Active Components in Digital Health Interventions for Sleep among Adolescents: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

Background Digital Health Interventions (DHIs) for promoting sleep, treating, and preventing insomnia are a scalable, accessible, and resource-efficient alternative to traditional interventions. Though sleep problems are common in adolescents, limited research has focused on this age group. The appropriateness of DHIs for sleep promotion or insomnia treatment in adolescent populations, along with the active components associated with effective interventions, needs to be assessed. This review evaluated effective DHIs for sleep among adolescents and distilled their active components. Methods Randomized Controlled Trials (RCTs) were selected from OVID (Medline), CINAHL, Web of Science, SCOPUS, PsycINFO, and Embase databases from their inception to June 30, 2023, and updated in May 2024. Adolescence was defined as the phase of life stretching between childhood and adulthood (10 to 24 years old). Results Nine studies were identified, involving 9238 participants, of whom n = 4498 (47.8%) were females, between 12 and 24 years old (Mean: 15.6 years). Eight studies focused on digital cognitive behavioural therapy for insomnia dCBT-I, and one study focused on a holistic lifestyle DHI. Most studies delivered the DHI unguided using automatic messages (n = 4; 44.4%). dCBT-I for adolescents demonstrated a medium positive effect (n = 5; g =- 0.64, p  = 0.01) on subjective sleep quality immediately after treatment. Results suggested that active components of effective dCBT-I for adolescents are cognitive restructuring, mindfulness, stimulus control sleep, and optional sleep restriction technique. Conclusions The findings suggest that dCBT-I could be beneficial for insomnia and comorbid mental health in adolescents. Possible active component interventions may include a sleep diary, as part of education, cognitive restructuring, mindfulness, and stimulus control.