Keywords
autism - sleep - melatonin
Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental deficiency characterized by
difficulties in learning, communication and social interaction, with limited interests
and stereotyped behaviors. In addition, the patient can commonly present sleep alterations,
especially in childhood, due to reduced levels of secretion of melatonin, a hormone
that functions as a biomarker of circadian rhythms. Its chronobiotic effect consists
in regulating the sleep-wake rhythm, which in individuals with ASD may be altered
from the first year of life.
Objective: To analyze the effects of exogenous melatonin administration for autistic patients
with sleep disorders, and its contribution to the treatment of these patients.
Methods: Systematic review conducted in August 2024, in the PubMed database, based on the
keywords “autism and sleep and melatonin”. There were 76 articles published between
2015 and 2024, and after analysis of the studies, only 12 were included in the research.
Results: Melatonin treatment for sleep disorders in autistic patients is indicated when behavioral
strategies, such as sleep hygiene, are insufficient. For these patients, the immediate
release formulation is less effective, since its therapeutic benefit is centered on
sleep induction, not being as efficient in reducing nocturnal awakenings. Long-release
melatonin, besides reducing latency, contributes to the increase of total duration
and improved sleep maintenance. This composition, whose peak is reached in 3 hours
after the intake of 2 mg, does not cause unwanted phase advance in the sleep-wake
cycle. Another important point is the positive impact on externalizing behaviors,
especially in hyperactivity and inattention, as well as on improving academic performance.
This drug has a favorable profile regarding tolerance and acceptability. Its adverse
effects are considered mild (headache, drowsiness, fatigue and dizziness) and manifest
in the initial weeks.
Conclusion: Melatonin with prolonged release is considered the first line pharmacological treatment
for insomnia in patients with ASD, due to its efficacy in effects that are not restricted
to sleep induction, besides safety with long-term use. Its therapeutic contribution
can also improve the quality of life of caregivers, since the well-being of patients
shows significant improvement, especially in the daytime. However, the preferential
treatment for insomnia in autistic people is based on behavioral and environmental
interventions.
