Sleep quality in children with autism spectrum disorder: a narrative review
TL;DR
Routine sleep screening should be integrated into the community medicine framework for neurodevelopmental disorders, and longitudinal research in low- and middle-income countries, including India, remains a critical gap.
Abstract
Sleep disturbances are among the most frequently reported yet inadequately addressed comorbidities in children with autism spectrum disorder (ASD). Affecting an estimated 50–80% of this population, sleep problems in ASD are multifactorial in origin and disproportionately severe compared to typically developing peers. Their consequences extend beyond the affected child to encompass family functioning, caregiver mental health, and child's neurodevelopmental trajectory. A systematic narrative review was conducted using PubMed, Scopus, Embase, and Google Scholar databases. Articles published between 2000 and 2024 were screened using the terms 'autism spectrum disorder,' 'sleep disturbances,' 'sleep quality,' 'children,' 'melatonin,' and 'behavioural sleep interventions.' Original research articles, systematic reviews, meta-analyses, and evidence-based clinical guidelines were included. Grey literature and single case reports were excluded. The reviewed literature consistently identifies sleep-onset insomnia, frequent nocturnal awakenings, irregular sleep-wake cycles, and reduced total sleep duration as the predominant sleep phenotypes in ASD. Aberrant melatonin synthesis, sensory processing atypicality’s, co-occurring psychiatric conditions, and genetic factors collectively underpin these disturbances. The Children's Sleep Habits Questionnaire (CSHQ) and actigraphy remain the most validated assessment tools. Behavioural interventions, particularly parent-delivered sleep education programmes, demonstrate moderate-to-high efficacy. Melatonin supplementation shows consistent short-term benefit, though long-term safety data in paediatric ASD populations remain limited. Sleep disturbances in children with ASD are prevalent, clinically significant, and amenable to evidence-based intervention. Routine sleep screening should be integrated into the community medicine framework for neurodevelopmental disorders. Longitudinal research in low- and middle-income countries, including India, remains a critical gap.