discontinuation. <h3>Conclusions</h3> This clinical guideline and the accompanying flowchart is expected to help clinicians provide a more uniform holistic evidence-based management for every child presenting with co-morbid sleep problems associated with complex emotional behavioural and neurodevelopmental disorders. It will likely lead to less risks of patient/parent dissatisfaction with individual clinicians and help the individual NHS Trusts to identify potential areas of cost saving involved in melatonin prescriptions, as well as identifying an integrated commissioning of further services such as Behavioural/parent training interventions. We plan to pilot the guidelines among a small number of CCH clinics.