Effectiveness of non-pharmacological interventions for insomnia in children with Autism Spectrum Disorder: A systematic review and meta-analysis

BackgroundAutism spectrum disorders (ASD) are a set of neurodevelopmental disorders characterised by behavioural, communication and social impairments. The prevalence of sleep disturbances in children with ASD is 40–80%, with significant effects on quality of life for the children and carers.This systematic review aimed to synthesise evidence of the effects of behavioural interventions to improve sleep among children with ASD.MethodsDatabases (MEDLINE, PsycINFO, CINAHL, ScienceDirect, Autism Data, CENTRAL, ClinicalTrials.gov and Current Controlled Trials) were searched for published, unpublished and ongoing randomised controlled trials evaluating the effect of non-pharmacological interventions for insomnia in children with autism spectrum conditions.ResultsThree studies met the inclusion criteria, one provided actigraphy data, one Children’s Sleep Habits Questionnaire (CSHQ) data, and one both actigraphy and CSHQ data for use in meta-analyses. There were significant differences between the behavioural intervention and comparison groups (actigraphy data) for total sleep time (24.41 minutes, 95% CI 5.71, 43.11, P = 0.01), sleep latency (-18.31 minutes, 95% CI -30.84, -5.77, P = 0.004) and sleep efficiency (5.59%, 95% CI 0.87, 10.31, P = 0.02). There was also a favourable intervention effect evident for the subjective CSHQ data (-4.71, 95% CI -6.70, -2.73, PConclusionsThere are very few high quality randomised controlled trials in this area. Here we provide initial synthesised quantitative evidence of the effectiveness of behavioural interventions for treating sleep problems in children with ASD.Trial registrationProtocol was registered (CRD42017081784) on the International Prospective Register of Systematic Reviews (http://www.crd.york.ac.uk/PROSPERO).## 背景 自闭症谱系障碍（Autism Spectrum Disorders, ASD）是一类以行为、沟通及社交功能受损为特征的神经发育障碍。自闭症儿童的睡眠障碍患病率达40%~80%，对患儿及其照料者的生活质量造成显著负面影响。本系统综述旨在整合相关证据，探讨行为干预对自闭症谱系障碍儿童睡眠状况的改善效果。 ## 方法 本研究检索了MEDLINE、PsycINFO、CINAHL、ScienceDirect、Autism Data、CENTRAL、ClinicalTrials.gov及Current Controlled Trials等数据库，搜集已发表、未发表及正在进行的随机对照试验，评估非药物干预对自闭症谱系障碍儿童失眠的临床疗效。 ## 结果 最终共有3项研究符合纳入标准：其中1项提供活动记录仪（actigraphy）数据，1项提供儿童睡眠习惯问卷（Children’s Sleep Habits Questionnaire, CSHQ）数据，剩余1项同时提供活动记录仪与儿童睡眠习惯问卷数据用于荟萃分析。行为干预组与对照组在总睡眠时间（24.41分钟，95%置信区间[5.71, 43.11]，P=0.01）、睡眠潜伏期（-18.31分钟，95%置信区间[-30.84, -5.77]，P=0.004）及睡眠效率（5.59%，95%置信区间[0.87, 10.31]，P=0.02）方面均存在显著统计学差异。主观报告的儿童睡眠习惯问卷数据亦显示出干预的有利效应（-4.71，95%置信区间[-6.70, -2.73]，P<0.001）。 ## 结论 该研究领域目前高质量随机对照试验极为匮乏。本研究首次提供了行为干预改善自闭症谱系障碍儿童睡眠问题的量化整合证据。 ## 试验注册 本研究方案已在国际系统综述前瞻性注册平台（International Prospective Register of Systematic Reviews，http://www.crd.york.ac.uk/PROSPERO）完成注册，注册编号为CRD42017081784。