51
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Seo WS. An update on the cause and treatment of sleep disturbance in children and adolescents with autism spectrum disorder. Yeungnam Univ J Med 2021; 38:275-281. [PMID: 34510867 PMCID: PMC8688794 DOI: 10.12701/yujm.2021.01410] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 08/25/2021] [Indexed: 11/30/2022] Open
Abstract
Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by abnormalities in social communication/interaction and restrictive, repetitive patterns of behavior. ASD is a relatively common psychiatric disorder, with a prevalence of approximately 1.7% in children. Although many children and adolescents with ASD visit the hospital for medical help for emotional and behavioral problems such as mood instability and self-harming behavior, there are also many visits for sleep disturbances such as insomnia and sleep resistance. Sleep disturbances are likely to increase fatigue and daytime sleepiness, impaired concentration, negatively impact on daytime functioning, and pose challenges in controlling anger and aggressive behavior. Sleep disturbance in children and adolescents with ASD negatively affects the quality of life, nothing to say the quality of life of their families and school members. In this review, sleep disturbances that are common in children and adolescents with ASD and adolescents are presented. The developmental and behavioral impacts of sleep disturbances in ASD were also considered. Finally, non-pharmacological and pharmacological treatments for sleep disturbances in children and adolescents with ASD and adolescents are reviewed.
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Affiliation(s)
- Wan Seok Seo
- Department of Psychiatry, Yeungnam University College of Medicine, Daegu, Korea
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52
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Subjective and Electroencephalographic Sleep Parameters in Children and Adolescents with Autism Spectrum Disorder: A Systematic Review. J Clin Med 2021; 10:jcm10173893. [PMID: 34501341 PMCID: PMC8432113 DOI: 10.3390/jcm10173893] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 08/18/2021] [Accepted: 08/26/2021] [Indexed: 01/01/2023] Open
Abstract
Background: Sleep problems have commonly manifested in children and adolescents with autism spectrum disorder (ASD) with a complex and multifactorial interaction between clinical and etiological components. These disorders are associated with functional impairment, and provoke significant physical and mental affliction. The purpose of this study is to update the existing literature about objective and subjective sleep parameters in children and adolescents with ASD, extrapolating information from polysomnography or sleep electroencephalography, and sleep related questionnaires. Methods: We have conducted a systematic review of case-control studies on this topic, performing a web-based search on PubMed, Scopus and the Web of Science databases according to the Preferred Reporting items for Systematic Review and Meta-analyses (PRISMA) guidelines. Results: Data collected from 20 survey result reports showed that children and adolescents with ASD experienced a higher rate of sleep abnormalities than in typically developing children. The macrostructural sleep parameters that were consistent with subjective parent reported measures unveil a greater percentage of nighttime signs of insomnia. Sleep microstructure patterns, in addition, pointed towards the bidirectional relationship between brain dysfunctions and sleep problems in children with ASD. Conclusions: Today’s literature acknowledges that objective and subjective sleep difficulties are more often recognized in individuals with ASD, so clinicians should assess sleep quality in the ASD clinical population, taking into consideration the potential implications on treatment strategies. It would be worthwhile in future studies to examine how factors, such as age, cognitive level or ASD severity could be related to ASD sleep abnormalities. Future research should directly assess whether sleep alterations could represent a specific marker for atypical brain development in ASD.
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53
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Schroder CM, Banaschewski T, Fuentes J, Hill CM, Hvolby A, Posserud MB, Bruni O. Pediatric prolonged-release melatonin for insomnia in children and adolescents with autism spectrum disorders. Expert Opin Pharmacother 2021; 22:2445-2454. [PMID: 34314281 DOI: 10.1080/14656566.2021.1959549] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Introduction: Insomnia is common among children and adolescents with Autism spectrum disorder (ASD). The first drug licensed for insomnia in this population, a pediatric-appropriate prolonged-release melatonin (PedPRM) formulation is described.Areas covered: Literature search on PedPRM efficacy and safety profile in clinical trials, and a proposed decision-making algorithm to optimize outcome in the treatment of insomnia in children and adolescents with ASD.Expert opinion: PedPRM treatment effectively improves sleep onset, duration and consolidation, and daytime externalizing behaviors in children and adolescents with ASD and subsequently caregivers' quality of life and satisfaction with their children's sleep. The coated, odorless and taste-free mini-tablets are well-accepted in this population who often have sensory hypersensitivity and problems swallowing standard tablet preparations. The most frequent long-term treatment-related adverse events were fatigue (6.3%), somnolence (6.3%), and mood swings (4.2%) with no evidence of delay in height, BMI, or pubertal development, or withdrawal effects. The starting dose is 2 mg once daily independent of age or weight, escalated to 5-10 mg/day if predefined treatment success criteria are unmet. Slow melatonin metabolizers (~10% of children), may require lower doses. Given its long-term efficacy, safety and acceptance, PedPRM may ameliorate long-term consequences of insomnia in this population.
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Affiliation(s)
- Carmen M Schroder
- Department of Child and Adolescent Psychiatry & Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000 Strasbourg, France; CNRS UPR 3212, Institute for Cellular and Integrative Neurosciences; Sleep Disorders Center& International Research Center for ChronoSomnology, Strasbourg, France
| | - Tobias Banaschewski
- Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, University of Heidelberg, Mannheim, Germany
| | - Joaquin Fuentes
- Child and Adolescent Psychiatry Unit, Service of Child and Adolescent Psychiatry, Policlínica Gipuzkoa and GAUTENA Autism Society, San Sebastián, Spain
| | - Catherine Mary Hill
- School of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, and Southampton Children's Hospital Department of Sleep Medicine, Southampton, UK
| | - Allan Hvolby
- Department of Child and Adolescent Psychiatry, Psychiatry in Region of South Denmark, Esbjerg, and Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Maj-Britt Posserud
- Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Bergen, Norway
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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54
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Black B. Sleep and Autism: An impactful and complex relationship that requires a personalized medicine approach. Sleep 2021; 44:6320054. [PMID: 34255079 DOI: 10.1093/sleep/zsab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Black
- University of Missouri, Department of Child Health, Columbia, MO, United States of America
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55
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Feng S, Huang H, Wang N, Wei Y, Liu Y, Qin D. Sleep Disorders in Children With Autism Spectrum Disorder: Insights From Animal Models, Especially Non-human Primate Model. Front Behav Neurosci 2021; 15:673372. [PMID: 34093147 PMCID: PMC8173056 DOI: 10.3389/fnbeh.2021.673372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/16/2021] [Indexed: 02/05/2023] Open
Abstract
Autism Spectrum Disorder (ASD) is a heterogeneous neurodevelopmental disorder with deficient social skills, communication deficits and repetitive behaviors. The prevalence of ASD has increased among children in recent years. Children with ASD experience more sleep problems, and sleep appears to be essential for the survival and integrity of most living organisms, especially for typical synaptic development and brain plasticity. Many methods have been used to assess sleep problems over past decades such as sleep diaries and parent-reported questionnaires, electroencephalography, actigraphy and videosomnography. A substantial number of rodent and non-human primate models of ASD have been generated. Many of these animal models exhibited sleep disorders at an early age. The aim of this review is to examine and discuss sleep disorders in children with ASD. Toward this aim, we evaluated the prevalence, clinical characteristics, phenotypic analyses, and pathophysiological brain mechanisms of ASD. We highlight the current state of animal models for ASD and explore their implications and prospects for investigating sleep disorders associated with ASD.
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Affiliation(s)
- Shufei Feng
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
| | - Haoyu Huang
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Na Wang
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yuanyuan Wei
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
| | - Yun Liu
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
| | - Dongdong Qin
- Department of Pediatric Rehabilitation Medicine, Kunming Children’s Hospital, Kunming, China
- State Key Laboratory of Primate Biomedical Research, Institute of Primate Translational Medicine, Kunming University of Science and Technology, Kunming, China
- School of Basic Medical Sciences, Yunnan University of Chinese Medicine, Kunming, China
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56
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Earl RK, Ward T, Gerdts J, Eichler EE, Bernier RA, Hudac CM. Sleep Problems in Children with ASD and Gene Disrupting Mutations. The Journal of Genetic Psychology 2021; 182:317-334. [PMID: 33998396 DOI: 10.1080/00221325.2021.1922869] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep difficulties are pervasive in autism spectrum disorder (ASD), yet how sleep problems relate to underlying biological mechanisms such as genetic etiology is unclear, despite recent reports of profound sleep problems in children with ASD-associated de novo likely gene disrupting (dnLGD) mutations, CHD8, DYRK1A, and ADNP. We aimed to inform etiological contributions to ASD and sleep by characterizing sleep problems in individuals with dnLGD mutations. Participants (N = 2886) were families who completed dichotomous questions about sleep problems within a medical history interview for their child with ASD (age 3-28 years). Confirmatory factor analyses compared between those with ASD and a dnLGD mutation and those with idiopathic ASD (i.e., no known genetic event, NON) highlighted four domains (sleep onset, breathing issues, nighttime awakenings, and daytime tiredness) with sleep onset as a strong factor for both groups. Overall, participant predictors indicated that internalizing behavioral problems and lower cognitive scores were related to increased sleep problems. Internalizing problems were also related to increase nighttime awakenings in the dnLGD group. As an exploratory aim, patterns of sleep issues are described for genetic subgroups with unique patterns including more overall sleep issues in ADNP (n = 19), problems falling asleep in CHD8 (n = 22), and increased daytime naps in DYRK1A (n = 23). Implications for considering genetically defined subgroups when approaching sleep problems in children with ASD are discussed.
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Affiliation(s)
- Rachel K Earl
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Tracey Ward
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Jennifer Gerdts
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Evan E Eichler
- Department of Genome Sciences, University of Washington, Seattle, Washington, USA.,Howard Hughes Medical Institute, Seattle, Washington, USA
| | - Raphael A Bernier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington, USA
| | - Caitlin M Hudac
- Center for Youth Development and Intervention and Department of Psychology, University of Alabama, Tuscaloosa, Alabama, USA
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57
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Ansari S, AdibSaber F, Elmieh A, Gholamrezaei S. The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism. Sleep Med 2021; 82:78-83. [PMID: 33906043 DOI: 10.1016/j.sleep.2021.03.045] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Previous studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD). METHODS Forty boys with ASD (aged 6-14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn't get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention. RESULTS Results revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group. CONCLUSIONS Overall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.
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Affiliation(s)
- Soleyman Ansari
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Fahimeh AdibSaber
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Alireza Elmieh
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Shahram Gholamrezaei
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
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58
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Manelis-Baram L, Meiri G, Ilan M, Faroy M, Michaelovski A, Flusser H, Menashe I, Dinstein I. Sleep Disturbances and Sensory Sensitivities Co-Vary in a Longitudinal Manner in Pre-School Children with Autism Spectrum Disorders. J Autism Dev Disord 2021; 52:923-937. [PMID: 33835353 PMCID: PMC8033551 DOI: 10.1007/s10803-021-04973-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 12/29/2022]
Abstract
Previous research has demonstrated that sleep disturbances are positively correlated with sensory sensitivities in children with ASD. Most of these studies, however, were based on cross-sectional analyses, where the relationship across symptom domains was examined at a single time-point. Here, we examined the development of 103 pre-school children with ASD over a 1–3-year period. The results revealed that spontaneous longitudinal changes in sleep disturbances were specifically correlated with changes in sensory sensitivities and not with changes in other sensory processing domains nor with changes in core ASD symptoms. These finding demonstrate a consistent longitudinal relationship between sleep disturbances and sensory sensitivities, which suggests that these symptoms may be generated by common or interacting underlying physiological mechanisms.
