Mammarella Valeria, Orecchio Silvia, Cameli Noemi, Occhipinti Sara, Marcucci Lavinia, De Meo Giuliano, Innocenti Alice, Ferri Raffaele, Bruni Oliviero
Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy.
Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy.
Expert Rev Neurother. 2023 Jul-Dec;23(12):1261-1276. doi: 10.1080/14737175.2023.2267761. Epub 2023 Dec 15.
Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD), with effects on daytime behavior and functioning, mood and anxiety, and autism core features. In children with ASD, insomnia also has a negative impact on the whole family's quality of life. Therefore, treatment of sleep disturbances should be considered as a primary goal in the management of ASD patients, and it is important to clarify the scientific evidence to inappropriate treatments.
The authors review the current literature concerning the pharmacological treatment options for the management of sleep-related disorders in patients with ASD (aged 0-18 years) using the PubMed and Cochrane Library databases with the search terms: autism, autistic, autism spectrum disorder, ASD, drug, drug therapy, drug intervention, drug treatment, pharmacotherapy, pharmacological treatment, pharmacological therapy, pharmacological intervention, sleep, sleep disturbance, and sleep disorder.
Currently, clinicians tend to select medications for the treatment of sleep disorders in ASD based on the first-hand experience of psychiatrists and pediatricians as well as expert opinion. Nevertheless, at the present time, the only compound for which there is sufficient evidence is melatonin, although antihistamines, trazodone, clonidine, ramelteon, gabapentin, or suvorexant can also be considered for selection.
睡眠障碍是自闭症谱系障碍（ASD）中第二常见的医学合并症，会影响日间行为与功能、情绪和焦虑以及自闭症核心特征。在患有ASD的儿童中，失眠对整个家庭的生活质量也有负面影响。因此，睡眠障碍的治疗应被视为ASD患者管理的首要目标，明确针对不恰当治疗方法的科学证据很重要。
作者使用PubMed和Cochrane图书馆数据库，以“自闭症 ”“孤独症 ”“自闭症谱系障碍 ”“ASD ”“药物 ”“药物治疗 ”“药物干预 ”“药物疗法 ”“药物治疗 ”“药物治疗 ”“药理学治疗 ”“药理学疗法 ”“药理学干预 ”“睡眠 ”“睡眠障碍 ”和“睡眠紊乱 ”为检索词，回顾了有关ASD（0至18岁）患者睡眠相关障碍管理的药物治疗选择的当前文献。
目前，临床医生倾向于根据精神科医生和儿科医生的第一手经验以及专家意见来选择治疗ASD睡眠障碍的药物。然而，目前有充分证据的唯一化合物是褪黑素，不过也可考虑选用抗组胺药、曲唑酮、可乐定、雷美替胺、加巴喷丁或苏沃雷生。
