From the Pediatrics and Developmental Neuroscience Branch (A.W.B., T.G., R.K., A.T.), National Institute of Mental Health, NIH, Bethesda, MD; Department of Neurological Sciences (D.H.), University of Vermont Medical Center, Burlington; Department of Pediatric Neurology (M.O.), McGill University Health Centre, Montréal, Canada; Department of Neurology (M.J.A.), University of Florida College of Medicine, Gainesville; Developmental Pediatrics (A.B.), Our Special Kids Pediatric Care, Los Angeles, CA; Division of Developmental Medicine (C.B.) and Center for Pediatric Sleep Disorders (J.O.), Boston Children's Hospital, MA; Departments of Pediatrics and Psychiatry (D.C.), The Ohio State University College of Medicine, Columbus; Duke Center for Autism and Brain Development (G.D., L.S.), Duke University School of Medicine, Durham, NC; Northern Michigan Neurology (D.D.), Traverse City; Department of Child and Behavioral Sciences (R.L.F.), Johns Hopkins University, Baltimore, MD; Department of Neurology (D.G.), Charleston Area Medical Center, WV; Department of Neurology (G.G.), Kansas University Medical Center, Kansas City; American Academy of Neurology (S.M.), Minneapolis, MN; Division of Pediatric Neurology, Department of Pediatrics (D.M., S.A.), Loma Linda University School of Medicine, CA; Department of Clinical Neurosciences (T.P.), University of Calgary, Alberta, Canada; Department of Psychiatry and Behavioral Science and MIND Institute (A.S.), University of California, Davis; Division of Neurology (R.T.), Nicklaus Children's Hospital and Miami Children's Hospital, FL; Treatment and Research Institute for Autism Spectrum Disorders (Z.W.), Vanderbilt Kennedy Center, Nashville, TN; Autism Institute, College of Medicine (A.W.), Florida State University, Tallahassee; and Division of Neurology (M.W.), Rainbow Babies & Children's Hospital, Cleveland, OH.
Neurology. 2020 Mar 3;94(9):392-404. doi: 10.1212/WNL.0000000000009033. Epub 2020 Feb 12.
To review pharmacologic and nonpharmacologic strategies for treating sleep disturbances in children and adolescents with autism spectrum disorder (ASD) and to develop recommendations for addressing sleep disturbance in this population.
The guideline panel followed the American Academy of Neurology 2011 guideline development process, as amended. The systematic review included studies through December 2017. Recommendations were based on evidence, related evidence, principles of care, and inferences.
For children and adolescents with ASD and sleep disturbance, clinicians should assess for medications and coexisting conditions that could contribute to the sleep disturbance and should address identified issues. Clinicians should counsel parents regarding strategies for improved sleep habits with behavioral strategies as a first-line treatment approach for sleep disturbance either alone or in combination with pharmacologic or nutraceutical approaches. Clinicians should offer melatonin if behavioral strategies have not been helpful and contributing coexisting conditions and use of concomitant medications have been addressed, starting with a low dose. Clinicians should recommend using pharmaceutical-grade melatonin if available. Clinicians should counsel children, adolescents, and parents regarding potential adverse effects of melatonin use and the lack of long-term safety data. Clinicians should counsel that there is currently no evidence to support the routine use of weighted blankets or specialized mattress technology for improving disrupted sleep. If asked about weighted blankets, clinicians should counsel that the trial reported no serious adverse events with blanket use and that blankets could be a reasonable nonpharmacologic approach for some individuals.
综述治疗自闭症谱系障碍（ASD）儿童和青少年睡眠障碍的药物和非药物策略，并就该人群的睡眠障碍提出处理建议。
指南小组遵循了美国神经病学学会 2011 年制定指南的流程，并进行了修订。系统综述纳入了截至 2017 年 12 月的研究。建议基于证据、相关证据、护理原则和推断。
主要推荐意见 B 级：对于有睡眠障碍的 ASD 儿童和青少年，临床医生应评估可能导致睡眠障碍的药物和并存疾病，并解决已确定的问题。临床医生应向家长提供有关改善睡眠习惯的策略，行为策略作为治疗睡眠障碍的一线治疗方法，无论是单独使用还是与药物或营养补充剂联合使用。如果行为策略无效，且已解决并存疾病和同时使用药物的问题，临床医生应在开始时使用低剂量的褪黑素。临床医生应建议使用药用级褪黑素。临床医生应向儿童、青少年和家长告知褪黑素使用的潜在不良反应以及缺乏长期安全性数据。临床医生应告知，目前没有证据支持常规使用加重毯子或专门的床垫技术来改善睡眠中断。如果有人询问加重毯子，临床医生应告知使用毯子的试验报告没有严重不良事件，并且毯子可能是一些人的合理非药物治疗方法。
