Whelan Sally, Mannion Arlene, Madden Azeem, Berger Fine, Costello Rachel, Ghadiri Saeid, Leader Geraldine
Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland.
Nat Sci Sleep. 2022 Apr 14;14:675-695. doi: 10.2147/NSS.S239622. eCollection 2022.
Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies' heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.
超过40%的自闭症儿童睡眠质量较差，而社交互动困难是自闭症的一个核心特征。然而，睡眠质量与社交功能及行为之间的关系仍未得到充分理解。本系统评价考察了关于睡眠质量对自闭症儿童及青少年社交功能和行为问题影响的证据。它还确定了关键相关因素，并评估了迄今为止该问题的研究方式。通过手工检索七本主要期刊，并使用关键词系统检索五个数据库。两名研究人员根据纳入标准筛选了4123篇文献的标题和摘要。如果相关研究是同行评审的实证论文，且于2000年至2021年期间以英文发表，则予以保留。然后，对97篇论文的全文进行筛选，若符合纳入标准，则手工检索其参考文献列表。最终综述纳入了46项研究。系统提取数据，两名作者使用批判性评价技能计划工具对研究的优缺点进行了严格评估。由于研究的异质性，无法进行荟萃分析，因此确定了关键主题。该综述发现睡眠质量与社交功能相互关联，并有少量证据表明可能存在双向因果关系。有证据表明，连续几个晚上睡眠时长不足以及缺乏深度持续睡眠会对外部化和内部化行为产生负面影响。焦虑和感官敏感性也会降低睡眠质量。然而，需要更大样本量的纵向研究来确定因果关系。未来的研究需要考察混杂因素，并就自闭症儿童睡眠客观测量的最佳实践流程达成共识。还需要进一步研究睡眠质量差对内部化行为的影响以及社会文化习俗的作用。
