1
|
Galion AW, Farmer JG, Connolly HV, Allhusen VD, Bennett A, Coury DL, Lam J, Neumeyer AM, Sohl K, Witmans M, Malow BA. A Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:2926-2945. [PMID: 37358787 PMCID: PMC11300650 DOI: 10.1007/s10803-023-06026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/27/2023]
Abstract
Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.
Collapse
Affiliation(s)
- Anjalee W Galion
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Justin G Farmer
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Virginia D Allhusen
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Amanda Bennett
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Janet Lam
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Sohl
- University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN, USA
| |
Collapse
|
2
|
Yetkin O, Zarowski M, Baykan B. Sleep in juvenile myoclonic epilepsy: A systematic review. Seizure 2024; 120:61-71. [PMID: 38908143 DOI: 10.1016/j.seizure.2024.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/16/2024] [Accepted: 05/22/2024] [Indexed: 06/24/2024] Open
Abstract
Sleep disturbances significantly impact the lives of individuals with Juvenile Myoclonic Epilepsy (JME). This study aimed to investigate sleep studies, disturbances, and the impact of anti-seizure drugs on sleep in JME patients. Relevant studies were retrieved from the National Library of Medicine (Pubmed) database and the Cochrane Library utilizing the search terms "Juvenile Myoclonic Epilepsy" and "sleep". A total of 160 papers' review, data extraction, and resolution of discrepancies were performed independently by two reviewers according to the PRISMA protocol and were registered in PROSPERO (CRD42023472439). A systematic review of 31 studies was conducted, encompassing various methodologies, including sleep questionnaires (Pittsburgh Sleep Quality Index (n = 13), Epworth Sleepiness Scale (n = 10)), polysomnography (n = 8), EEG (n = 9), actigraphy (n = 1), and transcranial magnetic stimulation (n = 1). Most studies were hospital-based (n = 31), cross-sectional (n = 11), and prospective (n = 25). Patients with JME exhibit a higher prevalence of sleep disturbances, worse quality of sleep (n = 4), daytime sleepiness (n = 2), sleep efficiency (n = 7), and increased sleep latency (n = 1) compared to controls. These disruptions are characterized by increased wakefulness (n = 3), frequent arousals (n = 3), decreased REM sleep (n = 2), and conflicting NREM sleep findings (n = 3). Additional sleep-related issues observed in JME patients include insomnia (n = 1) and increased prevalence of parasomnias such as nightmares and sleep talking. Periodic limb movement and obstructive sleep apnea are similar or less frequent (3/28). REM behavioral disorders and sleepwalking were not seen. Valproate showed conflicting effects on sleep (n = 7), while levetiracetam did not impact sleep (n = 1). These findings underlined the need for more sufficient evidence of sleep studies in JME. Future research should prioritize understanding the nature of sleep in JME and its impact on management.
Collapse
Affiliation(s)
- O Yetkin
- Poznan University of Medical Sciences Department of Developmental Neurology, Poland.
