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Gagnon K, Godbout R. Melatonin and Comorbidities in Children with Autism Spectrum Disorder. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2018; 5:197-206. [PMID: 30148039 PMCID: PMC6096870 DOI: 10.1007/s40474-018-0147-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Melatonin is used to treat sleep difficulties associated with autism spectrum disorder (ASD). There are growing evidence that melatonin could have an effect on other symptoms than sleep, such as anxiety, depression, pain, and gastrointestinal dysfunctions. Interestingly, these symptoms frequently are found as comorbid conditions in individuals with ASD. We aimed to highlight the potential effect of melatonin on these symptoms. RECENT FINDINGS Animal and human studies show that melatonin reduces anxiety. Regarding the effect of melatonin on pain, animal studies are promising, but results remain heterogeneous in humans. Both animal and human studies have found that melatonin can have a positive effect on gastrointestinal dysfunction. SUMMARY Melatonin has the potential to act on a wide variety of symptoms associated with ASD. However, other than sleep difficulties, no studies exist on melatonin as a treatment for ASD comorbid conditions. Such investigations should be on the research agenda because melatonin could improve a multitude of ASD comorbidities and, consequently, improve well-being.
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Affiliation(s)
- Katia Gagnon
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
| | - Roger Godbout
- Sleep Laboratory & Clinic, Hôpital Rivière-des-Prairies, CIUSSS du Nord-de-l’Île-de-Montréal, 7070 Boul. Perras, Montréal, Québec H1E 1A4 Canada
- Department of Psychiatry, Université de Montréal, Montréal, Québec Canada
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Bruni O, Angriman M, Calisti F, Comandini A, Esposito G, Cortese S, Ferri R. Practitioner Review: Treatment of chronic insomnia in children and adolescents with neurodevelopmental disabilities. J Child Psychol Psychiatry 2018; 59:489-508. [PMID: 28921528 DOI: 10.1111/jcpp.12812] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Sleep disturbances, in particular insomnia, represent a common problem in children with neurodevelopmental disabilities (NDDs). Currently, there are no approved medications for insomnia in children by the US Food and Drug Administration or European Medicines Agency and therefore they are prescribed off-label. We critically reviewed pediatric literature on drugs as well as nonpharmacological (behavioral) interventions used for sleep disturbances in children with NDDs. METHODS PubMed, Ovid (including PsycINFO, Ovid MEDLINE® , and Embase), and Web of Knowledge databases were searched through February 12, 2017, with no language restrictions. Two authors independently and blindly performed the screening. RESULTS Good sleep practices and behavioral interventions, supported by moderate-to-low level evidence, are the first recommended treatments for pediatric insomnia but they are often challenging to implement. Antihistamine agents, such as hydroxyzine or diphenhydramine, are the most widely prescribed sedatives in the pediatric practice but evidence supporting their use is still limited. An increasing body of evidence supports melatonin as the safest choice for children with NDDs. Benzodiazepines are not recommended in children and should only be used for transient insomnia, especially if daytime anxiety is present. Only few studies have been carried out in children's and adolescents' zolpidem, zaleplon, and eszopiclone, with contrasting results. Limited evidence supports the use of alpha-agonists such as clonidine to improve sleep onset latency, especially in attention deficit/hyperactivity disorder subjects. Tricyclic antidepressants, used in adults with insomnia, are not recommended in children because of their safety profile. Trazodone and mirtazapine hold promise but require further studies. CONCLUSIONS Here, we provided a tentative guide for the use of drugs for insomnia in children with NDDs. Well-controlled studies employing both objective polysomnography and subjective sleep measures are needed to determine the efficacy, effectiveness, and safety of the currently prescribed pediatric sleep medicines in children with NDDs.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Marco Angriman
- Department of Pediatrics, Child Neurology and Neurorehabilitation Unit, Central Hospital of Bolzano, Bolzano, Italy
| | | | | | | | - Samuele Cortese
- Academic Unit of Psychology, Developmental Brain-Behavior Laboratory, University of Southampton, Southampton, UK.,New York University Child Study Center, New York, NY, USA.,Solent NHS Trust, Southampton, UK
| | - Raffaele Ferri
- Sleep Research Centre; Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
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Tse ACY, Lee PH, Zhang J, Lai EWH. Study protocol for a randomised controlled trial examining the association between physical activity and sleep quality in children with autism spectrum disorder based on the melatonin-mediated mechanism model. BMJ Open 2018; 8:e020944. [PMID: 29654045 PMCID: PMC5905756 DOI: 10.1136/bmjopen-2017-020944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Sleep disturbance is commonly observed in children with autism spectrum disorders (ASD). Disturbed sleep may exacerbate the core symptoms of ASD. Behavioural interventions and supplemental melatonin medication are traditionally used to improve sleep quality, but poor sustainability of behavioural intervention effects and use of other medications that metabolise melatonin may degrade the effectiveness of these interventions. However, several studies have suggested that physical activity may provide an effective intervention for treating sleep disturbance in typically developing children. Thus, we designed a study to examine whether such an intervention is also effective in children with ASD. We present a protocol (4 December 2017) for a jogging intervention with a parallel and two-group randomised controlled trial design using objective actigraphic assessment and 6-sulfatoxymelatonin measurement to determine whether a 12-week physical activity intervention elicits changes in sleep quality or melatonin levels. METHODS AND ANALYSIS All eligible participants will be randomly allocated to either a jogging intervention group or a control group receiving standard care. Changes in sleep quality will be monitored through actigraphic assessment and parental sleep logs. All participants will also be instructed to collect a 24-hour urine sample. 6-sulfatoxymelatonin, a creatinine-adjusted morning urinary melatonin representative of the participant's melatonin levels, will be measured from the sample. All assessments will be carried out before the intervention (T1), immediately after the 12-week intervention or regular treatment (T2), 6 weeks after the intervention (T3) and 12 weeks after the intervention (T4) to examine the sustainability of the intervention effects. The first enrolment began in February 2018. ETHICS AND DISSEMINATION Ethical approval was obtained through the Human Research Ethics Committee, Education University of Hong Kong. The results of this trial will be submitted for publication in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT03348982.
