Subjective and objective sleep alterations in medication-naïve children and adolescents with autism spectrum disorder: a systematic review and meta-analysis.
Por:
Kim H, Kim JH, Kim J, Kim JY, Cortese S, Smith L, Koyanagi A, Radua J, Fusar-Poli P, Carvalho AF, Salazar de Pablo G, Shin JI, Cheon KA and Solmi M
Publicada:
20 jul 2023
Ahead of Print:
20 jul 2023
Resumen:
AIMS: This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD). METHODS: We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' g. To assess publication bias, Egger's test and p-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators. RESULTS: Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' g 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' g -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' g -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' g -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' g 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' g 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' g 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' g 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75). CONCLUSION: We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.
Filiaciones:
Kim H:
Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
Kim JH:
Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
Kim J:
Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
Kim JY:
Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
Cortese S:
Centre for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
Solent NHS Trust, Southampton, UK
Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
Smith L:
Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
Koyanagi A:
Parc Sanitari Sant Joan de Deu/CIBERSAM, Universitat de Barcelona, Fundacio Sant Joan de Deu, Sant Boi de Llobregat, Barcelona, Spain
Radua J:
Imaging Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS), Mental Health Research Networking Center(CIBERSAM), University of Barcelona, Barcelona, Spain
Fusar-Poli P:
Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
OASIS service, South London and Maudsley NHS Foundation Trust, London, UK
National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK
Carvalho AF:
IMPACT Strategic Research Centre, Barwon Health, Deakin University School of Medicine, Geelong, VIC, Australia
Salazar de Pablo G:
Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
Shin JI:
Department of Pediatrics, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea
Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
Cheon KA:
Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
Department of Child and Adolescent Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
Solmi M:
Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
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