Sleep problems are a common complaint in children/adolescents with autism spectrum disorder (ASD). Correctly diagnosing and treating sleep problems in individuals with ASD is key, as they can add to the psychosocial burden of the disorder and exacerbate associated symptoms, such as inattention or irritability. Here, we provide an overview of the epidemiology, diagnosis, and management of sleep problems/disorders in children and adolescents with ASD. This narrative review is mainly informed by a systematic search in PubMed and PsycInfo (last search: 10 October 2019) of available pertinent meta-analyses. We also searched for randomized controlled trials (RCTs) published after the search date of available meta-analyses. As for the epidemiology of sleep disorders in ASD, recent meta-analytic evidence shows a pooled prevalence of 13% (95% confidence interval [CI] 9-17) in the ASD population, compared with 3.7% in the general population. In terms of diagnosis of sleep disorders, it should be based on standardized criteria [e.g., the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or third edition of the International Classification of Sleep Disorders (ICSD)]; clinicians should bear in mind that the communication difficulties presented by individuals with ASD may make the diagnostic process more challenging. Regarding the treatment, a meta-analysis of behavioral interventions, including only three RCTs, found significant effects in terms of increase in total sleep time (24.41 min, 95% CI 5.71-43.11, P = 0.01), decrease in sleep-onset latency (- 18.31 min, 95% CI - 30.84 to - 5.77, P = 0.004), and a significant effect on sleep efficiency (5.59, 95% CI 0.87-10.31, P = 0.02), albeit the risk of bias of the included studies was rated "high" in relation to issues with the blinding. The bulk of the evidence for the pharmacological treatment is for melatonin, with a meta-analysis of five double-blind RCTs showing a large effect size, favoring melatonin, in sleep duration (44 min compared with placebo, Hedge's g 1.07 [95% CI 0.49-1.65]) and sleep-onset latency (39 min compared with placebo, Hedge's g - 2.46 [95% CI - 1.96 to - 2.98]). We conclude that additional RCTs are desperately needed to support the management of sleep disorders in ASD with an evidence-based, precision medicine approach.

中文翻译：

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自闭症谱系障碍儿童和青少年的睡眠障碍：诊断，流行病学和管理。

睡眠问题是自闭症谱系障碍（ASD）的儿童/青少年的常见病。正确诊断和治疗ASD患者的睡眠问题是关键，因为它们会加重疾病的心理负担，并加剧相关症状，例如注意力不集中或易怒。在这里，我们概述了ASD儿童和青少年的睡眠问题/疾病的流行病学，诊断和管理。这项叙述性评论主要是通过在PubMed和PsycInfo中进行系统搜索（最新搜索：2019年10月10日）来进行的，这些搜索均适用于相关的荟萃分析。我们还搜索了在可用荟萃分析的搜索日期之后发布的随机对照试验（RCT）。至于ASD睡眠障碍的流行病学，最近的荟萃分析证据显示，ASD人群的合并患病率为13％（95％置信区间[CI] 9-17），而普通人群为3.7％。就睡眠障碍的诊断而言，应基于标准化标准[例如，《精神障碍诊断和统计手册》第五版（DSM-5）或《国际睡眠障碍分类》第三版）。临床医生应记住，患有自闭症患者的沟通困难可能会使诊断过程更具挑战性。关于治疗，对一项仅包括三个RCT的行为干预进行的荟萃分析发现，在增加总睡眠时间（24.41分钟，95％CI 5.71-43.11，P = 0.01），减少睡眠发作潜伏期方面具有显着效果（-18.31分钟，95％CI-30.84至-5.77，P = 0.004），并且对睡眠效率有显着影响（5.59，95％CI 0.87-10.31，P = 0.02），尽管与盲目的问题相比，纳入研究的偏倚风险为“高”。药物治疗的大部分证据是褪黑激素，对五个双盲RCT的荟萃分析显示，在睡眠期间（有利于褪黑激素）的作用范围较大（与安慰剂相比为44分钟，Hedge's g 1.07 [95％CI 0.49-1.65]）和睡眠开始潜伏期（与安慰剂相比39分钟，Hedge's g-2.46 [95％CI-1.96至-2.98]）。我们得出结论，迫切需要通过基于证据的精确医学方法来支持ASD中睡眠障碍管理的其他RCT。尽管所纳入研究的偏倚风险相对于盲法问题被评为“高”。药物治疗的大部分证据是褪黑激素，对五个双盲RCT的荟萃分析显示，在睡眠期间（有利于褪黑激素）的作用范围较大（与安慰剂相比为44分钟，Hedge's g 1.07 [95％CI 0.49-1.65]）和睡眠开始潜伏期（与安慰剂相比39分钟，Hedge's g-2.46 [95％CI-1.96至-2.98]）。我们得出结论，迫切需要其他循证医学支持以循证，精密医学方法支持ASD睡眠障碍的管理。尽管所纳入研究的偏倚风险相对于致盲问题被评为“高”。药物治疗的大部分证据是褪黑激素，对五个双盲RCT的荟萃分析显示，在睡眠期间（有利于褪黑激素）的作用范围较大（与安慰剂相比为44分钟，Hedge's g 1.07 [95％CI 0.49-1.65]）和睡眠开始潜伏期（与安慰剂相比39分钟，Hedge's g-2.46 [95％CI-1.96至-2.98]）。我们得出结论，迫切需要其他循证医学支持以循证，精密医学方法支持ASD睡眠障碍的管理。对五个双盲RCT的荟萃分析显示，在睡眠持续时间（与安慰剂相比为44分钟，Hedge's g 1.07 [95％CI 0.49-1.65]）和睡眠发作潜伏期（39分钟）中，有较大的效应量，有利于褪黑激素与安慰剂相比，Hedge的g为2.46 [95％CI-1.96至-2.98]。我们得出结论，迫切需要其他循证医学支持以循证，精密医学方法支持ASD睡眠障碍的管理。对五个双盲RCT的荟萃分析显示，在睡眠持续时间（与安慰剂相比为44分钟，Hedge's g 1.07 [95％CI 0.49-1.65]）和睡眠发作潜伏期（39分钟）中，有较大的效应量，有利于褪黑激素与安慰剂相比，Hedge的g为2.46 [95％CI-1.96至-2.98]。我们得出结论，迫切需要其他循证医学支持以循证，精密医学方法支持ASD睡眠障碍的管理。