| | - M Zarowski
- Poznan University of Medical Sciences Department of Developmental Neurology, Poland
| | - B Baykan
- EMAR Medical Center Department of Neurology, Istanbul
| |
Collapse
|
3
|
Patel N, Berggren KN, Hung M, Bates K, Dixon MM, Bax K, Adams H, Butterfield RJ, Campbell C, Johnson NE. Neurobehavioral Phenotype of Children With Congenital Myotonic Dystrophy. Neurology 2024; 102:e208115. [PMID: 38359368 DOI: 10.1212/wnl.0000000000208115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 12/18/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND AND OBJECTIVES To describe the neurobehavioral phenotype of congenital myotonic dystrophy. Congenital myotonic dystrophy (CDM) is the most severe form of myotonic dystrophy, characterized by symptom presentation at birth and later, cognitive impairment, autistic features, and disordered sleep. METHODS The neurobehavioral phenotype was assessed in this cross-sectional study by a neuropsychological battery consisting of the Wechsler Preschool and Primary Scale of Intelligence, Third Edition, Weschler Intelligence Scale for Children, Fourth Edition, Vineland Adaptive Behavior Scale, Second Edition (Vineland-II), Behavior Rating Inventory of Executive Function including preschool and teacher reports, Autism Spectrum Screening Questionnaire, Social Communication Scale, and Repetitive Behavior Scale-Revised. Sleep quality was evaluated with the Pediatric Sleep Questionnaire and Pediatric Daytime Sleepiness Scale. RESULTS Fifty-five children with CDM, ages 5 weeks to 14 years, were enrolled. The mean age and (CTG)n repeats (±SD) were 6.4 ± 3.8 years and 1,263 ± 432, respectively. The mean IQ was 64.1 ± 14.9 on the Weschler scales with 65.6% of participants falling in the extremely low range for IQ. Adaptive functioning was significantly low for 57.1% of participants (n = 20). Caregiver report of executive functioning indicated 23.1% (9/39) of participants had clinically elevated levels of dysfunction, though teacher report was discrepant and indicated 53.3% of participants with CDM fell in this range (8/15). Spearman correlations were strongly positive (p ≤ 0.05) for estimated full scale IQ, overall adaptive functioning and with daily living and socialization domain standard scores on the Vineland-II ranging from r = 0.719 to r = 0.849 for all ages. Aspects of executive function were directly related to features of autism and sleep quality. Social communication was inversely related to all aspects of daily functioning, except communication, and directly related to aspects of autism behavior. DISCUSSION Depressed IQ, adaptive skills, and executive functioning, poor sleep quality, and features of autism and altered social functioning individually describe different aspects of the neurobehavioral phenotype in CDM. These neurobehavioral and sleep measures could help quantitatively measure and assess the burden of cognitive impairment in CDM.
Collapse
Affiliation(s)
- Namita Patel
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Kiera N Berggren
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Man Hung
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Kameron Bates
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Melissa M Dixon
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Karen Bax
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Heather Adams
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Russell J Butterfield
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Craig Campbell
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| | - Nicholas E Johnson
- From the Department of Neurology (N.P.), University of Rochester Medical Center, NY; Departments of Neurology and Pediatrics (H.A.), University of Rochester School of Medicine and Dentistry, NY; Department of Neurology and Center for Inherited Muscle Research (K.N.B., K. Bates, N.E.J.), Virginia Commonwealth University, Richmond; College of Dental Medicine (M.H.), Roseman University of Health Sciences, South Jordan, UT; Department of Pediatrics (M.M.D., R.J.B.), University of Utah, Salt Lake City; and Department of Psychology (K. Bax), and Department of Pediatrics (C.C.), London Children's Hospital, University of Western Ontario, London, Canada
| |
Collapse
|
4
|
Zhang X, Smits M, Curfs L, Spruyt K. Sleep and the Social Profiles of Individuals With Rett Syndrome. Pediatr Neurol 2024; 152:153-161. [PMID: 38290182 DOI: 10.1016/j.pediatrneurol.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND This study investigates the distinctive social behaviors observed in individuals with Rett syndrome (RTT), characterized by the loss of spoken language, impaired eye gaze communication, gait abnormalities, and sleep issues. The research aims to identify social profiles in RTT and explore their correlation with sleep, sleep-disordered breathing (SDB), and daytime sleepiness. METHODS Standard overnight sleep macrostructure and respiratory parameters were assessed. Extracting 25 social-related items and one for daytime sleepiness from the Rett Syndrome Behavioral Questionnaire, factor analysis was applied to establish latent social profiles. These profiles were then correlated with sleep parameters. The nonparametric Mann-Whitney U test compared social profiles based on the presence of SDB (defined by an apnea-hypopnea index greater than one per hour) and daytime sleepiness. RESULTS The study involved 12 female subjects with confirmed RTT diagnoses and MECP2 mutations, aged 8.54 ± 5.30 years. The Rett Syndrome Behavioral Questionnaire revealed a total average score of 25.83 ± 12.34, indicating varying degrees of social impairments. Comprising 25 social-related items, factor analysis yielded four social profiles: "interactive motricity," "mood change," "anxiety/agitation," and "gazing." Longer sleep onset latency correlated with increased socio-behavioral impairments, particularly in interactive motricity reduction. Conversely, higher rapid eye movement sleep was associated with fewer interactive socio-motor behaviors. No significant differences in social profiles were found concerning the presence of SDB or daytime sleepiness. CONCLUSIONS The findings suggest four distinct social profiles in RTT individuals, hinting at shared disrupted circuits between sensorimotor functioning and sleep-related neuronal pathways. Despite the absence of differences in SDB or daytime sleepiness, the study highlights the relationship between sleep parameters, such as sleep onset latency and rapid eye movement sleep, and socio-behavioral outcomes in RTT with MECP2 mutations.
