Adults with autism spectrum disorder (ASD) were found to display worse objective and subjective sleep outcomes in a systematic review and meta-analysis published in Sleep Medicine.

Researchers, primarily at the University of Southampton in the United Kingdom, searched Web of Knowledge, OVID databases, and PubMed through February 2019 for studies of adults with ASD diagnosed with standard assessment tools. The investigators assessed study quality with the Newcastle Ottawa Scale, standardized mean difference (SMD) through random-effects models, and heterogeneity.

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After applying the search criteria, the investigators identified 1948 potential records. A total of 14 studies comprising 8 unique datasets (194 individuals with ASD; 277 controls) were included in the meta-analysis. The mean Newcastle Ottawa Scale score was 4.88/6.

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The researchers found that adults with ASD showed significant impairments in both objective (10 of 17 total outcomes) and subjective (6 of 11 total outcomes) measures of sleep compared with controls. In particular, parameters included reduced sleep efficiency (SMD, -0.87; 95% CI, -1.14 to 0.60), prolonged wake after sleep onset (SMD, 0.57; 95% CI, 0.28-0.87) and sleep onset latency (SMD, 0.86; 95% CI, 0.29-1.07).

However, individuals with ASD and controls did not differ significantly in total sleep time or percentage of slow wave sleep, stage 2 sleep, REM sleep, or REM onset latency.

The small sample size of the included studies was a key limitation of the systematic review and meta-analysis, as well as relatively high heterogeneity, particularly for actigraphy results.

“This study provides a foundation for these areas of research to be developed, and for understanding and treatment of sleep disturbances in adults with autism spectrum disorder to be improved,” the researchers wrote.


Morgan B, Nageye F, Masi G, Cortese S. Sleep in adults with autism spectrum disorder: a systematic review and meta-analysis of subjective and objective studies [published online August 2, 2019]. Sleep Med. doi:10.1016/j.sleep.2019.07.019