Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management

Glangher, Adelina; Focsa, Ina-Ofelia; Nimigean, Vanda Roxana; Linca, Florentina Ionela; Ioana, Doina; Papuc, Sorina Mihaela; Erbescu-Dobre, Alina; Iliescu, Catrinel; Sirbu, Carmen-Adella; Budisteanu, Magdalena

doi:10.3390/diagnostics16111727

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Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management

by

Adelina Glangher

^1,2,†,

Ina-Ofelia Focsa

^1,3,*,†

,

Vanda Roxana Nimigean

^4,*

,

Florentina Ionela Linca

^1,5

,

Doina Ioana

¹,

Sorina Mihaela Papuc

⁶

,

Alina Erbescu-Dobre

^6,7,

Catrinel Iliescu

^8,9,

Carmen-Adella Sirbu

^8,10,‡

and

Magdalena Budisteanu

^1,6,11,‡

¹

Psychiatry Research Laboratory, Prof. Dr. Alex. Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania

²

Doctoral School, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 030167 Bucharest, Romania

³

Department of Medical Genetics, Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania

⁴

Department of Oral Rehabilitation, Faculty of Dentistry, Carol Davila University of Medicine and Pharmacy, 050037 Bucharest, Romania

⁵

Department of Special Psychopedagogy, Faculty of Psychology and Educational Sciences, 0506578 Bucharest, Romania

⁶

Medical Genetics Laboratory, Victor Babes National Institute of Pathology, 050096 Bucharest, Romania

⁷

Doctoral School, Faculty of Biology, University of Bucharest, 050095 Bucharest, Romania

⁸

Clinical Neuroscience Department, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania

⁹

Pediatric Neurology Department, Prof. Dr. Alex. Obregia Clinical Hospital of Psychiatry, 041914 Bucharest, Romania

¹⁰

Academy of Romanian Scientists, 050045 Bucharest, Romania

¹¹

Department of Genetics, Faculty of Medicine, Titu Maiorescu University, 031593 Bucharest, Romania

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^*

Authors to whom correspondence should be addressed.

^†

These authors contributed equally to this work.

^‡

These authors also contributed equally to this work.

Diagnostics 2026, 16(11), 1727; https://doi.org/10.3390/diagnostics16111727

Submission received: 13 March 2026 / Revised: 19 May 2026 / Accepted: 25 May 2026 / Published: 3 June 2026

(This article belongs to the Special Issue Advances in Diagnosis and Management of Sleep Disorders)

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Abstract

Sleep disturbances represent one of the most frequent and clinically significant comorbidities in children with autism spectrum disorder (ASD), affecting approximately 50–80% of individuals. Clinically, these disturbances encompass a broad spectrum of disorders, including insomnia, parasomnias, sleep-related movement disorders, and sleep-related breathing disorders, commonly presenting with prolonged sleep latency, frequent nocturnal awakenings, reduced total sleep time, and alterations in sleep architecture. Circadian rhythm dysregulation, abnormalities in neurotransmitter systems such as GABA and serotonin, and altered melatonin signaling have been consistently implicated. These processes may reflect underlying genetic and metabolic influences affecting circadian clock regulation and synaptic function. The management of sleep disturbances in ASD requires a comprehensive approach combining behavioral strategies, caregiver education, and sleep hygiene interventions, while pharmacological options, particularly melatonin, may be considered when non-pharmacological measures are insufficient. Understanding the multifactorial mechanisms underlying sleep disturbances in ASD is essential for improving early recognition and developing individualized therapeutic strategies. This review synthesizes current evidence on the prevalence, biological mechanisms, clinical manifestations, and management of sleep disturbances in ASD, providing an integrated perspective for both clinicians and researchers.

Keywords: autism spectrum disorder; sleep disturbances; circadian rhythm; insomnia; parasomnias; altered sleep architecture; sleep-related movement disorders; sleep-related breathing disorders; melatonin

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MDPI and ACS Style

Glangher, A.; Focsa, I.-O.; Nimigean, V.R.; Linca, F.I.; Ioana, D.; Papuc, S.M.; Erbescu-Dobre, A.; Iliescu, C.; Sirbu, C.-A.; Budisteanu, M. Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management. Diagnostics 2026, 16, 1727. https://doi.org/10.3390/diagnostics16111727

AMA Style

Glangher A, Focsa I-O, Nimigean VR, Linca FI, Ioana D, Papuc SM, Erbescu-Dobre A, Iliescu C, Sirbu C-A, Budisteanu M. Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management. Diagnostics. 2026; 16(11):1727. https://doi.org/10.3390/diagnostics16111727

Chicago/Turabian Style

Glangher, Adelina, Ina-Ofelia Focsa, Vanda Roxana Nimigean, Florentina Ionela Linca, Doina Ioana, Sorina Mihaela Papuc, Alina Erbescu-Dobre, Catrinel Iliescu, Carmen-Adella Sirbu, and Magdalena Budisteanu. 2026. "Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management" Diagnostics 16, no. 11: 1727. https://doi.org/10.3390/diagnostics16111727

APA Style

Glangher, A., Focsa, I.-O., Nimigean, V. R., Linca, F. I., Ioana, D., Papuc, S. M., Erbescu-Dobre, A., Iliescu, C., Sirbu, C.-A., & Budisteanu, M. (2026). Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management. Diagnostics, 16(11), 1727. https://doi.org/10.3390/diagnostics16111727

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Understanding the Complexity of Sleep Disturbances in ASD: From Mechanisms to Management

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