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Affiliation(s)
- Liora Manelis-Baram
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel. .,National Autism Research Center of Israel, Beer Sheva, Israel. .,The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel.
| | - Gal Meiri
- National Autism Research Center of Israel, Beer Sheva, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Ilan
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Michal Faroy
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,The Academic College of Tel-Aviv-Yaffo, Tel-Aviv, Israel.,Pre-School Psychiatry Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Analya Michaelovski
- National Autism Research Center of Israel, Beer Sheva, Israel.,Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Hagit Flusser
- National Autism Research Center of Israel, Beer Sheva, Israel.,Zusman Child Development Center, Soroka University Medical Center, Beer Sheva, Israel
| | - Idan Menashe
- National Autism Research Center of Israel, Beer Sheva, Israel.,Public Health Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Ilan Dinstein
- Psychology Department, Ben-Gurion University of the Negev, Beer Sheva, Israel.,National Autism Research Center of Israel, Beer Sheva, Israel.,Cognitive and Brain Sciences Department, Ben-Gurion University of the Negev, Beer Sheva, Israel
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59
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Balter LJT, Wiwe Lipsker C, Wicksell RK, Lekander M. Neuropsychiatric Symptoms in Pediatric Chronic Pain and Outcome of Acceptance and Commitment Therapy. Front Psychol 2021; 12:576943. [PMID: 33897515 PMCID: PMC8062759 DOI: 10.3389/fpsyg.2021.576943] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 02/25/2021] [Indexed: 12/29/2022] Open
Abstract
Considerable heterogeneity among pediatric chronic pain patients may at least partially explain the variability seen in the response to behavioral therapies. The current study tested whether autistic traits and attention-deficit/hyperactivity disorder (ADHD) symptoms in a clinical sample of children and adolescents with chronic pain are associated with socioemotional and functional impairments and response to acceptance and commitment therapy (ACT) treatment, which has increased psychological flexibility as its core target for coping with pain and pain-related distress. Children and adolescents aged 8–18 years (N = 47) were recruited. Patients and their parents completed questionnaires pre- and post-ACT of 17 sessions. Correlational analyses and mixed-effects models were used to assess the role of autistic traits and ADHD symptoms in pretreatment functioning and ACT-treatment response. Outcome variables were degree to which pain interfered with daily activities (i.e., pain interference, sleep, and physical and school functioning), socioemotional functioning (i.e., depressive symptoms, emotional, and social functioning), psychological inflexibility, and pain intensity. Autistic traits and ADHD symptoms, pain frequency, and pain duration were measured at pretreatment only. Higher autistic traits were associated with greater pain interference, higher depression, and greater psychological inflexibility. Higher ADHD symptomatology was associated with greater pretreatment pain interference, lower emotional functioning, greater depression, and longer duration of pain. Across patients, all outcome variables, except for sleep disturbances and school functioning, significantly improved from pre- to post-ACT. Higher autistic traits were associated with greater pre- to post-ACT improvements in emotional functioning and sleep disturbance and non-significant improvements in pain interference. ADHD symptomatology was not associated with treatment outcome. The current results showed that neuropsychiatric symptoms in pediatric chronic pain patients are associated with lower functioning, particularly pain interfering with daily life and lower socioemotional functioning. The results suggest that not only pediatric chronic pain patients low in neuropsychiatric symptoms may benefit from ACT, but also those high in autism traits and ADHD symptoms. With the present results in mind, pediatric chronic pain patients higher in autistic traits may actually derive extra benefit from ACT. Future research could assess whether increased psychological flexibility, the core focus of ACT, enabled those higher in autism traits to cope relatively better with pain-related distress and thus to gain more from the treatment, as compared to those lower in autism traits. Moreover, to address specific effects of ACT, inclusion of an appropriate control group is key.
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Affiliation(s)
- Leonie J T Balter
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden
| | - Camilla Wiwe Lipsker
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Rikard K Wicksell
- Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Functional Area Medical Psychology, Functional Unit Behavior Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Mats Lekander
- Department of Psychology, Stress Research Institute, Stockholm University, Stockholm, Sweden.,Division of Psychology, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
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60
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Complexity of Body Movements during Sleep in Children with Autism Spectrum Disorder. ENTROPY 2021; 23:e23040418. [PMID: 33807381 PMCID: PMC8066562 DOI: 10.3390/e23040418] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/30/2021] [Accepted: 03/30/2021] [Indexed: 12/15/2022]
Abstract
Recently, measuring the complexity of body movements during sleep has been proven as an objective biomarker of various psychiatric disorders. Although sleep problems are common in children with autism spectrum disorder (ASD) and might exacerbate ASD symptoms, their objectivity as a biomarker remains to be established. Therefore, details of body movement complexity during sleep as estimated by actigraphy were investigated in typically developing (TD) children and in children with ASD. Several complexity analyses were applied to raw and thresholded data of actigraphy from 17 TD children and 17 children with ASD. Determinism, irregularity and unpredictability, and long-range temporal correlation were examined respectively using the false nearest neighbor (FNN) algorithm, information-theoretic analyses, and detrended fluctuation analysis (DFA). Although the FNN algorithm did not reveal determinism in body movements, surrogate analyses identified the influence of nonlinear processes on the irregularity and long-range temporal correlation of body movements. Additionally, the irregularity and unpredictability of body movements measured by expanded sample entropy were significantly lower in ASD than in TD children up to two hours after sleep onset and at approximately six hours after sleep onset. This difference was found especially for the high-irregularity period. Through this study, we characterized details of the complexity of body movements during sleep and demonstrated the group difference of body movement complexity across TD children and children with ASD. Complexity analyses of body movements during sleep have provided valuable insights into sleep profiles. Body movement complexity might be useful as a biomarker for ASD.
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61
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Lights Out: Examining Sleep in Children with Vision Impairment. Brain Sci 2021; 11:brainsci11040421. [PMID: 33810398 PMCID: PMC8066760 DOI: 10.3390/brainsci11040421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Revised: 03/18/2021] [Accepted: 03/24/2021] [Indexed: 11/17/2022] Open
Abstract
Sleep is crucial for development across cognitive, physical, and social-emotional domains. Sleep quality and quantity impact domains of daytime functioning, attainment, and global development. Previous work has explored sleep profiles in typically developing children and children with developmental disorders such as Down syndrome and Williams Syndrome, yet there is a complete absence of published work regarding the sleep profiles of children with vision impairment aged 4–11 years. This is the first known study that examines the sleep profiles in children with vision impairment (n = 58) in comparison to 58 typically developing children (aged 4–11 years) in the UK. Sleep was measured using the Childhood Sleep Habits Questionnaire (CSHQ; parental report), actigraphy and sleep diaries. Results showed group differences in subjective CSHQ scores but not objective actigraphy measures. Surprisingly, the findings revealed disordered sleep (namely, poor sleep quantity) in both groups. Discordance between CSHQ and actigraphy measures could represent heightened awareness of sleeping problems in parents/caregivers of children with vision impairment. The implications of this study extend beyond group comparison, examining disordered sleep in ‘typically developing’ children, exploring the potential role of light perception and the importance of sleep quality and quantity in both groups.
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62
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Jamioł-Milc D, Bloch M, Liput M, Stachowska L, Skonieczna-Żydecka K. Tactile Processing and Quality of Sleep in Autism Spectrum Disorders. Brain Sci 2021; 11:brainsci11030362. [PMID: 33808992 PMCID: PMC8001965 DOI: 10.3390/brainsci11030362] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/17/2022] Open
Abstract
Individuals with autism spectrum disorders (ASDs) commonly experience problems with the processing of tactile stimuli and poor quality of sleep. The aim of the present study was to analyze whether tactile stimuli modulation (TSM) disorders might be linked to insomnia prevalence in ASD individuals. We hypothesized that sleep disorders in children with ASD may result from improper tactile under/over responsivity. The study included 27 children diagnosed with ASD, aged 6.8 (±2.9 years) with male dominance (n = 22, 81.5%). To evaluate the pattern of TSM we used a clinical interview with a parent, and guided and spontaneous observation of the patients. Sleep disorders were diagnosed using the Athens Insomnia Scale. Of all the children diagnosed with TSM, 20 patients (74.1%) had an over-responsivity pattern and 7 children (25.9%) had an under-responsivity pattern. Of the patients, 11 children (40.7%) met the diagnostic criteria for insomnia. The data indicated a statistical tendency for higher prevalence of insomnia in individuals diagnosed with tactile under-responsivity (p = 0.051). We concluded that under-responsivity toward tactile stimuli may be partly responsible for poor sleep quality in ASD. There is an urgent need to treat sleep and sensory disruptions which may intensify behavioral difficulties in ASD.
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Affiliation(s)
- Dominika Jamioł-Milc
- Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland
- Correspondence: ; Tel.: +48-91-441-48-06; Fax: +48-91-441-48-07
| | | | - Magdalena Liput
- Department of Pharmacognosy and Natural Medicines, Pomeranian Medical University in Szczecin, 70-111 Szczecin, Poland;
| | - Laura Stachowska
- Students Scientific Club at the Department of Human Nutrition and Metabolomics, Pomeranian Medical University in Szczecin, 71-460 Szczecin, Poland;
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63
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Luongo A, Lukowski A, Protho T, Van Vorce H, Pisani L, Edgin J. Sleep's role in memory consolidation: What can we learn from atypical development? ADVANCES IN CHILD DEVELOPMENT AND BEHAVIOR 2021; 60:229-260. [PMID: 33641795 DOI: 10.1016/bs.acdb.2020.08.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Research conducted over the last century has suggested a role for sleep in the processes guiding healthy cognition and development, including memory consolidation. Children with intellectual and developmental disabilities (IDDs) tend to have higher rates of sleep disturbances, which could relate to behavior issues, developmental delays, and learning difficulties. While several studies examine whether sleep exacerbates daytime difficulties and attention deficits in children with IDDs, this chapter focuses on the current state of knowledge regarding sleep and memory consolidation in typically developing (TD) groups and those at risk for learning difficulties. In particular, this chapter summarizes the current literature on sleep-dependent learning across developmental disabilities, including Down syndrome, Williams syndrome, Autism Spectrum Disorder, and Learning Disabilities (Attention-Deficit/Hyperactivity Disorder and Dyslexia). We also highlight the gaps in the current literature and identify challenges in studying sleep-dependent memory in children with different IDDs. This burgeoning new field highlights the importance of considering the role of sleep in memory retention across long delays when evaluating children's memory processes. Further, an understanding of typical and atypical development can mutually inform recent theories of sleep's role in memory.
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Affiliation(s)
- A Luongo
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - A Lukowski
- Department of Psychological Sciences, University of California Irvine, Irvine, CA, United States
| | - T Protho
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - H Van Vorce
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - L Pisani
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States
| | - J Edgin
- Department of Psychology, University of Arizona, Tucson, AZ, Unites States; University of Arizona Sonoran UCEDD, Tucson, AZ, United States.
