孤独症谱系障碍儿童睡眠障碍临床实践相关指南解读

Interpretation of Clinical Practice Guidelines for Sleep Disorders in Children with Autism Spectrum Disorder

睡眠障碍,尤其是失眠和睡眠行为紊乱在孤独症谱系障碍(ASD)儿童中极为常见,对ASD儿童及其家庭造成多方面损害。国际上多个专业组织强调将睡眠障碍纳入ASD儿童的综合诊疗之中,并发布了相关临床指南或专家共识,如美国孤独症治疗联盟(ATN)共识、英国国家卫生与临床优化研究所(NICE)指南、美国神经病学学会(AAN)指南等。然而,目前仍缺乏适用于我国ASD儿童睡眠障碍的临床指南或专家共识,极大限制了相关临床工作的开展。本文重点对上述3个临床指南或专家共识涉及的证据等级和推荐强度、睡眠障碍界定和相关因素评估,以及睡眠障碍行为治疗和褪黑素治疗等进行解读,以期为我国ASD儿童睡眠障碍的诊治,以及临床指南或专家共识的制订提供参考。

Sleep disorders,especially insomnia and sleep behavior disorders,are highly prevalent in children with autism spectrum disorder(ASD),which cause a wide range of detrimental effects on the children and their families.Several international professional organizations have highlighted integrating sleep disorders into the comprehensive evaluation and treatment in children with ASD,and developed relevant clinical guidelines or expert consensuses,such as the A Practice Pathway for the Identification,Evaluation,and Management of Insomnia in Children and Adolescents with Autism Spectrum Disorders by the Autism Treatment Network(ATN),Autism:the Management and Support of Children and Young People on the Autism Spectrum by the National Institute for Health and care Excellence(NICE),and Practice Guideline:Treatment for Insomnia and Disrupted Sleep Behavior in Children and Adolescents with Autism Spectrum Disorder by the American Academy of Neurology(AAN).However,there is no applicable clinical guideline or expert consensus for sleep disorders among Chinese children with ASD,which greatly restricts the development of relevant clinical practice.We interpreted the above-mentioned two guidelines and one consensus,focusing mainly on several aspects,such as the levels of evidence and strength of recommendations,the definition of sleep disorders and associated factors,and behavioral treatments and melatonin-based therapies.It is hoped that our endeavors will contribute to the diagnosis and management of sleep disorders in Chinese children with ASD and the development of relevant clinical guidelines or expert consensuses.