Collapse
Affiliation(s)
- Xinyan Zhang
- Université Paris Cité, NeuroDiderot - INSERM, Paris, France
| | - Marcel Smits
- Department of Sleep-Wake Disorders and Chronobiology, Hospital Gelderse Vallei Ede, Ede, Netherlands; Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Leopold Curfs
- Governor Kremers Centre, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot - INSERM, Paris, France.
| |
Collapse
|
5
|
Bianca B, Silvia G, Elisa F, Deny M, Giovanni V, Lino N, Stefano V. Insomnia in Children with Autism Spectrum Disorder: A Cross-Sectional Study on Clinical Correlates and Parental Stress. J Autism Dev Disord 2024; 54:46-55. [PMID: 36310306 DOI: 10.1007/s10803-022-05793-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2022] [Indexed: 03/12/2023]
Abstract
Insomnia is one of the most common co-occurring disorders in children with autism spectrum disorder (ASD). The purpose of this cross-sectional cohort study of 270 children with ASD was to assess the prevalence of insomnia using the Pediatric Sleep Clinical Global Impression Scale and to correlate sleep problems with cognitive level, adaptive behavior, parental stress, behavioral and emotional problems, and severity of core symptoms. Our findings revealed that one-third of children had insomnia and were related to reduced adaptive behaviors and higher levels of parental stress and behavioral and emotional problems. Insomnia must be evaluated in children with ASD to define an appropriate intervention to potentially alleviate the severity of clinical correlates and parental burden.
Collapse
Affiliation(s)
- Berloco Bianca
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
| | - Guerrera Silvia
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Fucà Elisa
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Menghini Deny
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Valeri Giovanni
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Nobili Lino
- Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genoa, Genoa, Italy
- Child Neuropsychiatry, IRCCS Istituto G. Gaslini, Genoa, Italy
| | - Vicari Stefano
- Child and Adolescent Psychiatric Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant'Onofrio 4, 00165, Rome, Italy
- Department of Life Sciences and Public Health, Catholic University, Rome, Italy
| |
Collapse
|
6
|
Kim H, Kim JH, Kim J, Kim JY, Cortese S, Smith L, Koyanagi A, Radua J, Fusar-Poli P, Carvalho AF, Salazar de Pablo G, Shin JI, Cheon KA, Solmi M. Subjective and objective sleep alterations in medication-naïve children and adolescents with autism spectrum disorder: a systematic review and meta-analysis. Epidemiol Psychiatr Sci 2023; 32:e48. [PMID: 37469173 PMCID: PMC10387490 DOI: 10.1017/s2045796023000574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2023] Open
Abstract
AIMS This study aimed to summarize the evidence on sleep alterations in medication-naïve children and adolescents with autism spectrum disorder (ASD). METHODS We systematically searched PubMed/Medline, Embase and Web of Science databases from inception through March 22, 2021. This study was registered with PROSPERO (CRD42021243881). Any observational study was included that enrolled medication-naïve children and adolescents with ASD and compared objective (actigraphy and polysomnography) or subjective sleep parameters with typically developing (TD) counterparts. We extracted relevant data such as the study design and outcome measures. The methodological quality was assessed through the Newcastle-Ottawa Scale (NOS). A meta-analysis was carried out using the random-effects model by pooling effect sizes as Hedges' g. To assess publication bias, Egger's test and p-curve analysis were done. A priori planned meta-regression and subgroup analysis were also performed to identify potential moderators. RESULTS Out of 4277 retrieved references, 16 studies were eligible with 981 ASD patients and 1220 TD individuals. The analysis of objective measures showed that medication-naïve ASD patients had significantly longer sleep latency (Hedges' g 0.59; 95% confidence interval [95% CI] 0.26 to 0.92), reduced sleep efficiency (Hedges' g -0.58; 95% CI -0.87 to -0.28), time in bed (Hedges' g -0.64; 95% CI -1.02 to -0.26) and total sleep time (Hedges' g -0.64; 95% CI -1.01 to -0.27). The analysis of subjective measures showed that they had more problems in daytime sleepiness (Hedges' g 0.48; 95% CI 0.26 to 0.71), sleep latency (Hedges' g 1.15; 95% CI 0.72 to 1.58), initiating and maintaining sleep (Hedges' g 0.86; 