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64
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Malow BA, Findling RL, Schroder CM, Maras A, Breddy J, Nir T, Zisapel N, Gringras P. Sleep, Growth, and Puberty After 2 Years of Prolonged-Release Melatonin in Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry 2021; 60:252-261.e3. [PMID: 31982581 PMCID: PMC8084705 DOI: 10.1016/j.jaac.2019.12.007] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/17/2019] [Accepted: 01/16/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVE A recent 3-month double-blind, placebo-controlled study demonstrated efficacy and safety of pediatric prolonged-release melatonin (PedPRM) for insomnia in children with autism spectrum disorder. This study examined the long-term effects of PedPRM treatment on sleep, growth, body mass index, and pubertal development. METHOD Eighty children and adolescents (2-17.5 years of age; 96% with autism spectrum disorder) who completed the double-blind, placebo-controlled trial were given 2 mg, 5 mg, or 10 mg PedPRM nightly up to 104 weeks, followed by a 2-week placebo period to assess withdrawal effects. RESULTS Improvements in child sleep disturbance and caregiver satisfaction with child sleep patterns, quality of sleep, and quality of life were maintained throughout the 104-week treatment period (p < .001 versus baseline for all). During the 2-week withdrawal placebo period, measures declined compared with the treatment period but were still improved compared with baseline. PedPRM was generally safe; the most frequent treatment-related adverse events were fatigue (6.3%), somnolence (6.3%), and mood swings (4.2%). Changes in mean weight, height, body mass index, and pubertal status (Tanner staging done by a physician) were within normal ranges for age with no evidence of delay in body mass index or pubertal development. CONCLUSION Nightly PedPRM at optimal dose (2, 5, or 10 mg nightly) is safe and effective for long-term treatment in children and adolescents with autism spectrum disorder and insomnia. There were no observed detrimental effects on children's growth and pubertal development and no withdrawal or safety issues related to the use or discontinuation of the drug. CLINICAL TRIAL REGISTRATION INFORMATION Efficacy and Safety of Circadin in the Treatment of Sleep Disturbances in Children With Neurodevelopment Disabilities; https://clinicaltrials.gov/; NCT01906866.
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Chen X, Liu H, Wu Y, Xuan K, Zhao T, Sun Y. Characteristics of sleep architecture in autism spectrum disorders: A meta-analysis based on polysomnographic research. Psychiatry Res 2021; 296:113677. [PMID: 33385781 DOI: 10.1016/j.psychres.2020.113677] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 12/22/2020] [Indexed: 01/11/2023]
Abstract
Eleven parameters recorded by polysomnography were used to evaluate the differences in sleep structure between individuals with autism spectrum disorders (ASDs) and typically developed individuals (TDs). Four databases (PubMed, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI)) were searched for potentially relevant literature published before July 14, 2019. Data extraction was performed by two independent assessors. The Cohen's d effect sizes and their 95% confidence intervals (CIs) were calculated to assess the effectiveness with the random-effects model. The heterogeneity was estimated by Cochran's Q test. The research yielded 14 case-control studies, 11 of which were included in this meta-analysis. Synthesis of the differences in 11 sleep parameters between individuals with ASDs and TDs demonstrated the pooled effect size of Cohen'd was -0.52 (95% CI: (-0.97, -0.08)) for total sleep time (TST), -0.69 (95% CI: (-1.27, -0.11)) for sleep efficiency (SE%) and 0.93 (95% CI: (0.37, 1.48)) for stage 1 sleep (S1%), respectively. Our findings suggested that compared with TDs, individuals with ASDs tend to have a decreased TST and SE% and an increased S1%. Differences of characteristics of sleep architecture in other sleep parameters between individuals with ASDs and TDs were not found in this study.
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Affiliation(s)
- Xin Chen
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Haixia Liu
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Yile Wu
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Kun Xuan
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Tianming Zhao
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China
| | - Yehuan Sun
- Department of Epidemiology and Health Statistics, School of Public Health Anhui Medical University, No. 81 Meishan Road, Hefei 230032, Anhui, PR China.
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66
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Rydzewska E, Dunn K, Cooper SA. Umbrella systematic review of systematic reviews and meta-analyses on comorbid physical conditions in people with autism spectrum disorder. Br J Psychiatry 2021; 218:10-19. [PMID: 33161922 DOI: 10.1192/bjp.2020.167] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Comorbid physical conditions may be more common in people with autism spectrum disorder (ASD) than other people. AIMS To identify what is and what is not known about comorbid physical conditions in people with ASD. METHOD We undertook an umbrella systematic review of systematic reviews and meta-analyses on comorbid physical conditions in people with ASD. Five databases were searched. There were strict inclusion/exclusion criteria. We undertook double reviewing for eligibility, systematic data extraction and quality assessment. Prospective PROSPERO registration: CRD42015020896. RESULTS In total, 24 of 5552 retrieved articles were included, 15 on children, 1 on adults, and 8 both on children and adults. Although the quality of included reviews was good, most reported several limitations in the studies they included and considerable heterogeneity. Comorbid physical conditions are common, and some are more prevalent than in the general population: sleep problems, epilepsy, sensory impairments, atopy, autoimmune disorders and obesity. Asthma is not. However, there are substantial gaps in the evidence base. Fewer studies have been undertaken on other conditions and some findings are inconsistent. CONCLUSIONS Comorbid physical conditions occur more commonly in people with ASD, but the evidence base is slim and more research is needed. Some comorbidities compound care if clinicians are unaware, for example sensory impairments, given the communication needs of people with ASD. Others, such as obesity, can lead to an array of other conditions, disadvantages and early mortality. It is essential that potentially modifiable physical conditions are identified to ensure people with ASD achieve their best outcomes. Heightening clinicians' awareness is important to aid in assessments and differential diagnoses, and to improve healthcare.
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Affiliation(s)
| | - Kirsty Dunn
- Institute of Health and Wellbeing, University of Glasgow, UK
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Sultana N, Asaduzzaman M, Al Mamun F, Hosen I, Yu Q, Pakpour AH, Gozal D, Mamun MA. Sleep Problems in Children with Autism Spectrum Disorder in Bangladesh: A Case-Control Study. Nat Sci Sleep 2021; 13:673-682. [PMID: 34079411 PMCID: PMC8165216 DOI: 10.2147/nss.s309860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Accepted: 04/23/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Sleep problems in children with Autism Spectrum Disorder (ASD) are highly prevalent, but little information is available on this issue in low- to middle-income countries (LMIC) such as Bangladesh. Therefore, the present study investigated the prevalence and socio-demographic determinants of ASD sleep disturbances in a comparison with typically developing children (TDC). METHODS A cross-sectional interview study was carried out within a total of 446 Bangladeshi mothers, whose children's mean age was 8.1±2.9 years (151 ASD [8.5±2.7 years] and 295 TDC [7.9±2.9 years]); in addition to socio-demographics, the Child Sleep Habit Questionnaire (CSHQ) was used, and a cut-off score of 41 out of 93 points considered as reflecting sleep problems. RESULTS About 89.7% of the children reported having problems in sleep, with ASD reporting higher frequency vs TDC (94.00% vs 87.50%; χ2=4.678, p=0.031). The overall mean CSHQ score was 48.7±7.6 in total sample, whereas ASD children reported higher scores compared to TDCs (50.9±8.1 vs 47.5±7.0, p<0.001). Similarly, subscales of CSHQ such as sleep duration (4.23±1.56 vs 3.90±1.31, p=0.017), sleep anxiety (7.23±2.05 vs 6.45±1.92, p<0.001), night waking (3.82±1.07 vs 3.17±1.89, p<0.001), parasomnias (8.86±2.06 vs 7.85±2.27, p<0.001), and sleep disordered breathing (4.02±2.92 vs 3.43±2.07, p=0.014) were more problematic among ASD compared to TDC. Lastly, 28.5% of ASD reported taking sleep-related medications vs 0.3% for TDC (n=1). CONCLUSION Bangladeshi ASD children are highly likely to manifest sleep disturbances, which warrant urgent implementation of parental educational and support programs to mitigate the impact of sleep problems in ASD families.
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Affiliation(s)
- Naznin Sultana
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Savar, Dhaka, Bangladesh.,Department of Public Health, North South University, Dhaka, Bangladesh
| | - Md Asaduzzaman
- Department of Public Health, American International University - Bangladesh, Dhaka, Bangladesh
| | - Firoj Al Mamun
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Savar, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Ismail Hosen
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Savar, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
| | - Qian Yu
- Exercise Psychophysiology Laboratory, Institute of KEEP Collaborative Innovation, School of Psychology, Shenzhen University, Shenzhen, 518060, People's Republic of China
| | - Amir H Pakpour
- Social Determinants of Health Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.,Department of Nursing, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - David Gozal
- Department of Child Health and the Child Health Research Institute, The University of Missouri School of Medicine, Columbia, MO, USA
| | - Mohammed A Mamun
- CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Savar, Dhaka, Bangladesh.,Department of Public Health and Informatics, Jahangirnagar University, Savar, Dhaka, Bangladesh
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Pevet P, Challet E, Felder-Schmittbuhl MP. Melatonin and the circadian system: Keys for health with a focus on sleep. HANDBOOK OF CLINICAL NEUROLOGY 2021; 179:331-343. [PMID: 34225973 DOI: 10.1016/b978-0-12-819975-6.00021-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Melatonin (MLT), secreted during the night by the pineal gland, is an efferent hormonal signal of the master circadian clock located in the suprachiasmatic nucleus (SCN). Consequently, it is a reliable phase marker of the SCN clock. If one defines as "chronobiotic," a drug able to influence the phase and/or the period of the circadian clock, MLT is a very potent one. The most convincing data obtained so far come from studies on totally blind individuals. Exogenous MLT administered daily entrains the sleep-wake cycle of these individuals to a 24-h cycle. MLT, however, is not essential to sleep. In nocturnally, active mammals, MLT is released during the night concomitantly with the daily period of wakefulness. Therefore, MLT cannot be simply considered as a sleep hormone, but rather as a signal of darkness. Its role in the circadian system is to reinforce nighttime physiology, including timing of the sleep-wake cycle and other circadian rhythms. MLT exerts its effects on the sleep cycle especially by a direct action on the master circadian clock. The sleep-wake cycle is depending not only on the circadian clock but also on an orchestrated network of different centers in the brain. Thus, the control of sleep-wake rhythm might be explained by a parallel and concomitant action of MLT on the master clock (chronobiotic effect) and on sleep-related structures within the brain. MLT acts through two high-affinity membrane receptors (MT1 and MT2) with striking differences in their distribution pattern. MLT is a powerful synchronizer of human circadian rhythms, thus justifying the use of MLT and MLT agonists in clinical medicine as pharmacological tools to manipulate the sleep-wake cycle, and to treat sleep disorders and other circadian disorders. Available MLT analogs/drugs are all nonspecific MT1/MT2 agonists. The development of new ligands which are highly selectivity for each subtype is clearly a new challenge for the field and will be at the root of new therapeutic agents for curing specific pathologies, including sleep disorders.
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Affiliation(s)
- Paul Pevet
- Institute of Cellular and Integrative Neurosciences, CNRS, University of Strasbourg, Strasbourg, France.
| | - Etienne Challet
- Institute of Cellular and Integrative Neurosciences, CNRS, University of Strasbourg, Strasbourg, France
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69
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Bonuck K. Sleep problem screening of young children by speech-language pathologists: A mixed-methods feasibility study. AUTISM & DEVELOPMENTAL LANGUAGE IMPAIRMENTS 2021; 6:23969415211035066. [PMID: 36381521 PMCID: PMC9620683 DOI: 10.1177/23969415211035066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Background & Aims Poor sleep in young children imperils language learning and use. Both sleep and language problems are prevalent in early childhood. Speech-language pathologists are in a unique position to expand surveillance of sleep problems, which in turn may contribute to communication difficulties. We conducted a feasibility study of speech-language pathologist screening for behavioral sleep problems and sleep-disordered breathing symptoms at a multidisciplinary evaluation and treatment center. Methods Speech-language pathologists administered screeners to parents of 2-6-year-olds: the Short Form-Children's Sleep Habits Questionnaire (for behavioral sleep problems) which includes an item asking if the child has a sleep problem (yes/no), and the pediatric sleep questionnaire (for sleep-disordered breathing). Speech-language pathologists participated in pre- and post-screening focus groups. Pre-screening topics included professional preparation and clinical experience regarding pediatric sleep issues. Post-screening, speech-language pathologists provided feedback about the screening experience and feasibility of incorporating such screening into practice. Results Among 51 children, 31% (16/51) screened positive for sleep-disordered breathing, 78% for behavioral sleep problems (40/51), and 43% (12/28) per parent report. Parent-reported problems were associated with sleep-disordered breathing (p = 0.00) but not behavioral sleep problems (p = 0.24). During focus groups, speech-language pathologists reported no formal pediatric sleep training, high parent concern about sleep, and agreed that screening fit their professional mandate. Speech-language pathologists affirmed that the ≤15 min screenings integrated seamlessly into practice but that additional training, particularly for sleep-disordered breathing, was needed. Conclusions The prevalence of sleep problems in 2-6-year-olds presenting to speech-language pathologists was higher than in community samples, but consistent with data from young children with developmental disabilities. Speech-language pathologists endorsed the utility and feasibility of sleep problem screening and education in their clinical practice. Implications Integrating sleep problem screening and education into speech-language pathologist practice is feasible and could widen surveillance of both sleep problems and risk factors for developmental language disorders. Further research should include larger samples and other settings, e.g. home or school.