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Affiliation(s)
- Andy C Y Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Hong Kong, China
| | - Paul H Lee
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Jihui Zhang
- Department of Psychiatry, The Chinese University of Hong Kong, Hong Kong, China
| | - Elvis W H Lai
- Department of Psychiatry, The Hong Kong Castle Peak Hospital, Hong Kong, China
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Assessing the Dim Light Melatonin Onset in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability. J Autism Dev Disord 2018; 47:2120-2137. [PMID: 28444476 DOI: 10.1007/s10803-017-3122-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
This study assessed melatonin levels and the dim light melatonin onset (DLMO) in adults with Autism Spectrum Disorder (ASD) and also investigated the relationships between melatonin and objectively measured sleep parameters. Sixteen adults with ASD (ASD-Only), 12 adults with ASD medicated for comorbid diagnoses of anxiety and/or depression (ASD-Med) and 32 controls participated in the study. Although, the timing of the DLMO did not differ between the two groups, advances and delays of the melatonin rhythm were observed in individual profiles. Overall mean melatonin levels were lower in the ASD-Med group compared to the two other groups. Lastly, greater increases in melatonin in the hour prior to sleep were associated with greater sleep efficiency in the ASD groups.
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Fernando S, Biggs SN, Horne RSC, Vollenhoven B, Lolatgis N, Hope N, Wong M, Lawrence M, Lawrence A, Russell C, Leong K, Thomas P, Rombauts L, Wallace EM. The impact of melatonin on the sleep patterns of women undergoing IVF: a double blind RCT. Hum Reprod Open 2018; 2017:hox027. [PMID: 30895239 PMCID: PMC6276665 DOI: 10.1093/hropen/hox027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 11/29/2017] [Accepted: 12/18/2017] [Indexed: 12/17/2022] Open
Abstract
STUDY QUESTION Does melatonin result in a dose–response effect on sleep quality and daytime sleepiness in women undergoing IVF? SUMMARY ANSWER Melatonin, even when given at high doses twice per day, does not cause significant daytime sleepiness or change night time sleep quantity or quality. WHAT IS KNOWN ALREADY Melatonin is being increasingly used as an adjuvant therapy for women undergoing IVF owing to its antioxidative effects. It is widely considered to be sedative but there are scant objective data on the effects of melatonin on sleep in the setting of IVF. STUDY DESIGN SIZE, DURATION The study was a double-blind placebo-controlled randomized trial of 116 women recruited between September 2014 and September 2016. PARTICIPANTS/MATERIALS, SETTING, METHOD Women who were undergoing their first cycle of IVF at private IVF centers were recruited into the RCT and randomized to receive either placebo, 2 mg, 4 mg or 8 mg of melatonin, twice per day (BD) from Day 2 of their cycle until the day before oocyte retrieval. Each participant wore an accelerometer that provides an estimate of sleep and wake activity for up to 1 week of baseline and throughout treatment (up to 2 weeks). They also kept sleep diaries and completed a Karolinska sleepiness score detailing their night time sleep activity and daytime sleepiness, respectively. MAIN RESULTS AND THE ROLE OF CHANCE In total, 116 women were included in the intention-to-treat analysis (placebo BD (n = 32), melatonin 2 mg BD (n = 29), melatonin 4 mg BD (n = 26), melatonin 8 mg BD (n = 29)). There were no significant differences in daytime Karolinska sleepiness score between groups (P = 0.4), nor was there a significant dose–response trend (β=0.05, 95% CI −0.22–0.31, P = 0.7). There were no differences in objective measures of sleep quantity or quality, including wake after sleep onset time, sleep onset latency, and sleep efficiency before and after treatment or between groups. There was an improvement in subjective sleep quality scores from baseline to during treatment in all groups, except 8 mg BD melatonin: placebo (percentage change −13.3%, P = 0.01), 2 mg (−14.1%, P = 0.03), 4 mg (−8.6%, P = 0.01) and 8 mg (−7.8%, P = 0.07). LIMITATIONS, REASONS FOR CAUTION As this was a subset of a larger trial, the melatonin in ART (MIART) trial, it is possible that the sample size was too small to detect statistically significant differences between the groups. WIDER IMPLICATIONS OF THE FINDINGS While this study suggests that melatonin can be used twice per day at high doses to achieve sustained antioxidation effects, with the reassurance that this will not negatively impact daytime sleepiness or night time sleep habits, the sample size is small and may have missed a clinically significant difference. Nevertheless, our findings may have implications not only for future studies of fertility treatments (including meta-analyses), but also in other medical fields where sustained antioxidation is desired. STUDY FUNDING/COMPETING INTERESTS This study was funded by the Monash IVF Research and Education Foundation (PY12_15). S.F. is supported by the National Health and Medical Research Council (Postgraduate Scholarship APP1074342) and the Royal Australian and New Zealand College of Obstetricians and Gynaecologists Ella Macknight Memorial Scholarship. E.W. is supported by an National Health and Medical Research Council Program Grant (APP1113902). S.F., E.W., R.H., B.V., N.L., N.H., M.W., M.L., A.L., P.T., K.L. have nothing to declare. L.R. is a Minority shareholder in Monash IVF Group, has unrestricted grants from MSD®, Merck-Serono® and Ferring® and receives consulting fees from Ferring®. S.N.B. reports consulting fees from Johnson & Johnson Consumer Inc®, outside the submitted work. TRIAL REGISTRATION NUMBER This trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (Project ID: ACTRN12613001317785). TRIAL REGISTRATION DATE 27/11/2013 DATE OF FIRST PATIENT’S ENROLMENT 1/9/2014
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Affiliation(s)
- Shavi Fernando
- Departments of Obstetrics and Gynaecology.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Sarah Nichole Biggs
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Rosemary Sylvia Claire Horne
- Paediatrics, Monash University, Wellington Rd, Clayton, Victoria 3800, Australia.,Hudson Institute of Medical Research, 27-31 Wright st, Clayton, Victoria3168, Australia
| | - Beverley Vollenhoven
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | | | - Nicole Hope
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Melissa Wong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Mark Lawrence
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | | | - Chris Russell
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Kenneth Leong
