Psychotropic Medications for Sleep Disorders in Autism Spectrum Disorders

Abstract

Sleep-related abnormalities are common in individuals with autism spectrum disorders (ASD) and correlate with ASD severity and ASD-related symptoms. To identify the evidence for medications and nutritional supplements used to treat sleep problems in ASD, a systematic review through June 2020 was performed. Each identified study was assigned a level of evidence (LOE) ranging from 1 (i.e., high-quality double-blind, placebo-controlled studies) to 5 (i.e., expert opinion or bench research). For each treatment, a grade of recommendation (GOR) was then assigned ranging from A (solid evidence) to D (limited, inconsistent, or inconclusive evidence). Only treatments which measured sleep as an outcome measure were included. Supportive evidence was found for 6 nutritional supplements and 10 medications. The strongest evidence was for melatonin with 27 studies (GOR A), followed by ubiquinol, carnosine, cannabidiol and quetiapine (all GOR B), and then a multivitamin, agomelatine, clonazepam, clonidine, donepezil, niaprazine, nicotine and ramelteon (all GOR C). Adverse events were uncommon and are listed with each treatment. Considering the quality of the studies, treatment safety, biological mechanisms and other ASD symptoms affected, two supplements (melatonin, ubiquinol) and one medication (clonidine) could be unreservedly recommended and one supplement (carnosine) and two medications (agomelatine, ramelteon) could be provisionally recommended. Given that many children with ASD have abnormalities in melatonin production, melatonin, which appears safe and effective, has an advantage in that it may restore circadian rhythms; melatonin should be recommended as a first line evidence-based treatment in children with ASD for sleep-related problems. It is essential to use all treatments in combination with good sleep hygiene practices and to exclude other factors that might disrupt sleep in children with ASD. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Source: book)