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Title [sv]
Utvärdering av hälsoeffekter och kostnadseffektivitet av en sömnintervention med tyngdtäcken hos barn med ADHD och sömnproblem
Title [en]
Evaluation of health effects and cost effectiveness from a sleep intervention with weight blankets in children with ADHD and sleep problems
Abstract [sv]
I oktober 2020 gick SKR:s Medicintekniska produktråd ut med rekommendation till alla regioner i Sverige att inte subventionera förskrivning av tyngdtäcken på grund av otillräcklig evidens kring tyngdtäckes effekt på sömn. För att förskrivning av tyngdtäcke fortsättningsvis skall kunna anses motiverad efterfrågas således mer evidens från både randomiserade placebokontrollerade studier och kvalitativa studier.SyfteDet övergripande syftet är att utvärdera en sömnintervention med tyngdtäcke hos barn mellan 6–13 år med nydiagnostiserad Attention Deficit Hyperactivity Disorder (ADHD) och sömnbesvär. Sju delstudier genomförs med syfte att utforska sömninterventionens hälsoeffekter och kostnadseffektivitet samt erfarenheter utifrån barnens respektive föräldrarnas perspektiv.MetodDesignStudien är en randomiserad placebokontrollerad interventionsstudie, med cross-over design.DeltagarePopulationen är 100 barn mellan 6–13 år med nydiagnostiserad ADHD och sömnbesvär.InterventionBarnen randomiseras till att börja använda tyngdtäcke respektive placebotäcke. Efter 4 veckor byter deltagarna till placebo- respektive tyngdtäcke (cross-over design).Datainsamling delstudie 1-2Datainsamling sker vid baseline samt under vecka 4, 8 och 16 och långtidsuppföljning efter 1 år. Sömn mäts objektivt med ActiGraf under 7 nätter och med enkäter till barn och förälder med frågor om sömn, barnets funktion, ADHD-symtom, oro, läkemedel, vårdkontakter, skolfrånvaro, samt föräldrars sjukfrånvaro och arbetsförmåga.Datainsamling delstudie 3Ett urval av 25 barn och 25 föräldrar intervjuas efter interventionen.DataanalysI RCT-studien (delstudie 1a, 1b) utvärderas effekten av tyngdtäcken primärt med avseende på förändrad sömn (objektiv och subjektiv).I den hälsoekonomiska studien (delstudie 2a, 2b) utvärderas kostnadseffektiviteten av sömninterventionen med tyngdtäcke jämfört med placebotäcke.I de kvalitativa studierna (delstudie 3a, 3b, 3c) analyseras intervjuerna med kvalitativ innehållsanalys.
Abstract [en]
In October 2020, SKR´s Medical Technology Product Council (MTR-rådet) recommended all regions in Sweden to not subsidize prescribing of weight blankets due to insufficient evidence regarding the effectiveness of weight blankets. To justify continuing prescribing weight blankets, more evidence is thus required from both randomized placebo-controlled and qualitative studies.AimThe overall aim is to evaluate a sleep intervention with weighted blankets for children aged 6–13 years with Attention Deficit Hyperactivity Disorder (ADHD) and sleep disorders. Seven studies are carried out to explore the health effects and cost-effectiveness of the sleep intervention, as well as experiences from the children and parentsMethodDesignThe study is a randomized placebo-controlled intervention trial, with a cross-over designParticipantsThe population is 100 children aged 6–13 with newly diagnosed ADHD and sleep disordersInterventioThe children are randomized to begin either to use a weighted blanket or placebo blanket. After 4 weeks, the participants switch to placebo blankets or weight blankets (cross-over design).Data collection study 1-2Data collection takes place at baseline, during weeks 4, 8, and 16 and at long-term follow-up after 1 year. Sleep is measured objectively with an ActiGraph for 7 nights and questionnaires about sleep, the child´s function, ADHD symptoms, anxiety, medication, care contacts, school absence, and parents´ sick leave and work capacity.Data collection study 3A purposive sample of 25 children and 25 parents are interviewed after the intervention.Data analysisIn the RCT (study 1a, 1b), the effect of weight blankets is evaluated primarily concerning a change in sleep (objective and subjective).In the health economic study (study 2a, 2b), the cost-effectiveness of the sleep intervention with weighted blankets is analyzed compared with placebo.In the qualitative studies (study 3a, 3b, 3c), the interviews are analyzed with qualitative content analysis.
Publications (4 of 4) Show all publications
Lindholm, A., Jarbin, H., Aili, K., Nygren, J. M., Svedberg, P. & Larsson, I. (2024). Sex Differences in Children with Uncomplicated Attention Deficit/Hyperactivity Disorder and Sleep Problems. Children, 11(6), Article ID 636.
Open this publication in new window or tab >>Sex Differences in Children with Uncomplicated Attention Deficit/Hyperactivity Disorder and Sleep Problems
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2024 (English)In: Children, E-ISSN 2227-9067, Vol. 11, no 6, article id 636Article in journal (Refereed) Published
Abstract [en]

