Sleep in Autism Spectrum Disorder: A Systematic Update
TL;DR
The question of whether individuals with ASD sleep worse than peers appears largely settled, and future priorities are harmonized objective sleep protocols, adequately powered trials in emerging intervention categories, and broader inclusion of adults with ASD, who remain markedly under-represented.
Abstract
Sleep disturbances are a common, heterogeneous comorbidity of autism spectrum disorder (ASD). This systematic review updates the field on sleep in ASD over 2022–2026, with attention to how the evidence has evolved. Eighty-nine studies met inclusion criteria. Sleep disturbance remained more prevalent in autistic individuals than in typically developing peers (47–84%), confirmed by actigraphic and polysomnographic measures. The most distinctive recent advance is in sleep microstructure: spindles, slow-oscillation–spindle coupling, and oscillatory EEG features are emerging as candidate neurophysiological markers. Behavioural and parent-mediated programmes remain the most consistent intervention evidence, while pharmacological trials produced largely null effects; neuromodulation, microbiota-targeted, and physical-activity interventions are preliminary but expanding. The question of whether individuals with ASD sleep worse than peers appears largely settled. Future priorities are harmonized objective sleep protocols, adequately powered trials in emerging intervention categories, and broader inclusion of adults with ASD, who remain markedly under-represented.