95% CI 0.39 to 1.33) and sleep hyperhidrosis (Hedges' g 0.48; 95% CI 0.29 to 0.66). Potential publication bias was detected for sleep latency, sleep period time and total sleep time measured by polysomnography. Some sleep alterations were moderated by age, sex and concurrent intellectual disability. The median NOS score was 8 (interquartile range 7.25-8.75). CONCLUSION We found that medication-naïve children and adolescents with ASD presented significantly more subjective and objective sleep alterations compared to TD and identified possible moderators of these differences. Future research requires an analysis of how these sleep alterations are linked to core symptom severity and comorbid behavioural problems, which would provide an integrated therapeutic intervention for ASD. However, our results should be interpreted in light of the potential publication bias.
Collapse
Affiliation(s)
- Heeyeon Kim
- Department of Psychiatry, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Republic of Korea
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
| | - Jae Han Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Junghwan Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Jong Yeob Kim
- Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
| | - Samuele Cortese
- Centre for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York, NY, USA
| | - Lee Smith
- Centre for Health, Performance, and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Ai Koyanagi
- Parc Sanitari Sant Joan de Déu/CIBERSAM, Universitat de Barcelona, Fundació Sant Joan de Déu, Sant Boi de Llobregat, Barcelona, Spain
| | - Joaquim Radua
- Imaging Mood- and Anxiety-Related Disorders (IMARD) Group, Institut d'Investigacions Biomèdiques August Pi i Sunyer(IDIBAPS), Mental Health Research Networking Center(CIBERSAM), University of Barcelona, Barcelona, Spain
| | - Paolo Fusar-Poli
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy
- OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK
- National Institute for Health Research, Maudsley Biomedical Research Centre, London, UK
| | - Andre F Carvalho
- IMPACT Strategic Research Centre, Barwon Health, Deakin University School of Medicine, Geelong, VIC, Australia
| | - Gonzalo Salazar de Pablo
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry and Mental Health, Hospital General Universitario Gregorio Marañón School of Medicine, Universidad Complutense, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), CIBERSAM, Madrid, Spain
- Child and Adolescent Mental Health Services, South London and Maudsley NHS Foundation Trust, London, UK
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Severance Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Severance Children's Hospital, Yonsei University Health System, Seoul, Republic of Korea
- Severance Underwood Meta-research Center, Institute of Convergence Science, Yonsei University, Seoul, Republic of Korea
| | - Keun-Ah Cheon
- Institute of Behavioral Science in Medicine, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Republic of Korea
- Department of Child and Adolescent Psychiatry, Yonsei University College of Medicine, Severance Hospital, Seoul, Republic of Korea
| | - Marco Solmi
- Department of Psychosis Studies, Early Psychosis: Interventions and Clinical-detection (EPIC) Lab, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin, Berlin, Germany
| |
Collapse
|
7
|
Lane SJ, Leão MA, Spielmann V. Sleep, Sensory Integration/Processing, and Autism: A Scoping Review. Front Psychol 2022; 13:877527. [PMID: 35656493 PMCID: PMC9152214 DOI: 10.3389/fpsyg.2022.877527] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Accepted: 04/15/2022] [Indexed: 01/09/2023] Open
Abstract
The prevalence of sleep dysfunction is considerably higher in the autistic population than in the non-autistic. Similarly, the incidence of sensory reactivity differences in autism exceeds that in the neurotypical population. The basis of sleep disorders in autism is multifactorial, but sensory integration/processing concerns may play a role. Research that investigates this interplay for autistic individuals is limited but vital. In this scoping review, we examined literature addressing the following research question: What is the relationship between sleep and sensory integration/processing in autism? We included articles if they were peer-reviewed, English or Spanish, purposefully addressed sensory integration/processing differences, were sleep focused and included autism as the primary diagnosis or