Does body cooling facilitated by bedding compared to control condition improve sleep among adults (18-64 years old)? A systematic review and meta-analysis

Introduction: The relationship between blood distribution, body temperature, and sleep/wakefulness states is still unclear. The aim of the present study is to systematically review the potential beneficial effects of bedding strategies (e.g., mattress, mattress topper or pillow) on body cooling and night-time sleep.

Material & methods: This systematic review with meta-analysis searched PubMed, ScienceDirect and Web of Science, from inception until March 4, 2024. We included randomized controlled trials aiming to investigate any type of bedding that induced body cooling compared to habitual sleep environment on sleep parameters in healthy adults. Two reviewers independently extracted data, appraised risk of bias by Cochrane tool, and estimated the mean differences between groups with 95% confidence interval. Meta-analyses and proportional meta-analyses were performed depending on the type of variable. The certainty of evidence was assessed using the Grades of Recommendation, Assessment, Development and Evaluation system.

Results: From 3454 articles screened, 9 studies met the inclusion criteria. Overall, with the certainty of the evidence ranging from very low to low we found no differences between groups on sleep onset latency, sleep efficiency, sleep proportion spent in each sleep stage (i.e. N1, N2, N3 and REM), wake after sleep onset, and total sleep time. Results could be interpreted with caution due to high heterogeneity in the estimated effects.

Conclusion: With uncertainty of evidence, that ranged from very low to low, different bedding strategies had no effects on night-time sleep characteristics; however, the studies included into the qualitative synthesis suggested an effect of different bedding strategies on body cooling (i.e., lower core body temperature, p < 0.05) from an acute perspective. Future studies on various forms of bedding interventions susceptible to favour and maintain sleep through a positive body thermal effect are highly warranted.

Prospero registration: CRD42021275369.