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia
| | - Philip Thomas
- Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
| | - Luk Rombauts
- Departments of Obstetrics and Gynaecology.,Monash IVF, 7/89 Bridge rd, Richmond, Victoria 3121, Australia.,Monash Women's, Monash Health, 246 Clayton Rd, Clayton 3168, Victoria, Australia
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Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls. Eur Child Adolesc Psychiatry 2018; 27:99-111. [PMID: 28689312 PMCID: PMC5799342 DOI: 10.1007/s00787-017-1025-8] [Citation(s) in RCA: 77] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2017] [Accepted: 07/03/2017] [Indexed: 12/05/2022]
Abstract
Sleep problems are highly prevalent in ADHD and autism spectrum disorder (ASD). Better insight in the etiology is of clinical importance since intervention and prevention strategies of sleep problems are directed at underlying mechanisms. We evaluated the association of sleep problems and sleep patterns with sleep hygiene (behavioral/environmental practices that influence sleep quality, e.g. caffeine use), access to electronic media, chronotype, and anxiety/depression in children aged 6-12 years with ADHD, ASD, or typical development (TD) using parental questionnaires. ANOVA and linear regression analyses were adjusted for age and sex. Children with ADHD and ASD showed more sleep problems (63.6 and 64.7%, vs 25.1% in TD) and shorter sleep duration than controls, while differences between ADHD and ASD were not significant. Sleep hygiene was worse in ADHD and ASD compared to TD, however, the association of worse sleep hygiene with more sleep problems was only significant in ASD and TD. There was a significant association of access to electronic media with sleep problems only in typically developing controls. Chronotype did not differ significantly between groups, but evening types were associated with sleep problems in ADHD and TD. Associations of greater anxiety/depression with more sleep problems were shown in ADHD and TD; however, anxiety/depression did not moderate the effects of chronotype and sleep hygiene. We conclude that sleep problems are highly prevalent in ADHD and ASD, but are differentially related to chronotype and sleep hygiene. In ASD, sleep problems are related to inadequate sleep hygiene and in ADHD to evening chronotype, while in TD both factors are important. Clinical implications are discussed.
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57
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Checa-Ros A, Muñoz-Gallego A, Muñoz-Gallego MDLÁ, Molina-Carballo A, Narbona-Galdó S, Jeréz-Calero A, Augustín-Morales MDC, Muñoz-Hoyos A. Clinical Considerations Derived From the Administration of Melatonin to Children With Sleep Disorders. Pediatr Neurol 2018; 78:61-69. [PMID: 29169867 DOI: 10.1016/j.pediatrneurol.2017.10.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the numerous investigations carried out in relation to melatonin, there is a lack of knowledge about the specific melatonin secretion patterns in the diverse primary sleep disturbances. The objective of this study was to analyze the plasma melatonin concentrations in children with primary sleep disorders and the effects of melatonin therapy on their serum levels and their actigraphic sleep parameters. METHODS Fourteen participants (nine girls; seven to 14 years old) diagnosed with diverse primary sleep disorders were recruited. Four different melatonin secretion patterns were identified: low plasma melatonin levels, absence of a circadian rhythm, advanced acrophase, and delayed acrophase. A placebo (one week) was administered followed by three months of melatonin therapy (3 mg/night). Urinary 6-sulfatoxymelatonin levels, 24-hour plasma melatonin concentrations, and a seven-day actigraphic record were collected after both treatments. RESULTS After melatonin therapy, a significant increase (P < 0.001) of urinary 6-sulfatoxymelatonin excretion with a clear circadian variation was observed. Plasma melatonin concentrations were also significantly higher with a recovery in the circadian rhythm. Actual sleep time was significantly longer, with a substantial reduction in the sleep onset latency and night awakenings. No severe side effects were reported. CONCLUSIONS The main clinical implication of this study is to demonstrate the efficacy of melatonin in three main circumstances: an insufficient hormone production, a disturbed circadian rhythm, and an advanced or delayed acrophase. As ongoing work, we are exploring the effect of different doses of melatonin on the regulation of its concentrations and of its secretion rhythm.
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Affiliation(s)
- Ana Checa-Ros
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain.
| | - Antonio Muñoz-Gallego
- Department of Languages and Computer Sciences, University of Málaga, Complejo Tecnológico, Campus de Teatinos, Málaga 29071, Spain
| | - María de Los Ángeles Muñoz-Gallego
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain
| | - Antonio Molina-Carballo
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain
| | - Susana Narbona-Galdó
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain
| | - Antonio Jeréz-Calero
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain
| | | | - Antonio Muñoz-Hoyos
- San Cecilio University Hospital, Department of Pediatrics, School of Medicine, University of Granada, Avenida de la Investigación 11, Granada 18016, Spain
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58
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Goldman SE, Alder ML, Burgess HJ, Corbett BA, Hundley R, Wofford D, Fawkes DB, Wang L, Laudenslager ML, Malow BA. Characterizing Sleep in Adolescents and Adults with Autism Spectrum Disorders. J Autism Dev Disord 2017; 47:1682-1695. [PMID: 28286917 DOI: 10.1007/s10803-017-3089-1] [Citation(s) in RCA: 61] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We studied 28 adolescents/young adults with autism spectrum disorders (ASD) and 13 age/sex matched individuals of typical development (TD). Structured sleep histories, validated questionnaires, actigraphy (4 weeks), and salivary cortisol and melatonin (4 days each) were collected. Compared to those with TD, adolescents/young adults with ASD had longer sleep latencies and more difficulty going to bed and falling asleep. Morning cortisol, evening cortisol, and the morning-evening difference in cortisol did not differ by diagnosis (ASD vs. TD). Dim light melatonin onsets (DLMOs) averaged across participants were not different for the ASD and TD participants. Average participant scores indicated aspects of poor sleep hygiene in both groups. Insomnia in ASD is multifactorial and not solely related to physiological factors.