population. Articles were excluded if the language was not English or Spanish, research was conducted with animals, they were non-peer-reviewed, the primary population was not autistic, the sensory focus reflected a specific sensorineural loss (e.g., blindness, or deafness), there was not a clear inclusion of sensory integration/processing or sleep. We searched six databases and included all citations from the inception of each database through June 2021. The search strategy identified 397 documents that were reduced to 24 included articles after exclusion criteria were applied. The majority of studies we identified characterized the relation between sleep and sensory integration/processing differences in autism. Investigators found multiple sleep concerns such as bedtime resistance, sleep anxiety, delayed sleep onset, night awaking, and short sleep duration in autistic individuals. Identified sensory concerns focused on reactivity, finding hyper- and hypo-reactivity as well as sensory seeking across sensory domains. Co-existence of sleep concerns and sensory integration/processing differences was frequently reported. Few intervention studies showed a clear sensory focus; those that did emphasized pressure, movement, touch, and individual sensory preferences/needs. Swimming programs and massage showed promising results. No studies were of high quality. At a minimum, there is a co-existence of sensory reactivity differences and sleep concerns in autistic children, and possibly autistic adults. The relationship between poor sleep and sensory integration/processing differences is complex and multi-faceted, requiring additional research. Interventions that purposefully include a central sensory component have not been well studied in autistic children or adults. Overall studies with greater rigor and purposeful use of sensation and sensorimotor supports as a component of intervention are needed. This study was not funded.
Collapse
Affiliation(s)
- Shelly J. Lane
- Sensory Integration, Play, and Occupational Therapy Research Lab, Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | - Marco A. Leão
- Sensory Integration, Play, and Occupational Therapy Research Lab, Department of Occupational Therapy, Colorado State University, Fort Collins, CO, United States
| | | |
Collapse
|
8
|
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: 12] [Impact Index Per Article: 4.0] [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.
Collapse
|
9
|
Wen J, Yang T, Zhu J, Guo M, Lai X, Tang T, Chen L, Chen J, Xue M, Li T. Vitamin a deficiency and sleep disturbances related to autism symptoms in children with autism spectrum disorder: a cross-sectional study. BMC Pediatr 2021; 21:299. [PMID: 34217246 PMCID: PMC8254303 DOI: 10.1186/s12887-021-02775-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 06/08/2021] [Indexed: 12/03/2022] Open
Abstract
Background Vitamin A deficiency (VAD) and sleep disturbances have been reported in children with autism spectrum disorder (ASD). The influence of vitamin A (VA) levels on sleep regulation and sleep disturbances in ASD has garnered concern. The present study aimed to characterize the association of VA levels with sleep disturbances in children with ASD. Methods This cross-sectional study compared children with ASD (n = 856) to typically developing children (TDC; n = 316). We used the Children’s Sleep Habits Questionnaire to assess sleep disturbances, Childhood Autism Rating Scale to evaluate the severity of autism symptoms, and Autism Behavior Checklist and Social Responsiveness Scale to assess autism behaviors. Serum VA levels were estimated using high-performance liquid chromatography. Multivariable linear regression and two-way analysis of variance were performed to investigate if VAD was related to sleep disturbances in children with ASD. Results Children with ASD had lower serum VA levels and a higher prevalence of sleep disturbances than TDC did. The incidence of VAD in ASD children with sleep disturbances was higher, and the symptoms more severe than those without sleep disturbances and TDC. Interestingly, the interaction between VAD and sleep disturbances was associated with the severity of autism symptoms. Conclusion VAD and sleep disturbances are associated with the core symptoms of ASD in children. Regular monitoring of sleep and VA levels may be beneficial for children with ASD. Trial registration Chinese Clinical Trial Registry, registration number: ChiCTR-ROC-14005442, registration date: December 9th 2014.
