Estratégia educativa on-line para diminuir despertares noturnos e prolongar o tempo de sono da díade mãe-bebê: ensaio clínico randomizado

Abstract

Problems with baby sleep, characterized by the baby's difficulty in falling asleep and staying asleep throughout the night, in addition to harm to child development, can cause physical and emotional discomfort within the family, especially for mothers. This study aimed to evaluate the effectiveness of an online educational strategy to reduce nighttime awakenings in babies and extend the mother-baby dyad's nighttime sleep time. This is a randomized clinical trial, with two groups: intervention group (IG), in which the intervention was applied (two individual online educational meetings + sending motivational reminders via Whatsapp); and control group (CG). Participants were recruited by disseminating the research in the form of posts and stories on the social networks Instagram®, Facebook® and Whatsapp®. When the inclusion criteria were met, randomization was carried out in blocks, with 10 blocks of 10 and one of four participants. Data collection took place online and using the Google-Meet®, Survey Monkey® and Whatsapp® platforms. At baseline, mothers responded to the collection instruments: Sociodemographic and clinical questionnaire, Brief Infant Sleep Questionnaire (BISQ), Pittsburg Sleep Quality Index (PSQI) and State-Trait Anxiety Inventory (STAI). After randomization, mothers allocated to the IG participated in two individual online meetings within 10 days of each other and received, for 30 days, via WhatsApp, motivational reminders that mentioned the guidelines given in the online meetings. At these meetings, there was guidance on the baby's sleep routine, naps, nighttime pre-sleep rituals and how to get the baby to sleep independently, as well as guidance on sleep quality and maternal anxiety related to infant sleep. The motivational reminders, in addition to recalling the guidelines given in the online meetings, also reminded IG mothers to respond to a baby's sleep diary, in order to ensure their continuity in the research. The mothers allocated to the GC received a message confirming their participation in the research via WhatsApp and from then on, they began to receive a single message repeated daily for 30 days via this same application, inviting them to respond to their baby's sleep diary. The measurement of outcomes occurred 15 and 30 days after the first online meeting for the IG and 15 and 30 days after inclusion in the research for the CG, using the BISQ, PSQI and IDATE instruments. Data were analyzed using the T Test for independent samples, Friedman test, Chi-square of independence and Pearson Correlation. The project was approved by the Research Ethics Committee of the Federal University of Ceará and registered on the Brazilian Clinical Trials Registry platform. 104 dyads participated (52 per group) and were homogeneous in relation to sociodemographic variables at baseline (P>0.05). After the intervention, there was a statistically significant decrease in the average number of nighttime awakenings and an increase in the total nighttime sleep time of babies in the IG, when compared to those in the CG, both at 15 days and 30 days (p<0.001). It was found that babies in the IG had a 97.7% reduction in the probability of sleeping dependently, when compared to babies in the CG RR0.025 (95%CI0.003-0.17). There was also better maternal sleep quality (p<0.001) and a statistically significant decrease in maternal trait anxiety scores (p<0.001) 15 and 30 days after the intervention. It is concluded that the online educational strategy was effective in reducing nighttime awakenings and increasing babies' nighttime sleep time, as well as increasing maternal sleep quality and reducing the mother's anxiety scores.