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Affiliation(s)
- Karen Bonuck
- Department of Family and Social Medicine, Albert Einstein College of
Medicine, USA
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70
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Wang HB, Tahara Y, Luk SHC, Kim YS, Hitchcock ON, MacDowell Kaswan ZA, In Kim Y, Block GD, Ghiani CA, Loh DH, Colwell CS. Melatonin treatment of repetitive behavioral deficits in the Cntnap2 mouse model of autism spectrum disorder. Neurobiol Dis 2020; 145:105064. [PMID: 32889171 PMCID: PMC7597927 DOI: 10.1016/j.nbd.2020.105064] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 08/04/2020] [Accepted: 08/26/2020] [Indexed: 02/07/2023] Open
Abstract
Nighttime light pollution is linked to metabolic and cognitive dysfunction. Many patients with autism spectrum disorders (ASD) show disturbances in their sleep/wake cycle, and may be particularly vulnerable to the impact of circadian disruptors. In this study, we examined the impact of exposure to dim light at night (DLaN, 5 lx) in a model of ASD: the contactin associated protein-like 2 knock out (Cntnap2 KO) mice. DLaN was sufficient to disrupt locomotor activity rhythms, exacerbate the excessive grooming and diminish the social preference in Cntnap2 mutant mice. On a molecular level, DLaN altered the phase and amplitude of PER2:LUC rhythms in a tissue-specific manner in vitro. Daily treatment with melatonin reduced the excessive grooming of the mutant mice to wild-type levels and improved activity rhythms. Our findings suggest that common circadian disruptors such as light at night should be considered in the management of ASD.
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Affiliation(s)
- Huei Bin Wang
- Molecular, Cellular, Integrative Physiology Graduate Program, David Geffen School of Medicine, University of California Los Angeles, USA; Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Yu Tahara
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Shu Hon Christopher Luk
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Yoon-Sik Kim
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Olivia N Hitchcock
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Zoe A MacDowell Kaswan
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Yang In Kim
- Department of Physiology and Neuroscience Research Institute, Korea University College of Medicine, Seoul, Republic of Korea
| | - Gene D Block
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Cristina A Ghiani
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA; Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Dawn H Loh
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA
| | - Christopher S Colwell
- Department of Psychiatry & Biobehavioral Sciences, David Geffen School of Medicine, University of California Los Angeles, USA.
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Lugo J, Fadeuilhe C, Gisbert L, Setien I, Delgado M, Corrales M, Richarte V, Ramos-Quiroga JA. Sleep in adults with autism spectrum disorder and attention deficit/hyperactivity disorder: A systematic review and meta-analysis. Eur Neuropsychopharmacol 2020; 38:1-24. [PMID: 32712061 DOI: 10.1016/j.euroneuro.2020.07.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 07/06/2020] [Indexed: 02/02/2023]
Abstract
Sleep-related problems have been frequently reported in neurodevelopmental disorders, with special emphasis in Autism Spectrum Disorder (ASD) and Attention Deficit/Hyperactivity Disorder (ADHD). The aim of the present study is to conduct a systematic review and meta-analysis on sleep disturbances in adults with ASD and/or ADHD (PROSPERO's CRD42019132916). PubMed and PsycINFO were searched for studies reporting data on sleep objective/subjective measures, as well as prevalence data of sleep disorders, in adults with ASD and/or ADHD. A manual search was conducted throughout reference lists of eligible studies. A total of 1126 studies and 66 references were identified by electronic and manual searches, respectively. Of these, 42 studies were included in the meta-analysis. Results showed that both disorders share a similar sleep-impaired profile with higher sleep onset latency, poorer sleep efficiency, greater number of awakenings during sleep, and a general lower self-perceived sleep quality compared with healthy controls. A higher proportion of N1 sleep was found in ASD participants, while a greater Periodic Limb Movements in Sleep is specific in ADHD adults. More studies are needed, especially those directly comparing ASD and ADHD participants. Controlling for medication, intellectual disability, and concurrent psychiatric disorders is mandatory.
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Affiliation(s)
- Jorge Lugo
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain.
| | - Christian Fadeuilhe
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain
| | - Laura Gisbert
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Imanol Setien
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Mercedes Delgado
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Montserrat Corrales
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Vanesa Richarte
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Psychiatric Genetics Unit, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Catalonia, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain.
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Kamara D, Beauchaine TP. A Review of Sleep Disturbances among Infants and Children with Neurodevelopmental Disorders. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2020; 7:278-294. [PMID: 33344102 PMCID: PMC7747783 DOI: 10.1007/s40489-019-00193-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 12/04/2019] [Indexed: 02/06/2023]
Abstract
Sleep problems are common among children with neurodevelopmental disorders (NDDs). We review sleep disturbance in three major NDDs: autism spectrum disorder, Down syndrome, and fetal alcohol spectrum disorder (FASD). We review associations with functional impairment, discuss how patterns of sleep disturbance inform understanding of etiology, and theorize about mechanisms of impairment. Sleep disturbance is a transdiagnostic feature of NDDs. Caregivers report high rates of sleep problems, including difficulty falling or staying asleep. Polysomnography data reveal differences in sleep architecture and increased rates of sleep disorders. Sleep disturbance is associated with functional impairment and stress among families. Further research is needed to elucidate mechanisms of impairment and develop more effective interventions. Despite significant sleep disturbance in FASD, limited research is available.
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Affiliation(s)
- Dana Kamara
- The Ohio State University, Department of Psychology, 1835 Neil Ave., Columbus, OH 43210
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73
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Alivar A, Carlson C, Suliman A, Warren S, Prakash P, Thompson DE, Natarajan B. Smart bed based daytime behavior prediction in Children with autism spectrum disorder - A Pilot Study. Med Eng Phys 2020; 83:15-25. [PMID: 32807344 DOI: 10.1016/j.medengphy.2020.07.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
Monitoring the sleep patterns of children with autism spectrum disorders (ASD) and understanding how sleep quality influences their daytime behavior is an important issue that has received very limited attention. Polysomnography (PSG) is commonly used as a gold standard for evaluating sleep quality in children and adults. However, the intrusive nature of sensors used as part of PSG can themselves affect sleep and is, therefore, not suitable for children with ASD. In this study, we evaluate an unobtrusive and inexpensive bed system for in-home, long-term sleep quality monitoring using ballistocardiogram (BCG) signals. Using the BCG signals from this smart bed system, we define "restlessness" as a surrogate sleep quality estimator. Using this sleep feature, we build predictive models for daytime behavior based on 1-8 previous nights of sleep. Specifically, we use two supervised machine learning algorithms namely support vector machine (SVM) and artificial neural network (ANN). For all daytime behaviors, we achieve more than 78% and 79% accuracy of correctly predicting behavioral issues with both SVM and ANN classifiers, respectively. Our findings indicate the usefulness of our designed bed system and how the restlessness feature can improve the prediction performance.
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Affiliation(s)
- Alaleh Alivar
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Charles Carlson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Ahmad Suliman
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Steve Warren
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - David E Thompson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Balasubramaniam Natarajan
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
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Tse AC, Yu C, Lee PH. Comparing sleep patterns between children with autism spectrum disorder and children with typical development: A matched case-control study. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2020; 24:2298-2303. [PMID: 32631069 DOI: 10.1177/1362361320936827] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
LAY ABSTRACT This study compared the sleep pattern between children with autism spectrum disorders and children with typical development using a matched case-control design (matched age, gender, and body mass index). Significant differences were found in night-time sleep duration (total amount of sleep at night), sleep efficiency (percentage of time spent asleep), sleep-onset latency (length of time that it takes to transit from awake to asleep), and wake after sleep onset (total amount of time spent awake after defined sleep onset). Findings showed that children with autism spectrum disorder had poorer sleep quality than children with typical development. Mechanisms underlying the differences should be further explored in order to develop an effective treatment intervention.
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Affiliation(s)
- Andy Cy Tse
- The Education University of Hong Kong, Hong Kong
| | - Ccw Yu
- The Hong Kong Polytechnic University, Hong Kong
| | - Paul H Lee
- The Hong Kong Polytechnic University, Hong Kong
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Wintler T, Schoch H, Frank M, Peixoto L. Sleep, brain development, and autism spectrum disorders: Insights from animal models. J Neurosci Res 2020; 98:1137-1149. [PMID: 32215963 PMCID: PMC7199437 DOI: 10.1002/jnr.24619] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 02/07/2020] [Accepted: 02/29/2020] [Indexed: 01/28/2023]
Abstract
Sleep is an evolutionarily conserved and powerful drive, although its complete functions are still unknown. One possible function of sleep is that it promotes brain development. The amount of sleep is greatest during ages when the brain is rapidly developing, and sleep has been shown to influence critical period plasticity. This supports a role for sleep in brain development and suggests that abnormal sleep in early life may lead to abnormal development. Autism spectrum disorder (ASD) is the most prevalent neurodevelopmental disorder in the United States. It is estimated that insomnia affects 44%-86% of the ASD population, predicting the severity of ASD core symptoms and associated behavioral problems. Sleep problems impact the quality of life of both ASD individuals and their caregivers, thus it is important to understand why they are so prevalent. In this review, we explore the role of sleep in early life as a causal factor in ASD. First, we review fundamental steps in mammalian sleep ontogeny and regulation and how sleep influences brain development. Next, we summarize current knowledge gained from studying sleep in animal models of ASD. Ultimately, our goal is to highlight the importance of understanding the role of sleep in brain development and the use of animal models to provide mechanistic insight into the origin of sleep problems in ASD.