Collapse
Affiliation(s)
- Jing Wen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ting Yang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Jiang Zhu
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Min Guo
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Xi Lai
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ting Tang
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Li Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Jie Chen
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China.,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China.,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China.,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China
| | - Ming Xue
- Department of Neurosciences and Neurology, Rutgers New Jersey Medical School, Newark, NJ, USA.
| | - Tingyu Li
- Children's Nutrition Research Center, Children's Hospital of Chongqing Medical University, Chongqing Key Laboratory of Child Nutrition and Health, Chongqing, PR China. .,Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing, PR China. .,National Clinical Research Center for Child Health and Disorder, Chongqing, PR China. .,China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing, PR China.
| |
Collapse
|
10
|
Migueis DP, Lopes MC, Ignacio PSD, Thuler LCS, Araujo-Melo MH, Spruyt K, Lacerda GCB. A systematic review and meta-analysis of the cyclic alternating pattern across the lifespan. Sleep Med 2021; 85:25-37. [PMID: 34271180 DOI: 10.1016/j.sleep.2021.06.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/13/2021] [Accepted: 06/19/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Cyclic alternating pattern (CAP) is the electroencephalogram (EEG) pattern described as a marker of sleep instability and assessed by NREM transient episodes in sleep EEG. It has been associated with brain maturation. The aim of this review was to evaluate the normative data of CAP parameters according to the aging process in healthy subjects through a systematic review and meta-analysis. METHODS Two authors independently searched databases using PRISMA guidelines. Discrepancies were reconciled by a third reviewer. Subgroup analysis and tests for heterogeneity were conducted. RESULTS Of 286 studies, 10 submitted a total of 168 healthy individuals to CAP analysis. Scoring of CAP can begin at 3 months of life, when K-complexes, delta bursts, or spindles can be recognized. Rate of CAP increased with age, mainly during the first 2 years of life, then decreased in adolescence, and increased in the elderly. The A1 CAP subtype and CAP rate were high in school-aged children during slow-wave sleep (SWS). A1 CAP subtypes were significantly more numerous in adolescents compared with other groups, while the elderly showed the highest amounts of A2 and A3 CAP subtypes. Our meta-analysis registered the lowest CAP rate in infants younger than 2 years old and the highest in the elderly. CONCLUSIONS This review summarized the normative data of CAP in NREM sleep during the aging process. The CAP rate increased with age and sleep depth, especially during SWS. Parameters of CAP may reflect gender hormonal effects and neuroplasticity. More reports on CAP subtypes are needed for their reference values establishment.
Collapse
Affiliation(s)
- D P Migueis
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil; Antonio Pedro University Hospital / Fluminense Federal University, Niterói, Brazil.