Background: Approximately 7.6% of children are diagnosed with attention deficit/hyperactivity disorder (ADHD), and sleep impairments affect 25–85%. There is a noticeable lack of research on girls and sex differences. The aim of this study was to examine sex differences in children with uncomplicated ADHD and sleep problems. Methods: Cross-sectional baseline data were retrieved from a randomized controlled trial with weighted blankets (55 boys and 41 girls, 6–14 years) on a cohort recently diagnosed with uncomplicated ADHD and sleep problems. Differences between boys and girls in ADHD symptoms, objectively and subjectively measured sleep, anxiety, and functioning were examined via parent- or self-reported validated instruments. Results: Girls reported significantly lower (worse) satisfaction with well-being, life overall, and school, but not for family. Parents reported more sleep anxiety and night-time wakings among boys, but no sex differences in other measures and also not in self-reported measures or objective sleep measures. Children who reported worry, sadness, or unhappiness had more sleep problems. Conclusions: Boys with ADHD and sleep problems may need support with sleep-related anxiety and night-time wakings, while girls may require support with overall functioning. Additionally, children who express feelings of worry, sadness, or unhappiness alongside their ADHD symptoms should have attention given to their sleep. © 2024 by the authors. Licensee MDPI, Basel, Switzerland.

Place, publisher, year, edition, pages
Basel: MDPI, 2024
Keywords
attention deficit/hyperactivity disorder, ADHD, paediatrics, sleep problems in children
National Category
Psychiatry
Research subject
Health Innovation, IDC
Identifiers
urn:nbn:se:hh:diva-53698 (URN)10.3390/children11060636 (DOI)
Funder
Knowledge Foundation, 20200012Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00664
Available from: 2024-06-12 Created: 2024-06-12 Last updated: 2024-08-15Bibliographically approved
Lönn, M., Svedberg, P., Nygren, J. M., Jarbin, H., Aili, K. & Larsson, I. (2024). The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder—A randomized controlled crossover trial. Journal of Sleep Research, Article ID e13990.
Open this publication in new window or tab >>The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder—A randomized controlled crossover trial
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2024 (English)In: Journal of Sleep Research, ISSN 0962-1105, E-ISSN 1365-2869, article id e13990Article in journal (Refereed) Published
Abstract [en]

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. −2.79 min, p = 0.015, Cohen's d = −0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11–14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions. © 2023 The Authors. Journal of Sleep Research published by John Wiley & Sons Ltd on behalf of European Sleep Research Society.

Place, publisher, year, edition, pages
Chichester: Wiley-Blackwell Publishing Inc., 2024
Keywords
actigraphy, attention-deficit/hyperactivity disorder, randomized controlled trial, sleep intervention, sleep problems
National Category
Psychiatry Medical and Health Sciences
Research subject
Health Innovation, IDC
Identifiers
urn:nbn:se:hh:diva-51406 (URN)10.1111/jsr.13990 (DOI)001028827400001 ()37452697 (PubMedID)2-s2.0-85165257033 (Scopus ID)
Funder
Knowledge Foundation, 20200012Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00664Region Halland
Note

Funding: This work was supported by external grants from The Knowledge Foundation [number 20200012], Swedish Research Council for Health Working Life and Welfare (Forte) [number 2021-00664]; Majblomman foundation and different grants from Region Halland.

Available from: 2023-08-15 Created: 2023-08-15 Last updated: 2024-07-11Bibliographically approved
Larsson, I., Svedberg, P., Nygren, J. M. & Malmborg, J. S. (2024). Validity and reliability of the Swedish version of the Children’s Sleep Habits Questionnaire (CSHQ-SWE). BMC Pediatrics, 24(1), Article ID 378.
Open this publication in new window or tab >>Validity and reliability of the Swedish version of the Children’s Sleep Habits Questionnaire (CSHQ-SWE)
2024 (English)In: BMC Pediatrics, E-ISSN 1471-2431, Vol. 24, no 1, article id 378Article in journal (Refereed) Published
Abstract [en]