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Affiliation(s)
- Taylor Wintler
- Washington State University Elson S Floyd College of Medicine, Biomedical Sciences Spokane, WA, 99202USA
| | - Hannah Schoch
- Washington State University Elson S Floyd College of Medicine, Biomedical Sciences Spokane, WA, 99202USA
| | - Marcos Frank
- Washington State University Elson S Floyd College of Medicine, Biomedical Sciences Spokane, WA, 99202USA
| | - Lucia Peixoto
- Washington State University Elson S Floyd College of Medicine, Biomedical Sciences Spokane, WA, 99202USA
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Jovevska S, Richdale AL, Lawson LP, Uljarević M, Arnold SR, Trollor JN. Sleep Quality in Autism from Adolescence to Old Age. AUTISM IN ADULTHOOD 2020; 2:152-162. [PMID: 36601570 PMCID: PMC8992849 DOI: 10.1089/aut.2019.0034] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background Sleep problems are common in autism from early childhood. Although research suggests that poor sleep continues at least into early middle age, the pattern of sleep problems has rarely been characterized beyond childhood. The aim of this study was to examine sleep quality from adolescence to old age in autistic individuals as compared with age-matched non-autistic comparison groups from the general population. Methods Participants ranged from 15 to 80 years; there were 297 participants in the autistic group (mean [M]age = 34.36 years, standard deviation [SD] = 15.24), and the comparison group had 233 participants (Mage = 33.01 years, SD = 15.53). Sleep quality, sleep onset latency (SoL), total night sleep, and sleep efficiency as measured by Pittsburgh Sleep Quality Index were compared between groups and across age groups (15-19, 20-39, 40-59, 60+ years). Five predictors of sleep quality (autistic traits, mental health condition, medication, employment, and sex) were also examined. Results Overall, problematic sleep was more common for the autistic participants (63.7%) than the comparison group (46.4%), and autistic participants had poorer sleep quality and longer SoL (all p < 0.001). In early adulthood and middle age, autistic adults had significantly poorer sleep quality and longer SoL than similar age comparison group adults; autistic and comparison group adolescents and the elderly did not differ. In the autistic group, predictors accounted for 21% of sleep quality variance. Sex (p < 0.001) was the strongest predictor, with all predictors except employment contributing unique variance. In the comparison group, predictors accounted for 25% of the variance in sleep quality. The strongest predictor was mental health condition (p < 0.001), with all predictors except sex contributing unique variance. Conclusions Autistic adolescents and adults, particularly females, remain vulnerable to sleep problems, with early and middle adulthood being at times of particular risk. Targeted sleep interventions are required. Lay summary Why was this study done?: Difficulty sleeping is a common occurrence among autistic individuals, but we know very little about sleep in autistic adults.What was the purpose of the study?: To compare self-reported sleep quality in autistic and non-autistic people aged 15 to 80 years.What did the researchers do?: Online surveys were completed by 297 autistic individuals (average age 34.36 years) and 233 non-autistic individuals (average age 33.01 years). Participants were asked questions about their sleep quality, the time it takes them to fall asleep (sleep latency), and the number of hours of sleep they usually get each night (total sleep). Using information about how long they slept and their responses to questions about their bedtime and wake time we calculated the percentage of time they spent in bed asleep (sleep efficiency [SE]). We compared these sleep measures between the autistic and non-autistic participants. We also split the participants into four age groups (15-19, 20-39, 40-59, and 60+ years) to look at any differences at specific age points. Finally, we looked to see whether autistic symptoms, having a mental health problem, being on medication, being unemployed, and/or sex (male/female) predicted sleep quality.What were the results of the study?: Poor sleep quality was more common for the autistic participants (63.7%) than non-autistic participants (46.4%). On average, autistic participants also had poorer sleep quality scores and it took them longer to fall asleep than non-autistic participants. Autistic participants in early adulthood (20-39) and middle age (40-59) had poorer sleep quality and took longer to fall asleep than non-autistic adults of the same age. There were no differences between autistic and non-autistic adolescents (15-19) or older adults (60+). For autistic participants, the best predictor of poor sleep quality was being female; other predictors of poor sleep quality were having a mental health problem, more autistic symptoms, and being on medication. Among non-autistic participants, the best predictor of poor sleep quality was having a mental health problem; other predictors were more autistic symptoms, being on medication, and being unemployed.What do these findings add to what is already known?: Similar to the findings in autistic children, autistic adults are more likely to have poor sleep quality compared with non-autistic adults. Autistic females are particularly at risk for poor sleep, and autistic adults aged 20 to 59 years are more at risk for poor sleep quality.What are potential weaknesses in the study?: Sleep was measured by using a self-report questionnaire, which is not as reliable as using a sleep diary or other objective measures of sleep (e.g., actigraphy). In addition, this study only looked at data collected at one point in time, and as such it is not possible to examine changes over time in sleep quality among autistic adults.How will these findings help autistic adults now or in the future?: The findings in this study identified that sleep difficulties persist across the lifespan for autistic adults. Therefore, there is a critical need for future research to focus on understanding the cause of poor sleep quality in autism and develop sleep interventions for autistic adults.
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Affiliation(s)
- Sanya Jovevska
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia.,Autism Cooperative Research Centre, University of Queensland, Brisbane, Australia
| | - Amanda L. Richdale
- Autism Cooperative Research Centre, University of Queensland, Brisbane, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia.,Address correspondence to: Amanda L. Richdale, BAppSc, MBehavSc (Prelim), PhD, Olga Tennison Autism Research Centre, La Trobe University, Melbourne 3086, Victoria, Australia
| | - Lauren P. Lawson
- Autism Cooperative Research Centre, University of Queensland, Brisbane, Australia.,Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia
| | - Mirko Uljarević
- Olga Tennison Autism Research Centre, La Trobe University, Melbourne, Australia.,Melbourne School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University, Stanford, California, USA
| | - Samuel R.C. Arnold
- Autism Cooperative Research Centre, University of Queensland, Brisbane, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
| | - Julian N. Trollor
- Autism Cooperative Research Centre, University of Queensland, Brisbane, Australia.,Department of Developmental Disability Neuropsychiatry, School of Psychiatry, University of New South Wales, Sydney, Australia
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Hossain MM, Khan N, Sultana A, Ma P, McKyer ELJ, Ahmed HU, Purohit N. Prevalence of comorbid psychiatric disorders among people with autism spectrum disorder: An umbrella review of systematic reviews and meta-analyses. Psychiatry Res 2020; 287:112922. [PMID: 32203749 DOI: 10.1016/j.psychres.2020.112922] [Citation(s) in RCA: 195] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 03/15/2020] [Indexed: 12/25/2022]
Abstract
With ever-increasing prevalence of various mental disorders worldwide, a comprehensive evaluation of the prevalence of co-occurring psychiatric disorders among individuals with autism spectrum disorder (ASD) is needed to strengthen the knowledge base. This umbrella review aims to summarize the current evidence on the prevalence of comorbid psychiatric disorders among people with ASD. A systematic search of 12 major databases and additional sources was conducted. Any systematically conducted narrative, qualitative, or meta-analytic review reporting the prevalence of psychiatric disorders among people with ASD with no age or geographical restriction were included. From a total of 2755 records, 26 articles representing 14 systematic reviews and 12 meta-analyses met the criteria of this review. The synthesized findings reveal a high burden of comorbid psychiatric disorders among people with ASD, including anxiety disorders, depressive disorders, bipolar and mood disorders, schizophrenia spectrum, suicidal behavior disorders, attention-deficit/hyperactivity disorder, disruptive, impulse-control and conduct disorders amongst diverse age groups, with a majority in younger participants. Most studies were conducted in developed nations, with limited evidence from low and middle-income countries. These synthesized findings provide high-quality evidence for clinical and policy-level decision-making from a global overview of the status of comorbid psychiatric disorders among people with ASD.
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Affiliation(s)
- Md Mahbub Hossain
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA.
| | - Nusrat Khan
- Department of Public Health and Primary Care, University of Cambridge, UK
| | | | - Ping Ma
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA
| | - E Lisako J McKyer
- Department of Health Promotion and Community Health Sciences, School of Public Health, Texas A&M University, TX 77843, USA
| | - Helal Uddin Ahmed
- National Institute of Mental Health (NIMH), Sher-E-Bangla Nagar, Dhaka, 1207 Bangladesh
| | - Neetu Purohit
- The IIHMR University, Jaipur, Rajasthan 302029, India
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78
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Bangerter A, Chatterjee M, Manyakov NV, Ness S, Lewin D, Skalkin A, Boice M, Goodwin MS, Dawson G, Hendren R, Leventhal B, Shic F, Esbensen A, Pandina G. Relationship Between Sleep and Behavior in Autism Spectrum Disorder: Exploring the Impact of Sleep Variability. Front Neurosci 2020; 14:211. [PMID: 32265629 PMCID: PMC7105870 DOI: 10.3389/fnins.2020.00211] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 02/26/2020] [Indexed: 11/13/2022] Open
Abstract
Objective The relationship between sleep (caregiver-reported and actigraphy-measured) and other caregiver-reported behaviors in children and adults with autism spectrum disorder (ASD) was examined, including the use of machine learning to identify sleep variables important in predicting anxiety in ASD. Methods Caregivers of ASD (n = 144) and typically developing (TD) (n = 41) participants reported on sleep and other behaviors. ASD participants wore an actigraphy device at nighttime during an 8 or 10-week non-interventional study. Mean and variability of actigraphy measures for ASD participants in the week preceding midpoint and endpoint were calculated and compared with caregiver-reported and clinician-reported symptoms using a mixed effects model. An elastic-net model was developed to examine which sleep measures may drive prediction of anxiety. Results Prevalence of caregiver-reported sleep difficulties in ASD was approximately 70% and correlated significantly (p < 0.05) with sleep efficiency measured by actigraphy. Mean and variability of actigraphy measures like sleep efficiency and number of awakenings were related significantly (p < 0.05) to ASD symptom severity, hyperactivity and anxiety. In the elastic net model, caregiver-reported sleep, and variability of sleep efficiency and awakenings were amongst the important predictors of anxiety. Conclusion Caregivers report problems with sleep in the majority of children and adults with ASD. Reported problems and actigraphy measures of sleep, particularly variability, are related to parent reported behaviors. Measuring variability in sleep may prove useful in understanding the relationship between sleep problems and behavior in individuals with ASD. These findings may have implications for both intervention and monitoring outcomes in ASD.
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Affiliation(s)
- Abigail Bangerter
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - Meenakshi Chatterjee
- Computational Biology, Discovery Sciences, Janssen Research & Development, Spring House, PA, United States
| | - Nikolay V Manyakov
- Computational Biology, Discovery Sciences, Janssen Research & Development, Beerse, Belgium
| | - Seth Ness
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - David Lewin
- Statistically Speaking Consulting, LLC, Chicago, IL, United States
| | - Andrew Skalkin
- Computational Biology, Discovery Sciences, Janssen Research & Development, Spring House, PA, United States
| | - Matthew Boice
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
| | - Matthew S Goodwin
- Department of Health Sciences, Bouvé College of Health Sciences, Northeastern University, Boston, MA, United States
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke Center for Autism and Brain Development, Duke University School of Medicine, Durham, NC, United States
| | - Robert Hendren
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Bennett Leventhal
- Department of Psychiatry, School of Medicine, University of California, San Francisco, San Francisco, CA, United States
| | - Frederick Shic
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, WA, United States.,Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Anna Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States.,University of Cincinnati, College of Medicine, Cincinnati, OH, United States
| | - Gahan Pandina
- Neuroscience Therapeutic Area, Janssen Research & Development, Titusville, NJ, United States
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79
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Abstract
Autism spectrum disorder is a neurodevelopmental disorder characterized by social interaction and communication disorder and restrictive and repetitive behaviors. Sleep disorders are frequently observed in children with autism spectrum disorder. We present a case of hypothermia in an autistic child with a sleep disorder whose body temperature decreased to 34°C after a single dose of melatonin. Hypothermia continued for 2 more days, but her nighttime sleeping problems decreased. This case is important because it demonstrates the possible risk of hypothermia with melatonin use in children with autism with a sleep disorder.
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80
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Smith ACM, Morse RS, Introne W, Duncan WC. Twenty-four-hour motor activity and body temperature patterns suggest altered central circadian timekeeping in Smith-Magenis syndrome, a neurodevelopmental disorder. Am J Med Genet A 2020; 179:224-236. [PMID: 30690916 DOI: 10.1002/ajmg.a.61003] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 09/04/2018] [Accepted: 10/22/2018] [Indexed: 01/21/2023]
Abstract
Smith-Magenis syndrome (SMS) is a contiguous gene syndrome linked to interstitial microdeletion, or mutation of RAI1, within chromosome 17p11.2. Key behavioral features of SMS include intellectual disability, sleep-disturbances, maladaptive, aggressive and self-injurious behaviors, hyperactivity, and sudden changes in mood. A distinguishing feature of this syndrome is an inverted pattern of melatonin characterized by elevated daytime and low nighttime melatonin levels. As the central circadian clock controls the 24-hr rhythm of melatonin, we hypothesized that the clock itself may contribute to the disrupted pattern of melatonin and sleep. In this report, 24-hr patterns of body temperature, a surrogate marker of clock-timing, and continuous wrist activity were collected to examine the links between body temperature, sleep behavior, and the circadian clock. In addition, age-dependent changes in sleep behavior were explored. Actigraphy-estimated sleep time for SMS was 1 hr less than expected across all ages studied. The timing of the 24-hr body temperature (Tb-24) rhythm was phase advanced, but not inverted. Compared to sibling (SIB) controls, the SMS group had less total night sleep, lower sleep efficiency, earlier sleep onset, earlier final awake times, increased waking after sleep onset (WASO), and increased daytime nap duration. The timing of wake onset varied with age, providing evidence of ongoing developmental sleep changes from childhood through adolescence. Clarification of the circadian and developmental factors that contribute to the disrupted and variable sleep patterns in this syndrome will be helpful in identifying more effective individualized treatments.