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Affiliation(s)
- S E Goldman
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA
| | - M L Alder
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA
| | - H J Burgess
- Departments of Behavioral Sciences & Internal Medicine, Rush University Medical Center, Chicago, USA
| | - B A Corbett
- Department of Psychiatry and Kennedy Center, Vanderbilt University School of Medicine, Nashville, USA
| | - R Hundley
- Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, USA
| | - D Wofford
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA
| | - D B Fawkes
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA
| | - L Wang
- Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, USA
| | - M L Laudenslager
- Behavioral Immunology and Endocrinology Laboratory, Department of Psychiatry, University of Colorado Anschutz Medical Campus, Denver, CO, USA
| | - B A Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University School of Medicine, 1161 21st Avenue South, Room A-0116, Nashville, TN, 37232-2551, USA.
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Examining the Behavioural Sleep-Wake Rhythm in Adults with Autism Spectrum Disorder and No Comorbid Intellectual Disability. J Autism Dev Disord 2017; 47:1207-1222. [PMID: 28160224 DOI: 10.1007/s10803-017-3042-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This study aimed to examine the behavioural sleep-wake rhythm in 36 adults with autism spectrum disorder (ASD) and to determine the prevalence of circadian sleep-wake rhythm disorders compared to age- and sex-matched controls. Participants completed an online questionnaire battery, a 14-day sleep-wake diary and 14-day actigraphy assessment. The results indicated that a higher proportion of adults with ASD met criteria for a circadian rhythm sleep-wake disorder compared to control adults. In particular, delayed sleep-wake phase disorder was particularly common in adults with ASD. Overall the findings suggest that individuals with ASD have sleep patterns that may be associated with circadian rhythm disturbance; however factors such as employment status and co-morbid anxiety and depression appear to influence their sleep patterns.
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60
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Moore M, Evans V, Hanvey G, Johnson C. Assessment of Sleep in Children with Autism Spectrum Disorder. CHILDREN-BASEL 2017; 4:children4080072. [PMID: 28786962 PMCID: PMC5575594 DOI: 10.3390/children4080072] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 07/23/2017] [Accepted: 08/02/2017] [Indexed: 01/30/2023]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) are significantly more prevalent than found in typically developing (TD) children. Given the detrimental impact of poor sleep on cognitive, emotional, and behavioral functioning, it is imperative to screen and assess for sleep disturbances in this population. In this paper, we describe the screening and assessment process, as well as specific measures commonly used for assessing sleep in children with ASD. Advantages and limitations for use in children with ASD are discussed. While subjective measures, such as parent-report questionnaires and sleep diaries, are the most widely used, more objective measures such as actigraphy, polysomnography, and videosomnography provide additional valuable information for both diagnostic purposes and treatment planning. These objective measures, nonetheless, are limited by cost, availability, and feasibility of use with children with ASD. The current review provides an argument for the complementary uses of both subjective and objective measures of sleep specifically for use in children with ASD.
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Affiliation(s)
- Makeda Moore
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Victoria Evans
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Grace Hanvey
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
| | - Cynthia Johnson
- Department of Clinical & Health Psychology, University of Florida, 1225 Center Dr., Room 3130, P.O. Box 100165, Gainesville, FL 32610, USA.
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61
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Souders MC, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C, Schaaf R, Pinto-Martin J. Sleep in Children with Autism Spectrum Disorder. Curr Psychiatry Rep 2017; 19:34. [PMID: 28502070 PMCID: PMC5846201 DOI: 10.1007/s11920-017-0782-x] [Citation(s) in RCA: 132] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.
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Affiliation(s)
- Margaret C Souders
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA.
| | - Stefanie Zavodny
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Whitney Eriksen
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
| | - Rebecca Sinko
- Thomas Jefferson University, 130 S. 9th St, Philadelphia, PA, 19107, USA
| | - James Connell
- AJ Drexel Autism Institute, 3020 Market St #560, Philadelphia, PA, 19104, USA
| | - Connor Kerns
- AJ Drexel Autism Institute, 3020 Market St #560, Philadelphia, PA, 19104, USA
| | - Roseann Schaaf
- Thomas Jefferson University, 130 S. 9th St, Philadelphia, PA, 19107, USA
| | - Jennifer Pinto-Martin
- University of Pennsylvania School of Nursing, 418 Curie Blvd, Philadelphia, PA, 19104, USA
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62
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Maski K, Owens JA. Insomnia, parasomnias, and narcolepsy in children: clinical features, diagnosis, and management. Lancet Neurol 2017; 15:1170-81. [PMID: 27647645 DOI: 10.1016/s1474-4422(16)30204-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 08/03/2016] [Accepted: 08/12/2016] [Indexed: 12/17/2022]
Abstract
Sleep problems are frequently encountered as presenting complaints in child neurology clinical practice. They can affect the functioning and quality of life of children, particularly those with primary neurological and neurodevelopmental disorders, since coexisting sleep problems can add substantially to neurocognitive and behavioural comorbidities. Additionally, symptoms of some sleep disorders such as parasomnias and narcolepsy can be confused with those of other neurological disorders (eg, epilepsy), posing diagnostic challenges for paediatric neurologists. The understanding of the neurophysiology of sleep disorders such as insomnia, parasomnias, and narcolepsy is still evolving. There is a complex relation between the sleeping brain and its waking function. The interplay among genetic factors, alterations in neurotransmitters, electrophysiological changes, and environmental factors potentially contribute to the genesis of these sleep disorders.
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Affiliation(s)
- Kiran Maski
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Judith A Owens
- Boston Children's Hospital and Harvard Medical School, Boston, MA, USA.
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63
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Xie Z, Chen F, Li WA, Geng X, Li C, Meng X, Feng Y, Liu W, Yu F. A review of sleep disorders and melatonin. Neurol Res 2017; 39:559-565. [PMID: 28460563 DOI: 10.1080/01616412.2017.1315864] [Citation(s) in RCA: 195] [Impact Index Per Article: 27.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Zizhen Xie
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Fei Chen
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - William A. Li
- Department of Neurological Surgery, Wayne State University School of Medicine, Detroit, MI, USA
| | - Xiaokun Geng
- Department of Neurology, Beijing Luhe Hospital Capital Medical University, Beijing, China
| | - Changhong Li
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Xiaomei Meng
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Yan Feng
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Wei Liu
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
| | - Fengchun Yu
- Department of Neurology, Beijing Haidian Hospital, Beijing, China
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64
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Abstract
Purpose
The purpose of this paper is to explore the role of fathers in the management of sleeping problems in children with autism and their perspectives of the impact of these difficulties on family life.