| | - M C Lopes
- Child and Adolescent Affective Disorder Program (PRATA), Department and Institute of Psychiatry at University of Sao Paulo Medical School, Sao Paulo, Brazil
| | - P S D Ignacio
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - L C S Thuler
- National Cancer Institute, Rio de Janeiro, Brazil
| | - M H Araujo-Melo
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| | - K Spruyt
- INSERM, Université de Paris, NeuroDiderot, France
| | - G C B Lacerda
- PPGNEURO, Gaffree and Guinle University Hospital / Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
| |
Collapse
|
11
|
Sleep and Cognition in People with Autism Spectrum Condition: A Systematic Literature Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2021. [DOI: 10.1007/s40489-021-00266-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
12
|
Hartmann S, Bruni O, Ferri R, Redline S, Baumert M. Cyclic alternating pattern in children with obstructive sleep apnea and its relationship with adenotonsillectomy, behavior, cognition, and quality of life. Sleep 2021; 44:5890588. [PMID: 32777055 DOI: 10.1093/sleep/zsaa145] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 07/06/2020] [Indexed: 11/13/2022] Open
Abstract
STUDY OBJECTIVES To determine in children with obstructive sleep apnea (OSA) the effect of adenotonsillectomy (AT) on the cyclic alternating pattern (CAP) and the relationship between CAP and behavioral, cognitive, and quality-of-life measures. METHODS CAP parameters were analyzed in 365 overnight polysomnographic recordings of children with mild-to-moderate OSA enrolled in the Childhood Adenotonsillectomy Trial (CHAT), randomized to either early AT (eAT) or watchful waiting with supportive care (WWSC). We also analyzed CAP in a subgroup of 72 children with moderate OSA (apnea-hypopnea index > 10) that were part of the CHAT sample. Causal mediation analysis was performed to determine the independent effect of changes in CAP on selected outcome measures. RESULTS At baseline, a higher number of A1 phases per hour of sleep was significantly associated with worse behavioral functioning (caregiver Behavior Rating Inventory of Executive Function (BRIEF) Global Executive Composite (GEC): ρ = 0.24, p = 0.042; caregiver Conners' Rating Scale Global Index: ρ = 0.25, p = 0.036) and lower quality of life (OSA-18: ρ = 0.27, p = 0.022; PedsQL: ρ = -0.29, p = 0.015) in the subgroup of children with moderate OSA, but not across the entire sample. At 7-months follow-up, changes in CAP parameters were comparable between the eAT and WWSC arms. CAP changes did not account for significant proportions of variations in behavioral, cognitive, and quality-of-life performance measures at follow-up. CONCLUSIONS We show a significant association between the frequency of slow, high-amplitude waves with behavioral functioning, as well as the quality of life in children with moderate OSA. Early AT in children with mild-to-moderate OSA does not alter the microstructure of nonrapid eye movement sleep compared with watchful waiting after an approximately 7-month period of follow-up. CLINICAL TRIAL The study "A Randomized Controlled Study of Adenotonsillectomy for Children With Obstructive Sleep Apnea Syndrome" was registered at Clinicaltrials.gov (#NCT00560859).
Collapse
Affiliation(s)
- Simon Hartmann
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | - Raffaele Ferri
- Sleep Research Center; Department of Neurology IC, Oasi Research Institute-IRCCS, Troina, Italy
| | - Susan Redline
- Department of Medicine, Brigham and Women's Hospital and Beth Israel Deaconess Medical School, Harvard Medical School, Boston, MA
| | - Mathias Baumert
- School of Electrical and Electronic Engineering, University of Adelaide, Adelaide, Australia
| |
Collapse
|
13
|
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.
Collapse
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.
| |
Collapse
|
14
|
Shelton AR, Malow B. Neurodevelopmental Disorders Commonly Presenting with Sleep Disturbances. Neurotherapeutics 2021; 18:156-169. [PMID: 33403472 PMCID: PMC8116361 DOI: 10.1007/s13311-020-00982-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/29/2020] [Indexed: 02/04/2023] Open
Abstract
There are multiple disorders of neurodevelopment that present with co-occurring sleep disturbances. Many of these neurodevelopmental disorders (NDD) include sleep disturbances in their diagnostic criteria. Neurobiological, genetic, and environmental factors overlap to cause different sleep disorders in individuals with NDD. Caregivers often present reporting either insomnia or hypersomnia, and based on the clinical history and findings from diagnostic tests, an appropriate diagnosis can be made. It is crucial that clinicians understand the different presentations of sleep disturbances in individuals with NDD.