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Affiliation(s)
- Ann C M Smith
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Rebecca S Morse
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Wendy Introne
- Office of the Clinical Director, Division of Intramural Research at the National Human Genome Research Institute, National Institutes of Health, Bethesda, Maryland
| | - Wallace C Duncan
- Division of Intramural Research at the National Institute of Mental Health, National Institutes of Health, Bethesda, Maryland
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81
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The Prevalence of Insomnia and the Link between Iron Metabolism Genes Polymorphisms, TF rs1049296 C>T, TF rs3811647 G>A, TFR rs7385804 A>C, HAMP rs10421768 A>G and Sleep Disorders in Polish Individuals with ASD. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020400. [PMID: 31936202 PMCID: PMC7014185 DOI: 10.3390/ijerph17020400] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 12/31/2019] [Accepted: 01/06/2020] [Indexed: 02/07/2023]
Abstract
Iron deficiency have been found to be linked to sleep disorders. Both genetic and environmental factors are risk factors for skewed iron metabolism, thus sleep disruptions in autism spectrum disorders (ASD). The aim of our study was to assess the prevalence of single nucleotide polymorphisms (SNPs) within transferrin gene (TF) rs1049296 C>T, rs3811647 G>A, transferrin receptor gene (TFR) rs7385804 A>C, and hepcidin antimicrobial peptide gene (HAMP) rs10421768 A>G in Polish individuals with ASD and their impact on sleep pattern. There were 61 Caucasian participants with ASD and 57 non-ASD controls enrolled. Genotypes were determined by real-time PCR using TaqMan SNP assays. The Athens Insomnia Scale (AIS) was used to identify sleep disruptions. There were 32 cases (57.14%) with insomnia identified. In the ASD group, the defined counts of genotypes were as follows: TF rs1049296, C/C n = 41 and C/T n = 20; TF rs3811647, G/G n = 22, G/A n = 34, and A/A n = 5; TFR rs7385804, A/A n = 22, A/C n = 29, and C/C n = 10; and HAMP rs10421768, A/A n = 34, A/G n = 23, and G/G n = 4. There were no homozygous carriers of the TF rs1049296 C>T minor allele in the ASD group. All analyzed SNPs were not found to be linked to insomnia. The investigated polymorphisms are not predictors of sleep disorders in the analyzed cohort of individuals with ASD.
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82
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Lasheras I, Seral P, Latorre E, Barroso E, Gracia-García P, Santabárbara J. Microbiota and gut-brain axis dysfunction in autism spectrum disorder: Evidence for functional gastrointestinal disorders. Asian J Psychiatr 2020; 47:101874. [PMID: 31785441 DOI: 10.1016/j.ajp.2019.101874] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 11/04/2019] [Accepted: 11/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The high frequency of functional gastrointestinal disorders (FGIDs) in autism spectrum disorders (ASD) has drawn attention to the composition of gut microbiota as a possible factor in ASD pathogenesis. However, characterization of a distinctive ASD microbial pattern is still unclear. OBJECTIVE To conduct a narrative review on ASD microbial profile and diversity changes relative to NT children and FGID comorbidity and ASD pathogenesis. METHODOLOGY First, we searched the PubMed database in peer-reviewed journals for evidence regarding the current epidemiological evidence on FGID comorbidity. For the identification of a microbial profile in ASD children, only original studies examining gut bacterial and fungal abundances and diversity in ASD children and adolescents were included. Lastly, research on the role of microbial dysbiosis as an interface between genetic and environmental risk factors in the pathogenesis of neuropsychiatric disorders, and specifically ASD, was examined. RESULTS Prevalence and risk of FGIDs is significantly higher in ASD children and correlates with the severity of ASD. Bacterial and fungal diversity differ between ASD and NT children, indicating a difference in taxonomic abundance profiles, which have been reported at all bacterial phylogenetic levels. However, studies analyzing gut microbiota have a heterogeneous methodology and several limitations that could account for the variety of findings for each taxon. Also, covariate analysis reveals influence of demographics, diet, disease severity, GI comorbidity and allergies. Integration of these findings with changes in metabolome and genetic risk factors allowed for a better understanding of microbiota involvement in ASD pathogenesis for future research.
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Affiliation(s)
- I Lasheras
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - P Seral
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain
| | - E Latorre
- Department of Biochemistry and Molecular and Cell Biology, Universidad de Zaragoza, Zaragoza, Spain; Instituto Agroalimentario de Aragón - IA2- (Universidad de Zaragoza - CITA), Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain.
| | - E Barroso
- Instituto de Investigación en Ciencias de la Alimentación, CIAL (CSIC-UAM), Madrid, Spain
| | - P Gracia-García
- Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Psychiatry Service, Hospital Clínico Universitario Miguel Servet, Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
| | - J Santabárbara
- Department of Preventive Medicine and Public Health, Universidad de Zaragoza, Zaragoza, Spain; Instituto de Investigación Sanitaria de Aragón (IIS Aragón), Zaragoza, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Ministry of Science and Innovation, Madrid, Spain
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83
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Koo HW, Ismail J, Yang WW, Syed Zakaria SZ. Sleep Disturbances in Children With Autism Spectrum Disorder at a Malaysian Tertiary Hospital. Front Pediatr 2020; 8:608242. [PMID: 33537265 PMCID: PMC7849202 DOI: 10.3389/fped.2020.608242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Children with autism spectrum disorder (ASD) have a variety of co-morbid medical problems, including sleep disturbances. Prevalence of sleep disorders has been reported to be higher in this group as compared to the general population. Identifying sleep problems in children with ASD may help increase awareness and improve the overall quality of care for them. The aim of this study was to determine the prevalence of sleep problems and associated factors in a group of Malaysian children aged 6-16 years, with ASD. Method: This is a cross-sectional study at the Child Development Centre of UKM Medical Centre (UKM MC) on ASD children aged 6-16 years. Demographic data was obtained and the Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. Logistic regression analysis was used to determine factors related to higher total SDSC scores. Results: A total of 128 patients were recruited (111 boys) with a median age of 8 years 3 months (IQR: 2 years 10 months). Forty-seven (36.7%) of them obtained total SDSC scores in the pathological range with 19 (14.8%) scoring high for overall disturbances and 28 (21.9%) for at least one subtype of sleep disorders: 25 (19.5%) DIMS, 18 (14.1%) SBD, 10 (7.8%) DOES, 5 (3.9%) DOA, 6 (4.7%) SWTD, and 3 (2.3%) SHY. More than half of the children (57.8%) were reported to have sufficient sleep duration of 8-11 h, but longer sleep latency of at least 15 min (82.8%). Half of the ASD children also had co-morbidities in which one-third (34.4%) had attention-deficit hyperactivity disorder (ADHD). Using logistic regression analysis, four factors were significantly associated with higher total SDSC scores; female gender (p = 0.016), older age group (11-16 years old) (p = 0.039), shorter sleep length (p = 0.043), and longer sleep latency (p < 0.001). Conclusion: The prevalence of sleep disturbances is high among Malaysian children with ASD, especially DIMS. Female gender, older age group, shorter sleep length, and longer sleep latency were found to be associated with the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with ASD.
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Affiliation(s)
- Ho Wai Koo
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Juriza Ismail
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Wai Wai Yang
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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84
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Missig G, McDougle CJ, Carlezon WA. Sleep as a translationally-relevant endpoint in studies of autism spectrum disorder (ASD). Neuropsychopharmacology 2020; 45:90-103. [PMID: 31060044 PMCID: PMC6879602 DOI: 10.1038/s41386-019-0409-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Revised: 04/16/2019] [Accepted: 04/19/2019] [Indexed: 02/07/2023]
Abstract
Sleep has numerous advantages for aligning clinical and preclinical (basic neuroscience) studies of neuropsychiatric illness. Sleep has high translational relevance, because the same endpoints can be studied in humans and laboratory animals. In addition, sleep experiments are conducive to continuous data collection over long periods (hours/days/weeks) and can be based on highly objective neurophysiological measures. Here, we provide a translationally-oriented review on what is currently known about sleep in the context of autism spectrum disorder (ASD), including ASD-related conditions, thought to have genetic, environmental, or mixed etiologies. In humans, ASD is frequently associated with comorbid medical conditions including sleep disorders. Animal models used in the study of ASD frequently recapitulate dysregulation of sleep and biological (diurnal, circadian) rhythms, suggesting common pathophysiologies across species. As our understanding of the neurobiology of ASD and sleep each become more refined, it is conceivable that sleep-derived metrics may offer more powerful biomarkers of altered neurophysiology in ASD than the behavioral tests currently used in humans or lab animals. As such, the study of sleep in animal models for ASD may enable fundamentally new insights on the condition and represent a basis for strategies that enable the development of more effective therapeutics.
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Affiliation(s)
- Galen Missig
- 0000 0000 8795 072Xgrid.240206.2Basic Neuroscience Division, Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA USA
| | - Christopher J. McDougle
- 0000 0004 0386 9924grid.32224.35Lurie Center for Autism, Massachusetts General Hospital, Lexington, MA USA ,000000041936754Xgrid.38142.3cDepartment of Psychiatry, Harvard Medical School, Boston, MA USA
| | - William A. Carlezon
- 0000 0000 8795 072Xgrid.240206.2Basic Neuroscience Division, Department of Psychiatry, Harvard Medical School, McLean Hospital, Belmont, MA USA
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85
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Morgan B, Nageye F, Masi G, Cortese S. Sleep in adults with Autism Spectrum Disorder: a systematic review and meta-analysis of subjective and objective studies. Sleep Med 2020; 65:113-120. [DOI: 10.1016/j.sleep.2019.07.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 12/20/2022]
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86
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Knowland VCP, Fletcher F, Henderson LM, Walker S, Norbury CF, Gaskell MG. Sleep Promotes Phonological Learning in Children Across Language and Autism Spectra. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2019; 62:4235-4255. [PMID: 31770054 DOI: 10.1044/2019_jslhr-s-19-0098] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Purpose Establishing stable and flexible phonological representations is a key component of language development and one which is thought to vary across children with neurodevelopmental disorders affecting language acquisition. Sleep is understood to support the learning and generalization of new phonological mappings in adults, but this remains to be examined in children. This study therefore explored the time course of phonological learning in childhood and how it varies by structural language and autism symptomatology. Method Seventy-seven 7- to 13-year-old children, 30 with high autism symptomatology, were included in the study; structural language ability varied across the sample. Children learned new phonological mappings based on synthesized speech tokens in the morning; performance was then charted via repetition (without feedback) over 24 hr and followed up 4 weeks later. On the night following learning, children's sleep was monitored with polysomnography. Results A period of sleep but not wake was associated with improvement on the phonological learning task in childhood. Sleep was associated with improved performance for both trained items and novel items. Structural language ability predicted overall task performance, though language ability did not predict degree of change from one session to the next. By contrast, autism symptomatology did not explain task performance. With respect to sleep architecture, rapid eye movement features were associated with greater phonological generalization. Conclusions Children's sleep was associated with improvement in performance on both trained and novel items. Phonological generalization was associated with brain activity during rapid eye movement sleep. This study furthers our understanding of individual differences in the acquisition of new phonological mappings and the role of sleep in this process over childhood. Supplemental Material https://doi.org/10.23641/asha.11126732.