Design/methodology/approach
Semi-structured interviews with 25 UK-based fathers of children with autism were undertaken.
Findings
Two-thirds of fathers reported that their children experienced severe sleeping problems in the areas of bed-time resistance, sleep onset and night-time waking. Fathers were significantly involved in the management of these difficulties and reported a range of associated deleterious impacts on the family, including significant negative effects on paternal and maternal health, father’s employment, couple relationship and sibling experiences.
Research limitations/implications
The interview sample cannot be said to be representative of all fathers of children with autism since the backgrounds of those taking part were relatively homogeneous in respect of ethnicity, marital status and level of education.
Practical implications
Improvements in effective, family-centred provision are urgently needed which employ a co-parenting, gender-differentiated methodology.
Social implications
Given the severity and frequency of difficulties, sleeping problems in children with autism should be viewed as a significant public health concern.
Originality/value
This is one of the first studies, qualitative or quantitative, to explore the role and perspectives of fathers of children with autism in the important area of sleep management.
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65
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Grigg-Damberger MM, Ianakieva D. Poor Quality Control of Over-the-Counter Melatonin: What They Say Is Often Not What You Get. J Clin Sleep Med 2017; 13:163-165. [PMID: 28095978 DOI: 10.5664/jcsm.6434] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/22/2016] [Indexed: 01/24/2023]
Affiliation(s)
- Madeleine M Grigg-Damberger
- Department of Neurology, University of New Mexico School of Medicine, Albuquerque, NM.,Pediatric Sleep Services, University of New Mexico Sleep Disorders Center, Albuquerque, NM
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66
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Blackmer AB, Feinstein JA. Management of Sleep Disorders in Children With Neurodevelopmental Disorders: A Review. Pharmacotherapy 2016; 36:84-98. [PMID: 26799351 DOI: 10.1002/phar.1686] [Citation(s) in RCA: 118] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Neurodevelopmental disorders (NDDs) are defined as a group of disorders caused by changes in early brain development, resulting in behavioral and cognitive alterations in sensory and motor systems, speech, and language. NDDs affect approximately 1-2% of the general population. Up to 80% of children with NDDs are reported to have disrupted sleep; subsequent deleterious effects on daytime behaviors, cognition, growth, and overall development of the child are commonly reported. Examples of NDDs discussed in this review include autism spectrum disorder, cerebral palsy, Rett syndrome, Angelman syndrome, Williams syndrome, and Smith-Magenis syndrome. The etiology of sleep disorders in children with NDDs is largely heterogeneous and disease specific. The diagnosis and management of sleep disorders in this population are complex, and little high-quality data exist to guide a consistent approach to therapy. Managing sleep disorders in children with NDDs is critical both for the child and for the family but is often frustrating due to the refractory nature of the problem. Sleep hygiene must be implemented as first-line therapy; if sleep hygiene alone fails, it should be combined with pharmacologic management. The available evidence for the use of common pharmacologic interventions, such as iron supplementation and melatonin, as well as less common interventions, such as melatonin receptor agonists, clonidine, gabapentin, hypnotics, trazodone, and atypical antipsychotics is reviewed. Further, parents and caregivers should be provided with appropriate education on the nature of the sleep disorders and the expectation for modest pharmacologic benefit, at best. Additional data from well-designed trials in children with NDDs are desperately needed to gain a better understanding of sleep pharmacotherapy including efficacy and safety implications. Until then, clinicians must rely on the limited available data, as well as clinical expertise, when managing sleep disorders in the population of children with NDDs.
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Affiliation(s)
- Allison Beck Blackmer
- Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Aurora, Colorado.,Department of Pharmacy/Special Care Clinic, Children's Hospital Colorado, Aurora, Colorado
| | - James A Feinstein
- Adult and Child Center for Health Outcomes Research and Delivery Science, Children's Hospital Colorado, Aurora, Colorado.,Division of General Pediatrics, University of Colorado, Aurora, Colorado
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67
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Goril S, Zalai D, Scott L, Shapiro CM. Sleep and melatonin secretion abnormalities in children and adolescents with fetal alcohol spectrum disorders. Sleep Med 2016; 23:59-64. [PMID: 27692277 DOI: 10.1016/j.sleep.2016.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 05/02/2016] [Accepted: 06/04/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Caregivers describe significant sleep disturbances in the vast majority of children and adolescents, which is diagnosed as fetal alcohol spectrum disorders (FASD), but objective data on sleep disorders in this population are almost completely lacking. Animal models suggest that intrauterine alcohol exposure may disrupt sleep wake patterns, cause sleep fragmentation, and specifically affect the suprachiasmatic nucleus, thus disrupting melatonin secretion. The objective of this pioneering study was to evaluate sleep and melatonin abnormalities in children with FASD using objective, gold-standard measures. METHODS Children and adolescents (N = 36, 6-18 years) with FASD participated in clinical assessments by sleep specialists, overnight polysomnography (PSG), and a dim light melatonin onset (DLMO) test in a pediatric sleep laboratory. PSG was analyzed according to standardized scoring guidelines and sleep architecture was compared with normative data. DLMOs were determined and melatonin secretion curves were evaluated qualitatively to classify melatonin profiles. Sleep disorders were evaluated according to international diagnostic criteria. RESULTS There was a high prevalence (58%) of sleep disorders. The most common sleep problems were parasomnias (27.9%) and insomnia (16.8%). The sleep studies showed lower than normal sleep efficiency and high rates of sleep fragmentation. Most participants (79%) had an abnormal melatonin profile. CONCLUSIONS This study led to the recognition that both sleep and melatonin secretion abnormalities are present in children with FASD. Therefore, to be effective in managing the sleep problems in children with FASD, one needs to consider both the sleep per se and a possible malfunction of the circadian regulation.
