Sleep in Children with Autism Spectrum Disorder: A Narrative Review and Systematic Update

Abstract

Purpose of Review Sleep problems are a common comorbidity for children with autism spectrum disorder (ASD), and research in this area has a relatively long history. Within this review, we first outline historic patterns in the field of sleep and ASD. Second, we conducted a systematic update and coded these studies based on their alignment with historic patterns. Research on ASD and sleep over the past two decades has primarily focused on four principal areas: (1) documenting the prevalence and types of sleep problems; (2) sleep problem treatment options and efficacy; (3) how sleep problems are associated with other behavioral, contextual, or biological elements; and (4) the impact of child sleep problems on families and care providers. The systematic update in this paper includes empirical studies published between 2018 and 2021 with terms for sleep and ASD within the title, keywords, or abstract. Recent Findings In sum, 60 studies fit the inclusion/exclusion criteria and most fit within the historic patterns noted above. Notable differences included more global representation in study samples, studies on the impacts of COVID-19, and a growing body of work on sleep problems as an early marker of ASD. The majority of studies focus on correlates of sleep problems noting less optimal behavioral, contextual, and biological elements are associated with sleep problems across development for children with ASD. Summary Recommendations for future directions include continued expansion of global and age representation across samples, a shift toward more treatment and implementation science, and studies that inform our mechanistic understanding of how sleep and ASD are connected. Supplementary Information The online version contains supplementary material available at 10.1007/s40675-022-00234-5.

Sleep and Activity Patterns in Autism Spectrum Disorder

“…First, many studies are based on subjective data, gathered from parental questionnaires, rather than objective measures of sleep 27 . Second, the number of children evaluated in any given study using actimetry or other objective measures has been small, with frequently less than one hundred per study 27,28 . Third, because of conflicting data, it is unclear whether children with ASD and ID differ from those with ASD without ID with respect to the degree of sleep disturbance 7,29–32 .…”

“…The data currently available on sleep in children with ASD are restricted by several experimental limitations that also complicate interpretation. First, many studies are based on subjective data, gathered from parental questionnaires, rather than objective measures of sleep 27 . Second, the number of children evaluated in any given study using actimetry or other objective measures has been small, with frequently less than one hundred per study 27,28 .…”

Sleep Disordered Breathing in Children with Autism Spectrum Disorder: An In-Depth Review of Correlations and Complexities

“…The resulting impact reverberates across a comprehensive spectrum of domains, encompassing the intricate threads of communication, the fabric of learning, the dance of social behavior, and the tapestry of motor skills. While ASD maintains its distinct identity with unique attributes, acknowledging the latent potential for multiple neurodevelopmental disorders to converge within the presentation of children remains of paramount significance [17][18][19].…”

Spindle Chirp and other Sleep Oscillatory Features in Young Children with Autism

“…As ASD involves differences in brain maturation and neuronal differentiation, these changes should be observable early in development. Indeed, spindles are well known to evolve with age (42) (39) and have been proposed as markers of brain maturation (43) (44) (45) (46).…”

“…As ASD involves characteristic differences in brain maturation, these changes should be observable early in development. Indeed, spindles are well known to evolve with age (42) (39) and have been proposed as markers of brain maturation (43) (44) (45) (46). Page et al performed a daytime nap study of NREM sleep in children with ASD compared to typically-developing (TD) controls aged 13-30 months and found specific changes in theta, fast sigma and beta oscillations (18) In this present study we utilized the dataset reported in Farmer et al, enlarged following their publication (15% increase in participants), to further investigate NREM sleep neurophysiology in children with ASD, extending the list of the investigated spindle characteristics and including analyses of SO and coupling between spindles and SOs which were not performed in this sample before.…”