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Affiliation(s)
| | - Fay Fletcher
- Department of Psychology, University of York, United Kingdom
| | | | - Sarah Walker
- Department of Psychology, University of York, United Kingdom
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87
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Deliens G, Peigneux P. Sleep-behaviour relationship in children with autism spectrum disorder: methodological pitfalls and insights from cognition and sensory processing. Dev Med Child Neurol 2019; 61:1368-1376. [PMID: 30968406 DOI: 10.1111/dmcn.14235] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/20/2019] [Indexed: 11/30/2022]
Abstract
Sleep disturbances are frequent and varied in autism spectrum disorder (ASD). Growing evidence suggests that sleep problems in children with ASD are driven by their clinical characteristics and psychiatric comorbidities. Therefore, the wide range of reported sleep disturbances reflects the marked heterogeneity of clinical pictures in ASD. Whether sleep disturbances and their various forms may, in turn, account for at least part of the phenotypical variability of ASD is a crucial question discussed in this review. We first outline studies both validating and challenging a bidirectional theoretical framework for sleep disorders in children with ASD. We then propose to extend this model by including cognition and sensory processing as key factors in the vicious circle linking sleep disorders and autistic symptoms. WHAT THIS PAPER ADDS: There is a bidirectional interplay between autism symptoms and sleep disturbances. Sleep influence on daytime cognitive and sensory skills should be further investigated.
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Affiliation(s)
- Gaétane Deliens
- Autism in Context: Theory and Experiment (ACTE), Center for Research in Linguistics (LaDisco), Université Libre de Bruxelles, Brussels, Belgium.,Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Peigneux
- Neuroscience Institute, Université Libre de Bruxelles, Brussels, Belgium.,Neuropsychology and Functional Neuroimaging Research Group, Center for Research in Cognition and Neurosciences, Université Libre de Bruxelles, Brussels, Belgium
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88
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Papadopoulos N, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Engel L, Fuller-Tyszkiewicz M, Bellows ST, Marks D, Howlin P, Rinehart N. Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD. BMJ Open 2019; 9:e029767. [PMID: 31748288 PMCID: PMC6887021 DOI: 10.1136/bmjopen-2019-029767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child's socio-emotional functioning, as well as on parents' psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children's sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed. METHODS AND ANALYSIS The RCT aims to recruit 234 children with a diagnosis of ASD, aged 5-13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child's sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children's sleep problems as measured by the Children's Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated. ETHICS AND DISSEMINATION Findings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online. TRIAL REGISTRATION NUMBER ISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Affiliation(s)
| | - Emma Sciberras
- Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | | | - Lidia Engel
- Deakin University, Geelong, Victoria, Australia
| | | | | | - Deborah Marks
- Deakin University, Geelong, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Patricia Howlin
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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89
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How did I get so late so soon? A review of time processing and management in autism. Behav Brain Res 2019; 374:112121. [DOI: 10.1016/j.bbr.2019.112121] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/30/2022]
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90
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Tomkies A, Johnson RF, Shah G, Caraballo M, Evans P, Mitchell RB. Obstructive Sleep Apnea in Children With Autism. J Clin Sleep Med 2019; 15:1469-1476. [PMID: 31596212 PMCID: PMC6778353 DOI: 10.5664/jcsm.7978] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 06/04/2019] [Accepted: 06/04/2019] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES To describe the demographic and clinical characteristics of children with autism spectrum disorder (ASD) referred for polysomnography (PSG) and to look for predictors of obstructive sleep apnea (OSA) and severe OSA in these children. METHODS This is a retrospective case series of children ages 2 to 18 years who underwent PSG between January 2009 and February 2015. Children were excluded if they had major comorbidities, prior tonsillectomy, or missing data. The following information was collected: age, sex, race, height, weight, tonsil size, and prior diagnosis of allergies, asthma, gastroesophageal reflux disease, seizure disorder, developmental delay, cerebral palsy, or attention deficit hyperactivity disorder. Predictors of OSA were evaluated. RESULTS A total of 45 children were included with a mean (standard deviation [SD]) age of 6.1 years (2.8). The patients were 80% male, 49% Hispanic, 27% African American, 22% Caucasian, and 2.2% other. Of these children 26 (58%) had OSA (apnea-hypopnea index [AHI] > 1 event/h) and 15 (33%) were obese (body mass index, body mass index z-score ≥ 95th percentile). The mean (SD) AHI was 7.7 (15.0) events/h (range 1.0-76.6). A total of 9 (20%) had severe OSA (AHI ≥ 10 events/h). There were no demographic or clinical predictors of OSA in this group. However, increasing weight served as a predictor of severe OSA and African American or Hispanic children were more likely obese. CONCLUSIONS The absence of demographic or clinical predictors of OSA supports using general indications for PSG in children with ASD.
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Affiliation(s)
- Anna Tomkies
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
| | - Romaine F. Johnson
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
| | - Gopi Shah
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
| | - Michelle Caraballo
- Division of Respiratory Medicine, Department of Pediatrics, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
| | - Patricia Evans
- Division of Neurology, Department of Pediatrics, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
| | - Ron B. Mitchell
- Division of Pediatric Otolaryngology, Department of Otolaryngology, Head and Neck Surgery, University of Texas Southwestern Medical Center and Children’s Health, Dallas, Texas
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91
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Schroder CM, Malow BA, Maras A, Melmed RD, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Pediatric Prolonged-Release Melatonin for Sleep in Children with Autism Spectrum Disorder: Impact on Child Behavior and Caregiver's Quality of Life. J Autism Dev Disord 2019; 49:3218-3230. [PMID: 31079275 PMCID: PMC6647439 DOI: 10.1007/s10803-019-04046-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
A randomized, 13-weeks, placebo-controlled double-blind study in 125 subjects aged 2-17.5 years with Autism Spectrum Disorder or Smith-Magenis syndrome and insomnia demonstrated efficacy and safety of easily-swallowed prolonged-release melatonin mini-tablets (PedPRM; 2-5 mg) in improving sleep duration and onset. Treatment effects on child behavior and caregiver's quality of life were evaluated. PedPRM treatment resulted in significant improvement in externalizing but not internalizing behavior (Strengths and Difficulties questionnaire; SDQ) compared to placebo (p = 0.021) with clinically-relevant improvements in 53.7% of PedPRM-treated versus 27.6% of placebo-treated subjects (p = 0.008). Caregivers' quality of life also improved with PedPRM versus placebo (p = 0.010) and correlated with the change in total SDQ (p = 0.0005). PedPRM alleviates insomnia-related difficulties, particularly externalizing behavior in the children, subsequently improving caregivers' quality of life.
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Affiliation(s)
- Carmen M Schroder
- Department of Child and Adolescent Psychiatry & CIRCSom, Strasbourg University Hospital, Strasbourg, France.,CNRS UPR 3212, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Beth A Malow
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Dordrecht, Delft, The Netherlands
| | - Raun D Melmed
- Southwest Autism Research and Resource Center, Scottsdale, Phoenix, AZ, USA
| | - Robert L Findling
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins University, Baltimore, MD, USA
| | | | - Tali Nir
- Neurim Pharmaceuticals Ltd, Tel Aviv, Israel
| | | | | | - Paul Gringras
- Children's Sleep Medicine, Evelina London Children's Hospital, Guy's and St Thomas', London, UK
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92
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Modification of the Children's Sleep Habits Questionnaire for Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:2629-2641. [PMID: 29500758 DOI: 10.1007/s10803-018-3520-2] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children's Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 children (age 4-10 years) enrolled in the Autism Treatment Network. A four-factor solution (Sleep Initiation and Duration, Sleep Anxiety/Co-Sleeping, Night Waking/Parasomnias, and Daytime Alertness) with 5-6 items per factor explained 75% of the total variation. Ten items failed to load on any factor. This abbreviated 23-item four-factor version of this measure may be useful when assessing sleep in children with ASD.
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93
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Course and Predictors of Sleep and Co-occurring Problems in Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 49:2101-2115. [PMID: 30684086 DOI: 10.1007/s10803-019-03894-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The chronicity of sleep disturbance and its relation to co-occurring symptoms in children with autism spectrum disorder (ASD) are not well understood. The current study examined longitudinal relations among sleep and co-occurring symptoms in a large well-characterized sample of 437 children with ASD assessed at baseline and follow-up (M = 3.8 years later). Twenty-three percent experienced worsening sleep problems over time, while 31.5% showed improvement. Path analysis indicated that sleep problems at baseline predicted later development of ADHD symptoms in younger children and somatic complaints in older children. For younger children, sensory over-responsivity predicted future sleep problems. Findings suggest that sensory over-reactivity may contribute to sleep problems in some children with ASD, and that sleep problems may result in poor daytime functioning.
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94
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Naito N, Kikuchi M, Yoshimura Y, Kumazaki H, Kitagawa S, Ikeda T, Hasegawa C, Saito DN, Tomiyama S, Minabe Y. Atypical body movements during night in young children with autism spectrum disorder: a pilot study. Sci Rep 2019; 9:6999. [PMID: 31061424 PMCID: PMC6502823 DOI: 10.1038/s41598-019-43397-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 04/23/2019] [Indexed: 11/16/2022] Open
Abstract
Children with autism spectrum disorder (ASD) reportedly suffer from sleep problems at a higher rate than typically developing (TD) children. Several previous studies have reported differences in sleep indices (e.g., sleep latency) in children with ASD. However, no previous studies have focused specifically on the time course of body movements. In the present study, we investigated the time course of body movements in young TD children and young children with ASD as well as the relationship between body movements during night and social ability. Seventeen TD children and 17 children with ASD participated in this study (5 to 8 years old). We used an accelerometer attached to the waist to record movements during night and measured the average time course of body movements for 3 nights. Our results demonstrated that the rate of body movement 2 to 3 hours after the onset of body stillness was higher in children with ASD than in TD children. In addition, the higher rate of body movement at 0.5 to 1 hour after the onset of body stillness was associated with a lower social ability in the children with ASD. Our results suggested that the time course of body movements is an objective behavioural index for young children with ASD.
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Affiliation(s)
- Nobushige Naito
- Department of Psychiatry & Behavioral Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Mitsuru Kikuchi
- Department of Psychiatry & Behavioral Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, 920-8640, Japan. .,Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan.
| | - Yuko Yoshimura
- Institute of Human and Social Sciences, Kanazawa University, Kanazawa, 920-1192, Japan
| | - Hirokazu Kumazaki
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Sachiko Kitagawa
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Takashi Ikeda
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Chiaki Hasegawa
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Daisuke N Saito
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Sarah Tomiyama
- Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
| | - Yoshio Minabe
- Department of Psychiatry & Behavioral Science, Graduate School of Medical Science, Kanazawa University, Kanazawa, 920-8640, Japan.,Research Center for Child Mental Development, Kanazawa University, Kanazawa, 920-8640, Japan
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95
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Johansson AEE, Dorman JS, Chasens ER, Feeley CA, Devlin B. Variations in Genes Related to Sleep Patterns in Children With Autism Spectrum Disorder. Biol Res Nurs 2019; 21:335-342. [DOI: 10.1177/1099800419843604] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Background: Sleep disturbance is a frequent comorbidity in children with autism spectrum disorder (ASD), affecting an estimated 40–80% of cases. Previous reports have shown relationships between several circadian rhythm–related genes and sleep problems in ASD. The purpose of the present study was to relate variation in and around melatonin synthesis and suprachiasmatic nucleus genes to sleep problems in a large sample of children with ASD. Method: This secondary analysis used existing genotypic and phenotypic data for 2,065 children, aged 4–18 years, from the Simons Simplex Collection (SSC). Sleep problems were measured with the SSC Sleep Interview. Expression quantitative trait loci and single nucleotide polymorphisms in 25 circadian genes were chosen primarily for their impact on expression levels of target genes in the brain. Associations between variants and composite sleep problems, nighttime problems, daytime problems, and sleep duration problems were calculated using logistic regression analysis. Age, sex, nonverbal IQ, ASD severity, gastrointestinal distress, seizures, and ancestry were included as covariates. Transmission disequilibrium tests were performed to test for overtransmission of alleles in the same variants. Results: No significant associations or transmission disequilibrium were found between gene variants and sleep problems in this sample of children with ASD. Conclusion: Variation in expression of investigated genes in the melatonin synthesis and suprachiasmatic nucleus pathways did not have notable impacts on sleep problems in this large sample of children with ASD. Future research could explore translational and posttranslational effects of these genes or the effects of genes in other sleep-homeostasis pathways on sleep patterns.