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Affiliation(s)
- Shery Goril
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Collaborative Program in Neurosciences, University of Toronto, Toronto, Ontario, Canada
| | - Dora Zalai
- Department of Psychology, Ryerson University, Toronto, Ontario, Canada.
| | | | - Colin M Shapiro
- Youthdale Child and Adolescent Sleep Centre, Toronto, Ontario, Canada; Department of Psychiatry and Ophthalmology, University Health Network, Toronto, Ontario, Canada
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68
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Gregory AM, Sadeh A. Annual Research Review: Sleep problems in childhood psychiatric disorders--a review of the latest science. J Child Psychol Psychiatry 2016; 57:296-317. [PMID: 26412255 DOI: 10.1111/jcpp.12469] [Citation(s) in RCA: 147] [Impact Index Per Article: 18.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/13/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hippocrates flagged the value of sleep for good health. Nonetheless, historically, researchers with an interest in developmental psychopathology have largely ignored a possible role for atypical sleep. Recently, however, there has been a surge of interest in this area, perhaps reflecting increased evidence that disturbed or insufficient sleep can result in poor functioning in numerous domains. This review outlines what is known about sleep in the psychiatric diagnoses most relevant to children and for which associations with sleep are beginning to be understood. While based on a comprehensive survey of the literature, the focus of the current review is on the latest science (largely from 2010). There is a description of both concurrent and longitudinal links as well as possible mechanisms underlying associations. Preliminary treatment research is also considered which suggests that treating sleep difficulties may result in improvements in behavioural areas beyond sleep quality. FINDINGS To maximise progress in this field, there now needs to be: (a) greater attention to the assessment of sleep in children; (b) sleep research on a wider range of psychiatric disorders; (c) a greater focus on and examination of mechanisms underlying associations; (d) a clearer consideration of developmental questions and (e) large-scale well-designed treatment studies. CONCLUSIONS While sleep problems may sometimes be missed by parents and healthcare providers; hence constituting a hidden risk for other psychopathologies - knowing about these difficulties creates unique opportunities. The current excitement in this field from experts in diverse areas including developmental psychology, clinical psychology, genetics and neuropsychology should make these opportunities a reality.
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Affiliation(s)
- Alice M Gregory
- Department of Psychology, Goldsmiths, University of London, New Cross, London, UK
| | - Avi Sadeh
- School of Psychological Sciences, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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69
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Abstract
Sleep disturbances are extremely prevalent in children with neurodevelopmental disorders compared to typically developing children. The diagnostic criteria for many neurodevelopmental disorders include sleep disturbances. Sleep disturbance in this population is often multifactorial and caused by the interplay of genetic, neurobiological and environmental overlap. These disturbances often present either as insomnia or hypersomnia. Different sleep disorders present with these complaints and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. This review aims to provide an overview of causes, diagnosis, and treatment of sleep disturbances in neurodevelopmental disorders that present primarily with symptoms of hypersomnia and/or insomnia.
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71
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Genetic variation in melatonin pathway enzymes in children with autism spectrum disorder and comorbid sleep onset delay. J Autism Dev Disord 2015; 45:100-10. [PMID: 25059483 DOI: 10.1007/s10803-014-2197-4] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sleep disruption is common in individuals with autism spectrum disorder (ASD). Genes whose products regulate endogenous melatonin modify sleep patterns and have been implicated in ASD. Genetic factors likely contribute to comorbid expression of sleep disorders in ASD. We studied a clinically unique ASD subgroup, consisting solely of children with comorbid expression of sleep onset delay. We evaluated variation in two melatonin pathway genes, acetylserotonin O-methyltransferase (ASMT) and cytochrome P450 1A2 (CYP1A2). We observed higher frequencies than currently reported (p < 0.04) for variants evidenced to decrease ASMT expression and related to decreased CYP1A2 enzyme activity (p ≤ 0.0007). We detected a relationship between genotypes in ASMT and CYP1A2 (r(2) = 0.63). Our results indicate that expression of sleep onset delay relates to melatonin pathway genes.
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72
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Kwon KJ, Lee EJ, Kim MK, Jeon SJ, Choi YY, Shin CY, Han SH. The potential role of melatonin on sleep deprivation-induced cognitive impairments: implication of FMRP on cognitive function. Neuroscience 2015; 301:403-14. [PMID: 26047724 DOI: 10.1016/j.neuroscience.2015.05.079] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 05/05/2015] [Accepted: 05/29/2015] [Indexed: 12/31/2022]
Abstract
While prolonged sleep deprivation (SD) could lead to profound negative health consequences, such as impairments in vital biological functions of immunity and cognition, melatonin possesses powerful ameliorating effects against those harmful insults. Melatonin has strong antioxidant and anti-inflammatory effects that help to restore body's immune and cognitive functions. In this study, we investigated the possible role of melatonin in reversing cognitive dysfunction induced by SD in rats. Our experimental results revealed that sleep-deprived animals exhibited spatial memory impairment in the Morris water maze tasks compared with the control groups. Furthermore, there was an increased glial activation most prominent in the hippocampal region of the SD group compared to the normal control (NC) group. Additionally, markers of oxidative stress such as 4-hydroxynonenal (4-HNE) and 7,8-dihydro-8-oxo-deoxyguanine (8-oxo-dG) were significantly increased, while fragile X-mental retardation protein (FMRP) expression was decreased in the SD group. Interestingly, melatonin treatment normalized these events to control levels following SD. Our data demonstrate that SD induces oxidative stress through glial activation and decreases FMRP expression in the neurons. Furthermore, our results suggest the efficacy of melatonin for the treatment of sleep-related neuronal dysfunction, which occurs in neurological disorders such as Alzheimer's disease and autism.
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Affiliation(s)
- K J Kwon
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Neurology, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - E J Lee
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - M K Kim
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - S J Jeon
- Department of Oriental Pharmaceutical Science, College of Pharmacy, Kyung Hee University, 1 Hoegi-dong, Dongdaemun-gu, Seoul 130-701, Republic of Korea
| | - Y Y Choi
- Department of Biomedical Sciences, The University of Auckland, Private Bag 92019, Auckland, New Zealand
| | - C Y Shin
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea
| | - S-H Han
- Department of Neuroscience, Center for Neuroscience Research, Institute of Biomedical Science and Technology, Konkuk University School of Medicine, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea; Department of Neurology, Konkuk University Medical Center, 120 Neungdong-ro, Gwangjin-gu, Seoul 143-701, Republic of Korea.
