Digital and telehealth behavioral sleep interventions for improving sleep outcomes in children and adolescents with autism spectrum disorder: a systematic review and meta-analysis
- Forfatter(e)
- Duan, Z., Wang, X., Zhang, Z., Wang, X., Zhang, Y., Du, X.
- År
- 2025
- Tidsskrift
- Sleep Medicine
- Volum
- 136
- Sider
- 106870
- Kategori(er)
- Autismespekter Søvn (inkl. søvnforstyrrelser)
- Tiltakstype(r)
- E-helsetiltak (spill, internett, telefon)
- Abstract
BACKGROUND
Sleep problems are highly prevalent in children with Autism Spectrum Disorder (ASD), negatively impacting core symptoms, daytime functioning, and family well-being. While behavioral interventions are the first-line treatment, access is often limited. Digital and telehealth delivery models offer a promising approach to increase accessibility. This review systematically evaluates the effectiveness of these technology-based behavioral sleep interventions for youth with ASD.
METHODS
Following PRISMA guidelines, we systematically searched five databases for randomized controlled trials (RCTs) and non-randomized studies (NRCTs) of digital or telehealth behavioral sleep interventions for youth (2-18 years) with ASD. The primary outcome was child sleep. Two reviewers independently screened studies, extracted data, and assessed the risk of bias. We conducted random-effects meta-analyses and sensitivity analyses.
RESULTS
12 studies met inclusion criteria: 6 RCTs (N = 349) and 6 NRCTs (N = 57). Across RCTs, digital and telehealth interventions significantly improved parent-reported sleep problems compared with controls (pooled SMD = -0.57, 95 % CI -1.10 to -0.03; I
= 62 %), reflecting a small-to-moderate benefit. Improvements were most evident for sleep initiation outcomes such as sleep-onset delay. In contrast, pooled NRCT results indicated large apparent gains (SMC = -1.03) but with wide confidence intervals and substantial heterogeneity, limiting interpretability.
CONCLUSION
Evidence from randomized trials supports that digital and telehealth-delivered behavioral sleep interventions can yield small-to-moderate improvements in caregiver-reported sleep outcomes among autistic youth-particularly in reducing time to sleep onset. Non-randomized findings are encouraging but methodologically uncertain. Future research should prioritize adequately powered RCTs using objective sleep measures, standardized intervention frameworks, and longer follow-up to strengthen causal inference and inform scalable best-practice models.