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Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies
  1. Amparo Díaz-Román1,
  2. Junhua Zhang2,3,
  3. Richard Delorme4,5,
  4. Anita Beggiato4,5,
  5. Samuele Cortese3,6,7,8,9
  1. 1 Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
  2. 2 School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University, Yancheng, China
  3. 3 Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
  4. 4 Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
  5. 5 Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
  6. 6 Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
  7. 7 Solent NHS Trust, Southampton, UK
  8. 8 New York University Child Study Center, New York City, New York, USA
  9. 9 Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
  1. Correspondence to Dr Amparo Díaz-Román, Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Center, University of Granada, Granada 18011, Spain; adiazroman{at}


Background Sleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking.

Objective We conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD.

Methods We searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran’s Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger’s test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis.

Findings From a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9.

Discussion and clinical implications A number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.

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  • AD-R and JZ contributed equally.

  • Contributors All authors approved the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.