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73
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Kennaway DJ. Potential safety issues in the use of the hormone melatonin in paediatrics. J Paediatr Child Health 2015; 51:584-9. [PMID: 25643981 DOI: 10.1111/jpc.12840] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/22/2014] [Indexed: 11/29/2022]
Abstract
Melatonin is a hormone produced by the pineal gland during the night in response to light/dark information received by the retina and its integration by the suprachiasmatic nucleus. When administered to selected populations of adults, in particular those displaying delayed sleep phase disorder, melatonin may advance the time of sleep onset. It is, however, being increasingly prescribed for children with sleep disorders despite the fact that (i) it is not registered for use in children anywhere in the world; (ii) it has not undergone the formal safety testing expected for a new drug, especially long-term safety in children; (iii) it is known to have profound effects on the reproductive systems of rodents, sheep and primates, as well as effects on the cardiovascular, immune and metabolic systems; and (iv) there is the potential for important interactions with drugs sometimes prescribed for children. In this review, I discuss properties of melatonin outside its ability to alter sleep timing that have been widely ignored but which raise questions about the safety of its use in infants and adolescents.
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Affiliation(s)
- David J Kennaway
- Robinson Research Institute, Medical School, University of Adelaide, Adelaide, South Australia, Australia.,School of Paediatrics and Reproductive Health, Medical School, University of Adelaide, Adelaide, South Australia, Australia
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74
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Accardo JA, Malow BA. Sleep, epilepsy, and autism. Epilepsy Behav 2015; 47:202-6. [PMID: 25496798 DOI: 10.1016/j.yebeh.2014.09.081] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2014] [Revised: 09/26/2014] [Accepted: 09/29/2014] [Indexed: 01/11/2023]
Abstract
The purpose of this review article is to explore the links between sleep and epilepsy and the treatment of sleep problems in children with autism spectrum disorder (ASD). Epilepsy and sleep have bidirectional relationships, and problems with both are highly prevalent in children with ASD. Literature is reviewed to support the view that sleep is particularly important to address in the context of ASD. Identification and management of sleep disorders may improve seizure control and challenging behaviors. In closing, special considerations for evaluating and treating sleep disorders in children with ASD and epilepsy are reviewed. This article is part of a Special Issue entitled "Autism and Epilepsy".
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Affiliation(s)
- Jennifer A Accardo
- Kennedy Krieger Institute, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Neurology, Baltimore, MD, USA; Johns Hopkins University School of Medicine, Department of Pediatrics, Baltimore, MD, USA.
| | - Beth A Malow
- Vanderbilt University Medical Center, Department of Neurology, Nashville, TN, USA; Vanderbilt University Medical Center, Department of Pediatrics, Nashville, TN, USA; Kennedy Center, Nashville, TN, USA
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75
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Abstract
Autism spectrum disorders (ASD) are common neurodevelopmental conditions, affecting 1 in 68 children. Sleep disturbance, particularly insomnia, is very common in children diagnosed with ASD, with evidence supporting overlapping neurobiological and genetic underpinnings. Disturbed sleep exacerbates core and related ASD symptoms and has a substantial negative impact on the entire family. Treatment of sleep disturbance holds promise for ameliorating many of the challenging behavioral symptoms that children with ASD and their families face. Behavioral and pharmacological studies indicate promising approaches to treating sleep disturbances in this population. Awareness of treatment options is particularly important as parents and clinicians may believe that sleep disturbance is part of autism and refractory to therapy. In addition, autism symptoms refractory to treatment with conventional psychiatric medications may improve when sleep is addressed. Additional evidence-based studies are needed, including those that address the underlying biology of this condition.
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Affiliation(s)
- Olivia J Veatch
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Angela C Maxwell-Horn
- Department of Developmental Medicine, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beth A Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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76
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Abstract
Melatonin is commonly recommended to treat sleep problems in children with developmental disabilities. However, few studies document the efficacy and safety of melatonin in these populations. This article reviews recent studies of melatonin efficacy in developmental disabilities. Overall, short treatment trials were associated with a significant decrease in sleep onset latency time for each of the disorders reviewed, with 1 notable exception-tuberous sclerosis. Reported side effects were uncommon and mild. Across disorders, additional research is needed to draw disability-specific conclusions. However, studies to date provide positive support for future trials that include larger groups of children with specific disabilities/syndromes.
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Affiliation(s)
- A J Schwichtenberg
- Department of Human Development and Family Studies, Department of Psychological Sciences, Department of Speech, Language, and Hearing Sciences, Purdue University, 1202 West State Street, West Lafayette, IN 47907-2055, USA.