Background: To translate and culturally adapt the Children’s Sleep Habits Questionnaire (CSHQ) to a Swedish version, CSHQ-SWE, and to assess its validity and reliability for use with children with attention deficit hyperactivity disorder (ADHD). Methods: A total of 84 children with ADHD (51 boys and 33 girls; 6–12 years) and parents (7 men and 77 women; 28–51 years) were included in the study. CSHQ was translated and culturally adapted to Swedish, and assessed for concurrent validity with sleep actigraphy (analyzed by Kendall’s Tau) and for reliability by internal consistency (analyzed by McDonald’s Omega H). Face and content validity was evaluated by parents (n = 4) and healthcare professionals (n = 6) qualitatively (comprehensiveness, relevance, and comprehensibility assessed by interviews and analyzed by thematic analysis) and quantitatively (analyzed by content validity ratio and content validity index for 33 items and four non-scored inquiries). Results: Parent-reported sleep problems (CSHQ-SWE total score) were moderately correlated with less “Sleep Efficiency” (Tau = −0.305; p < 0.001) measured by sleep actigraphy. Parent-reported problems with “Sleep Onset Delay” was moderately correlated with measured time for ”Sleep Onset Latency” (Tau = 0.433; p < 0.001). Parent-reported problems with “Night Wakings” were weakly correlated with measured time for “Wake After Sleep Onset” (Tau = 0.282; p < 0.001). Parents estimation of “Total daily sleep duration” was moderately correlated with measured “Total Sleep Time” (Tau = 0.386; p < 0.001). Five of the seven subscales reached an acceptable level for internal consistency (McDonald’s Omega H > 0.700). Comprehensiveness, relevance, and comprehensibility of CSHQ-SWE were satisfactory overall. Content validity ratio was 0.80 to 1.00 for six items, 0.00 to 0.60 for 22 items, and < 0.00 for nine items. Content validity index was 0.22. Conclusions: CSHQ-SWE demonstrated acceptable concurrent validity with objectively measured sleep and internal consistency, whereas the overall results of face and content validity assessment varied. The instrument needs to be further evaluated regarding construct validity, responsiveness, test-retest reliability, and its generalization to other populations. © The Author(s) 2024

Place, publisher, year, edition, pages
London: BioMed Central (BMC), 2024
Keywords
ADHD, CSHQ, Children’s sleep habits questionnaire, Reliability, Sleep, Sleep actigraphy, Validity
National Category
Health Sciences
Research subject
Health Innovation, IDC
Identifiers
urn:nbn:se:hh:diva-53700 (URN)10.1186/s12887-024-04859-z (DOI)001236571600002 ()38822278 (PubMedID)2-s2.0-85194996765& (Scopus ID)
Funder
Halmstad UniversityForte, Swedish Research Council for Health, Working Life and Welfare, 2021 − 00664Knowledge Foundation, 20200012Knowledge Foundation, 20180185
Available from: 2024-06-12 Created: 2024-06-12 Last updated: 2024-07-04Bibliographically approved
Harris, U., Svedberg, P., Aili, K., Nygren, J. M. & Larsson, I. (2022). Parents’ Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD: A Qualitative Study. International Journal of Environmental Research and Public Health, 19(22), Article ID 15099.
Open this publication in new window or tab >>Parents’ Experiences of Direct and Indirect Implications of Sleep Quality on the Health of Children with ADHD: A Qualitative Study
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2022 (English)In: International Journal of Environmental Research and Public Health, ISSN 1661-7827, E-ISSN 1660-4601, Vol. 19, no 22, article id 15099Article in journal (Refereed) Published
Abstract [en]

Sleep problems represent a significant challenge for children with ADHD. However, lack of knowledge about how sleep affects children with ADHD in terms of their health and everyday life prevents the development and implementation of interventions to promote sleep. The aim of this study was to explore parents’ experiences of direct and indirect implications of sleep quality onthe health of children with ADHD. The study used an abductive qualitative design, with Tengland’s two-dimensional theory of health as a deductive analysis framework. Semi-structured interviews were conducted with 21 parents of children aged 6–13 with ADHD and sleep problems. The parents experienced that sleep influenced their children’s abilities to control emotional behaviour relatedto ADHD and to manage everyday life. Sleep also had an impact on the children’s well-being,in relation to both vitality and self-esteem. In conclusion, the results show important direct and indirect implications of sleep quality on the health of children with ADHD. This implies a need forgreater focus on sleep, to target both abilities and well-being in promoting health among childrenwith ADHD. © 2022 by the authors

Place, publisher, year, edition, pages
Basel: MDPI, 2022
Keywords
ADHD, children, parents, sleep, ability, well-being, qualitative content analysis, abductive approach
National Category
Medical and Health Sciences Health Sciences Nursing
Research subject
Health Innovation, IDC
Identifiers
urn:nbn:se:hh:diva-48724 (URN)10.3390/ijerph192215099 (DOI)000887200600001 ()36429815 (PubMedID)2-s2.0-85142479727 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2021-00664Knowledge Foundation, 20200012
Available from: 2022-12-02 Created: 2022-12-02 Last updated: 2023-01-26Bibliographically approved
Co-InvestigatorJohansson, Pia
Co-InvestigatorNygren, Jens M.
Principal InvestigatorLarsson, Ingrid
Co-InvestigatorJarbin, Håkan
Co-InvestigatorAili, Katarina
Co-InvestigatorSvedberg, Petra
Coordinating organisation
Halmstad University
Funder
Period
2022-01-01 - 2023-12-31
National Category
Occupational Therapy
Identifiers
DiVA, id: project:2701Project, id: 2021-00664_Forte

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