Sleep Health in Adults with Intellectual Disability: Recent Advances and Persistent Evidence Gaps

Abstract

Adults with intellectual disability (ID) experience a disproportionate burden of sleep disorders with major impacts on physical, neuropsychiatric and behavioural health, yet evidence to guide practice has lagged behind the general population. This review updates our 2024 narrative synthesis, focusing on clinically actionable advances in sleep health for adults with ID. Recent observational data in adults with Down syndrome indicate that obstructive sleep apnoea is associated with adverse cardiometabolic, mortality and Alzheimer disease outcomes. Positive airway pressure can be feasible with individualised support, while retrospective studies of surgical treatment suggest possible benefits in selected patients, although residual OSA and confounding by treatment selection remain important considerations. Emerging diagnostic technologies, including home-based acoustic sensors, wearables, cardiorespiratory algorithms and three-dimensional facial biomarkers, represent promising developments that require further evaluation against established diagnostic pathways. Meta-analytic and cohort studies describe aetiology-related sleep phenotypes and persistent sleep and circadian disruption in autistic adults; a small uncontrolled case series provides preliminary evidence that daridorexant may be tolerated and associated with improved sleep in selected adults with intellectual disability. Despite recent advances, major inequalities persist, highlighting the need for accessible diagnostics, population‑specific instruments and adult‑focused guidelines embedding sleep management within lifelong care for people with ID.