Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial

Abstract

Study objectives: This study evaluated the effect on infant sleep of a novel intervention (Play2Sleep) that combined infant sleep information with self-modeled video feedback on parent-infant interactions.

Methods: An explanatory sequential mixed-methods design consisting of a randomized controlled trial with 63 mother-father-infant triads randomized to Play2Sleep or comparison home visit interventions was used. We used repeated measures analysis of covariance to detect changes in infant night wakings, nocturnal wakefulness, and sleep durations and Wilcoxon signed rank test to evaluate changes in perception of infant sleep problems. Family interviews (n = 20) were used to explain the quantitative findings and analyzed qualitatively using thematic analysis.

Results: Play2Sleep was effective in reducing maternal-reported infant wakefulness, F(1,55) = 5.33, P = .03, partial η2 = .09, and the number of paternal-reported naps, F(1,58) = 4.90, P = .03, partial η2 = .08. Parents in the Play2Sleep group reported significant improvements in problematic infant sleep that were not observed in the comparison group; however, Play2Sleep was not effective in reducing the number of parent-reported night wakings. Information overwhelm, learning infant cues, and working together with a subtheme of father involvement were key qualitative themes developed to explain the quantitative results. Unplanned exploratory analyses revealed a significant improvement in maternal depression symptoms in the Play2Sleep group.

Conclusions: This study suggests Play2Sleep could improve infant sleep by promoting parental awareness of infant cues and father involvement and improving maternal depression. Additional research is needed to determine the optimal number and timing of sessions.

Clinical trial registration: Registry: ClinicalTrials.gov; Name: Play2Sleep: Using Play to Improve Sleep; URL: https://ichgcp.net/clinical-trials-registry/NCT02742155; Identifier: NCT02742155.

Citation: Keys EM, Benzies KM, Kirk VG, Duffett-Leger L. Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial. J Clin Sleep Med. 2022;18(2):439-452.

Keywords: fathers; infants; mothers; parent-child interaction; parenting; sleep; wakefulness.

Conflict of interest statement

All authors have seen and approved this manuscript. Work for this study was performed at University of Calgary. E.M.K. was supported by a Pre-Doctoral Canadian Child Health Clinician Scientist Program Award, Alberta Children’s Hospital Research Institute—Canadian Institute for Health Research Training Program, Alberta Children’s Hospital Foundation, and an Alberta Innovates—Health Solutions Clinician Fellowship (#201504). The authors report no conflicts of interest.

© 2022 American Academy of Sleep Medicine.

Figures

Figure 1. CONSORT (Consolidated Standards of Reporting Trials) flow diagram.

Figure 2. Parent-reported night wakings by group at baseline and outcome.

(Left) Maternal-reported number of night wakings by group at baseline and outcome (covariates = child sleep location, child falling asleep by self in own crib/bed, ethnicity, English spoken at home, and MCISQ total score). (Right) Paternal-reported number of night wakings by group at baseline and outcome (covariates = father MCISQ Limits, infant sleep surface, child falling asleep by self in own crib/bed). MCISQ = Maternal Cognitions about Infant Sleep Questionnaire.