| | - Beth A Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, 1161 21st Avenue South, Room A-0116, Nashville, TN 37232-2551, USA
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77
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Bruni O, Alonso-Alconada D, Besag F, Biran V, Braam W, Cortese S, Moavero R, Parisi P, Smits M, Van der Heijden K, Curatolo P. Current role of melatonin in pediatric neurology: clinical recommendations. Eur J Paediatr Neurol 2015; 19:122-33. [PMID: 25553845 DOI: 10.1016/j.ejpn.2014.12.007] [Citation(s) in RCA: 154] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 12/09/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND/PURPOSE Melatonin, an indoleamine secreted by the pineal gland, plays a key role in regulating circadian rhythm. It has chronobiotic, antioxidant, anti-inflammatory and free radical scavenging properties. METHODS A conference in Rome in 2014 aimed to establish consensus on the roles of melatonin in children and on treatment guidelines. RESULTS AND CONCLUSION The best evidence for efficacy is in sleep onset insomnia and delayed sleep phase syndrome. It is most effective when administered 3-5 h before physiological dim light melatonin onset. There is no evidence that extended-release melatonin confers advantage over immediate release. Many children with developmental disorders, such as autism spectrum disorder, attention-deficit/hyperactivity disorder and intellectual disability have sleep disturbance and can benefit from melatonin treatment. Melatonin decreases sleep onset latency and increases total sleep time but does not decrease night awakenings. Decreased CYP 1A2 activity, genetically determined or from concomitant medication, can slow metabolism, with loss of variation in melatonin level and loss of effect. Decreasing the dose can remedy this. Animal work and limited human data suggest that melatonin does not exacerbate seizures and might decrease them. Melatonin has been used successfully in treating headache. Animal work has confirmed a neuroprotective effect of melatonin, suggesting a role in minimising neuronal damage from birth asphyxia; results from human studies are awaited. Melatonin can also be of value in the performance of sleep EEGs and as sedation for brainstem auditory evoked potential assessments. No serious adverse effects of melatonin in humans have been identified.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
| | - Daniel Alonso-Alconada
- Institute for Women's Health, University College London, London, UK; Department of Cell Biology and Histology, University of the Basque Country, Spain
| | - Frank Besag
- South Essex Partnership University NHS Foundation Trust, Bedfordshire, & Institute of Psychiatry, London, UK
| | - Valerie Biran
- Neonatal Intensive Care Unit, Hôpital Robert Debré, Assistance Publique-Hôpitaux de Paris, Univ Paris Diderot, 75019 Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, INSERM, U1141, 75019 Paris, France
| | - Wiebe Braam
- 's Heeren Loo, Department Advisium, Wekerom, The Netherlands; Governor Kremers Centre, University Maastricht, The Netherlands
| | - Samuele Cortese
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; School of Medicine, and the Centre for ADHD and Neurodevelopmental Disorders Across the Lifespan, Institute of Mental Health, University of Nottingham, UK; New York University Child Study Center, NY, USA
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy; Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Pasquale Parisi
- Child Neurology-Chair of Pediatrics, c/o Sant'Andrea Hospital, NESMOS Department, Faculty of Medicine & Psychology, Sapienza University, Rome, Italy
| | - Marcel Smits
- Governor Kremers Centre, University Maastricht, The Netherlands; Department of Sleep-wake Disorders and Chronobiology, Hospital Gelderse Vallei Ede, The Netherlands
| | - Kristiaan Van der Heijden
- Leiden Institute for Brain and Cognition & Institute of Education and Child Studies, Leiden University, The Netherlands
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University of Rome, Italy.
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78
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Veatch OJ, Goldman SE, Adkins KW, Malow BA. Melatonin in Children with Autism Spectrum Disorders: How Does the Evidence Fit Together? JOURNAL OF NATURE AND SCIENCE 2015; 1:e125. [PMID: 26120597 PMCID: PMC4478596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Autism spectrum disorders (ASD) are prevalent neurodevelopmental conditions, affecting 1 in 68 children in the United States alone. Sleep disturbance, particularly insomnia, is very common in children diagnosed with ASD, with evidence supporting overlapping neurobiological and genetic underpinnings. One of the most well studied mechanisms related to ASD and insomnia is dysregulation of the melatonin pathway, which has been observed in many individuals with ASD compared to typically developing controls. Furthermore, variation in genes whose products regulate endogenous melatonin modify sleep patterns in humans and have also been implicated in some cases of ASD. However, the relationship between comorbid insomnia, melatonin processing, and genes that regulate endogenous melatonin levels in ASD is complex and requires further study to fully elucidate. The aim of this review is to provide an overview of the current findings related to the effects of genetic variation in the melatonergic pathway on risk for expression of sleep disorders in children with ASD. In addition, functional findings related to endogenous levels of melatonin and pharmacokinetic profiles in this patient population are evaluated.
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Affiliation(s)
- Olivia J. Veatch
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | | | - Karen W. Adkins
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Beth A. Malow
- Sleep Disorders Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
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79
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Cohen S, Conduit R, Lockley SW, Rajaratnam SMW, Cornish KM. The relationship between sleep and behavior in autism spectrum disorder (ASD): a review. J Neurodev Disord 2014; 6:44. [PMID: 25530819 PMCID: PMC4271434 DOI: 10.1186/1866-1955-6-44] [Citation(s) in RCA: 208] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2014] [Accepted: 11/26/2014] [Indexed: 01/27/2024] Open
Abstract
Although there is evidence that significant sleep problems are common in children with autism spectrum disorder (ASD) and that poor sleep exacerbates problematic daytime behavior, such relationships have received very little attention in both research and clinical practice. Treatment guidelines to help manage challenging behaviors in ASD fail to mention sleep at all, or they present a very limited account. Moreover, limited attention is given to children with low-functioning autism, those individuals who often experience the most severe sleep disruption and behavioral problems. This paper describes the nature of sleep difficulties in ASD and highlights the complexities of sleep disruption in individuals with low-functioning autism. It is proposed that profiling ASD children based on the nature of their sleep disruption might help to understand symptom and behavioral profiles (or vice versa) and therefore lead to better-targeted interventions. This paper concludes with a discussion of the limitations of current knowledge and proposes areas that are important for future research. Treating disordered sleep in ASD has great potential to improve daytime behavior and family functioning in this vulnerable population.
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Affiliation(s)
- Simonne Cohen
- />School of Psychological Sciences, Faculty of Biomedical and Psychological Sciences, Monash University, Melbourne, Australia
| | - Russell Conduit
- />School of Health Sciences, Royal Melbourne Institute of Technology, Melbourne, Australia
| | - Steven W Lockley
- />School of Psychological Sciences, Faculty of Biomedical and Psychological Sciences, Monash University, Melbourne, Australia
- />Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, USA
- />Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Shantha MW Rajaratnam
- />School of Psychological Sciences, Faculty of Biomedical and Psychological Sciences, Monash University, Melbourne, Australia
- />Division of Sleep and Circadian Disorders, Brigham and Women’s Hospital, Boston, USA
- />Division of Sleep Medicine, Harvard Medical School, Boston, USA
| | - Kim M Cornish
- />School of Psychological Sciences, Faculty of Biomedical and Psychological Sciences, Monash University, Melbourne, Australia
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80
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Haney T, Kott KM. Sleep Problems in Children: An Overlooked Factor in Evaluating Behavior. J Psychosoc Nurs Ment Health Serv 2014; 52:27-32. [DOI: 10.3928/02793695-20140916-01] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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