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Abstract
Aim The aim of our systematic review and meta-analysis was to synthesise the high-quality evidence on the efficacy and safety of pharmacological interventions to manage sleep problems in children and adolescents with autism spectrum disorder (ASD).
Methods The studies we included here were (RCTs) looking at the efficacy and safety of pharmacological intervention for sleep problems in children and adolescents with ASD. The studies had to include objective sleep measures and/or subjective sleep measures. They all dealt with pharmacological interventions, with medications including melatonin and antipsychotics, and they all compared these drugs with placebos. We used four databases: ERIC, ProQuest, PubMed and Ovid Medline. We assessed the papers in accordance with the Cochrane risk of bias tool.
Results We found six studies that used RCT designs. Five of them used melatonin, and one study used an antipsychotic. In studies using melatonin, a meta-analysis revealed that there was a large effect size of using melatonin in reducing sleep latency in children and adolescents with ASD. The overall effect size was -0.87 (95% confidence interval [CI]) -1.11, -0.63, Z=7.11 (P<0.00001). In terms of antipsychotics, our review revealed that the antipsychotic resperidon was safe and effective in managing sleep problems in children and adolescents with ASD. Both melatonin and resperidon improved sleep latency and reduced night-time awakenings. However, mild side effects were reported in a small number of participants (figure 1).
Meta-analysis of the efficacy of using melatonin in improving sleep latency in children and adolescents with ASD
Discussion Although the quality of the evidence in these studies was moderate according to the GRADE approach, both melatonin and resperidon seem to be safe and effective in improving sleep in children and adolescents with ASD. Some side effects have been observed in a small number of children. Observing and recording side effects is crucial to control medication doses.