Sleep disturbance in children with prenatal alcohol exposure: a systematic review and meta-analysis

Background: Sleep disturbances are prevalent in children with prenatal alcohol exposure (PAE), including those with Fetal Alcohol Spectrum Disorders (FASD), potentially exacerbating behavioural and cognitive deficits. Despite this, no review has systematically assessed the timing or severity of these sleep disturbances. The aim of this review was to identify sleep disturbances in children with PAE.
Methods: A systematic search across seven databases followed PRISMA guidelines. Studies included children aged 3–10 with PAE and provided quantitative sleep data. Two reviewers independently screened articles. A meta-analysis of subjective sleep outcomes used a random-effects model, with heterogeneity assessed via I².
Results: Fourteen studies met inclusion criteria. Children with PAE had consistently worse sleep than typically developing peers, including longer sleep onset, shorter duration, more awakenings, lower sleep efficiency, and greater sleep variability. Higher PAE levels were linked to earlier onset and persistence of sleep disturbances, with more severe issues in early pregnancy exposure. Meta-analysis of seven studies showed high heterogeneity (I² = 0.91) with medium to large effect sizes, particularly for night awakenings (d = 1.04) and sleep duration (d = 0.89).
Conclusions: Children with PAE face persistent sleep disturbances, worsening with heavier or earlier exposure, highlighting the need for early screening and interventions.