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Affiliation(s)
| | - Janice S. Dorman
- School of Nursing, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | - Bernie Devlin
- Department of Psychiatry, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
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96
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Benson S, Bender AM, Wickenheiser H, Naylor A, Clarke M, Samuels CH, Werthner P. Differences in sleep patterns, sleepiness, and physical activity levels between young adults with autism spectrum disorder and typically developing controls. Dev Neurorehabil 2019; 22:164-173. [PMID: 30067414 DOI: 10.1080/17518423.2018.1501777] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To investigate the differences in sleep, sleepiness, and physical activity (PA) between young adults with autism spectrum disorder (ASD) and typically developing controls (TDC). METHOD Actigraphic data and questionnaires on sleep, sleepiness, and PA were compared between fifteen adults with ASD (ADOS range 7-19; ages 22.8 ± 4.5 years) and TDC. RESULTS In comparison to the TDC group, the ASD group slept longer on average per night but took longer to fall asleep. In relationship to PA levels, the objective PA levels were lower in the ASD group than the TDC group. Fewer wake minutes during the sleep period in the ASD sample were associated with more PA the following day. CONCLUSION The findings support previous research that demonstrates differences in sleep parameters and PA between ASD and TDC. Interventions aimed at increasing PA in an ASD population may be beneficial for improved sleep.
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Affiliation(s)
- Sarah Benson
- a Faculty of Kinesiology , University of Calgary
| | - Amy M Bender
- b Centre for Sleep, Faculty of Kinesiology , University of Calgary
| | | | | | | | - Charles H Samuels
- d Centre for Sleep & Human Performance , Faculty of Medicine, University of Calgary
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97
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Autistic traits and sleep in typically developing adolescents. Sleep Med 2019; 54:164-171. [DOI: 10.1016/j.sleep.2018.09.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 09/26/2018] [Accepted: 09/29/2018] [Indexed: 01/19/2023]
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98
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Yavuz-Kodat E, Reynaud E, Geoffray MM, Limousin N, Franco P, Bourgin P, Schroder CM. Validity of Actigraphy Compared to Polysomnography for Sleep Assessment in Children With Autism Spectrum Disorder. Front Psychiatry 2019; 10:551. [PMID: 31428003 PMCID: PMC6688709 DOI: 10.3389/fpsyt.2019.00551] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Accepted: 07/15/2019] [Indexed: 01/12/2023] Open
Abstract
Actigraphy (ACT) is a non-invasive objective assessment tool for the study of sleep-wake rhythms. It is of particular interest in children with autism spectrum disorder (ASD), as sleep disorders are highly prevalent and have a significant impact on both cognitive and behavioral functions. As polysomnography (PSG), the gold standard for the assessment of sleep, is difficult to perform in children with ASD, ACT has become a tool of choice but has not yet been validated against PSG using state-of-the-art methodology. The main objective of this study was to assess, for the first time, the validity of ACT compared to PSG for the measurement of sleep in children with ASD. During the same night of hospitalization, PSG and ACT were conducted in 26 children (6 girls and 20 boys; mean age 5.4 years ± 1.6) diagnosed with ASD according to DSM-5 criteria and standardized diagnostic scales. Sleep parameters were total sleep time (TST), sleep latency (SL), wake after sleep onset (WASO), and sleep efficiency (SE). To compare PSG and ACT, we conducted sleep parameter agreement analyses including: intraclass correlation coefficient (ICC), Bland-Altman plots, and equivalence tests. The comparison also included an epoch-by-epoch (EBE) agreement analysis to determine sensitivity (ability to detect sleep) and specificity (ability to detect wake). According to equivalence tests, the difference between ACT and PSG measures was clinically acceptable for TST (<30 min, p < 0.01), SL (<15 min, p < 0.001), and SE (10%, p < 0.01), but not for WASO (<15 min, p = 0.13). There was a good agreement between methods for SL (ICC = 0.79) and TST (ICC = 0.85) and a moderate agreement for WASO (ICC = 0.73) and SE (ICC = 0.68). The EBE agreement analysis revealed a high sensitivity (0.94 ± 0.06) and moderate specificity (0.5 ± 0.2). Since sleep disorders are one of the most common comorbidities within the ASD population and are highly prevalent, it is essential to validate objective tools of assessment. To our knowledge, our study is the first to validate ACT compared to PSG, using a state-of-the-art methodology, in children with ASD. The results suggest ACT to be a valid method to evaluate sleep within this population, with a good reliability for most sleep parameters.
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Affiliation(s)
- Enise Yavuz-Kodat
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Eve Reynaud
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Neurodevelopmental Psychiatry, Le Vinatier Hospital, Bron, France.,Health Services and Performance Research (HESPER), Claude Bernard University Lyon 1, Lyon, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, Tours, France
| | - Patricia Franco
- Lyon Neuroscience Research Center U1028/UMR 5292, Claude Bernard University Lyon 1, Lyon, France
| | - Patrice Bourgin
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France.,Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, Strasbourg, France
| | - Carmen M Schroder
- Centre National de la Recherche Scientifique, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, Strasbourg, France.,Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, Strasbourg, France.,Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals & University of Strasbourg Medical School, Strasbourg, France
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99
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Sannar EM, Palka T, Beresford C, Peura C, Kaplan D, Verdi M, Siegel M, Kaplan S, Grados M. Sleep Problems and Their Relationship to Maladaptive Behavior Severity in Psychiatrically Hospitalized Children with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2018; 48:3720-3726. [PMID: 29086209 DOI: 10.1007/s10803-017-3362-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined the relationship between sleep duration and awakenings to Aberrant Behavior Checklist-Community (ABC-C) and Autism Diagnostic Observation Schedule (ADOS-2) scores in hospitalized youth with ASD and behavioral disturbance. Participants included 106 patients with a stay of at least 10 nights. Sleep in the hospital was recorded by staff observation. Higher scores on the ABC-C (irritability, stereotypy, and hyperactivity subscales) at admission were significantly associated with fewer minutes slept during the last five nights of hospitalization. There was no association between total awakenings and ABC-C scores or ADOS-2 comparison scores. Improved understanding of the relationship between sleep quality and maladaptive behavior in this challenging cohort of patients with ASD is vital to the definition and design of future effective interventions.
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Affiliation(s)
- Elise M Sannar
- Children's Hospital Colorado, 13123 E. 16th Ave., B-130, Aurora, CO, 80045, USA.
| | - Tamara Palka
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Carol Beresford
- Children's Hospital Colorado, 13123 E. 16th Ave., B-130, Aurora, CO, 80045, USA
| | - Christine Peura
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Desmond Kaplan
- Sheppard Pratt Health System, 6501 N. Charles St., Towson, MD, 21204, USA.,Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
| | - Mary Verdi
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Matthew Siegel
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA.,Tufts University School of Medicine, 136 Harrison Ave., Boston, MA, 02111, USA
| | - Shir Kaplan
- University of Maryland, College Park, MD, 20742, USA
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
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Maras A, Schroder CM, Malow BA, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol 2018; 28:699-710. [PMID: 30132686 PMCID: PMC6306655 DOI: 10.1089/cap.2018.0020] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: A recent double-blind randomized placebo-controlled study demonstrated 3-month efficacy and safety of a novel pediatric-appropriate prolonged-release melatonin (PedPRM) for insomnia in children and adolescents with autism spectrum disorder (ASD) and neurogenetic disorders (NGD) with/without attention-deficit/hyperactivity disorder comorbidity. Long-term efficacy and safety of PedPRM treatment was studied. Methods: A prospective, open-label efficacy and safety follow-up of nightly 2, 5, or 10 mg PedPRM in subjects who completed the 13-week double-blind trial (51 PedPRM; 44 placebo). Measures included caregiver-reported Sleep and Nap Diary, Composite Sleep Disturbance Index (CSDI), caregiver's Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and quality of life (WHO-5 Well-Being Index). Results: Ninety-five subjects (74.7% males; mean [standard deviation] age, 9 [4.24]; range, 2-17.5 years) received PedPRM (2/5 mg) according to the double-blind phase dose, for 39 weeks with optional dose adjustment (2, 5, or 10 mg/day) after the first 13 weeks. After 52 weeks of continuous treatment (PedPRM-randomized group) subjects slept (mean [SE]) 62.08 (21.5) minutes longer (p = 0.007); fell asleep 48.6 (10.2) minutes faster (p < 0.001); had 89.1 (25.5) minutes longer uninterrupted sleep episodes (p = 0.001); 0.41 (0.12) less nightly awakenings (>50% decrease; p = 0.001); and better sleep quality (p < 0.001) compared with baseline. The placebo-randomized group also improved with PedPRM. Altogether, by the end of 39-week follow-up, regardless of randomization assignment, 55/72 (76%) of completers achieved overall improvement of ≥1 hour in total sleep time (TST), sleep latency or both, over baseline, with no evidence of decreased efficacy. In parallel, CSDI child sleep disturbance and caregivers' satisfaction of their child's sleep patterns (p < 0.001 for both), PSQI global (p < 0.001), and WHO-5 (p = 0.001) improved in statistically significant and clinically relevant manner (n = 72) compared with baseline. PedPRM was generally safe; most frequent treatment-related adverse events were fatigue (5.3%) and mood swings (3.2% of patients). Conclusion: PedPRM, an easily swallowed formulation shown to be efficacious versus placebo, is an efficacious and safe option for long-term treatment (up to 52 weeks reported here) of children with ASD and NGD who suffer from insomnia and subsequently improves caregivers' quality of life.
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Affiliation(s)
- Athanasios Maras
- Yulius Academy, Yulius Mental Health Organization, Barendrecht, The Netherlands.,Address correspondence to: Athanasios Maras, MD, Yulius Academy, Yulius Mental Health Organization, Dennenhout 1, Barendrecht 2994 GC, The Netherlands
| | - Carmen M. Schroder
- Strasbourg University Hospital Department of Child and Adolescent Psychiatry, Strasbourg, France.,CNRS UPR 3212, Department of Psychiatry and Mental Health, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
| | - Beth A. Malow
- Sleep Division, Department of Neurology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Robert L. Findling
- Department of Psychiatry and Behavioral Sciences, Kennedy Krieger Institute/Johns Hopkins University, Baltimore, Maryland
| | - John Breddy
- Pharmastat Consulting Ltd., Canterbury, United Kingdom
| | - Tali Nir
- Neurim Pharmaceuticals Ltd., Tel Aviv, Israel
| | | | | | - Paul Gringras
- Children's Sleep Medicine, Evelina London Children's Hospital, Guy's and St. Thomas', London, United Kingdom
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