Collapse
Affiliation(s)
- Althea Robinson Shelton
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA.
| | - Beth Malow
- Department of Neurology, Vanderbilt University Medical Center, 1161 21st Ave South, Medical Center North A-0118, Nashville, TN, 37232, USA
| |
Collapse
|
15
|
DelRosso LM, Hartmann S, Baumert M, Bruni O, Ruth C, Ferri R. Non-REM sleep instability in children with restless sleep disorder. Sleep Med 2020; 75:276-281. [DOI: 10.1016/j.sleep.2020.07.033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 07/10/2020] [Accepted: 07/18/2020] [Indexed: 11/26/2022]
|
16
|
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: 5.0] [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.
Collapse
Affiliation(s)
- Dana Kamara
- The Ohio State University, Department of Psychology, 1835 Neil Ave., Columbus, OH 43210
| | | |
Collapse
|
17
|
Ballester P, Richdale AL, Baker EK, Peiró AM. Sleep in autism: A biomolecular approach to aetiology and treatment. Sleep Med Rev 2020; 54:101357. [PMID: 32759030 DOI: 10.1016/j.smrv.2020.101357] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 05/04/2020] [Accepted: 05/06/2020] [Indexed: 01/24/2023]
Abstract
People with autism spectrum disorder (ASD) commonly experience other comorbidities. Studies indicate that between 50% and 83% of individuals with ASD have sleep problems or disorders. The most commonly reported sleep problems are: (a) insomnia symptoms including the inability to get to sleep or stay asleep; and (b) circadian rhythm sleep-wake disorders, defined as a misalignment between the timing of endogenous circadian rhythms and the external environment. The circadian system provides timing information for the sleep-wake cycle that is regulated by the interaction of an endogenous processes (circadian - Process C, and homeostatic - Process S) and synchronizing agents (neurohormones and neurotransmitters), which produce somnogenic activity. A clinical priority in ASD is understanding the cause of these sleep problems in order to improve treatment outcomes. This review approaches sleep in autism from several perspectives: Sleep-wake mechanisms and problems, and brain areas and molecules controlling sleep (e.g., GABA and melatonin) and wake maintenance (e.g., serotonin, acetylcholine and glutamate). Specifically, this review examines how altered sleep structure could be related to neurobiological alterations or genetic mutations and the implications this may have for potential pharmacological treatments in individuals with ASD.
Collapse
Affiliation(s)
- P Ballester
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain.
| | - A L Richdale
- Olga Tennison Autism Research Centre, School of Psychology & Public Health, La Trobe University, Melbourne, Australia
| | - E K Baker
- Diagnosis and Development, Murdoch Children's Research Institute, Parkville, Australia; Department of Paediatrics, University of Melbourne, Parkville, Australia; School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - A M Peiró
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain
| |
Collapse
|
18
|
Yavuz-Kodat E, Reynaud E, Geoffray MM, Limousin N, Franco P, Bonnet-Brilhault F, Bourgin P, Schroder CM. Disturbances of Continuous Sleep and Circadian Rhythms Account for Behavioral Difficulties in Children with Autism Spectrum Disorder. J Clin Med 2020; 9:jcm9061978. [PMID: 32599848 PMCID: PMC7356341 DOI: 10.3390/jcm9061978] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 06/20/2020] [Accepted: 06/21/2020] [Indexed: 12/27/2022] Open
Abstract
Sleep disorders are among the most common comorbidities in children with Autism Spectrum Disorder (ASD), and subjectively defined sleep disturbances have been related to ASD symptom severity. However, no study has investigated the differential impact of objectively measured sleep and circadian rhythm disturbances on behavioral difficulties in this population. Fifty-two children with ASD aged 3-10 years underwent assessments of sleep and circadian rest-activity rhythms objectively with actigraphy and subjectively with the Children's Sleep Habits Questionnaire. Behavioral difficulties were assessed using the ABC-C. Group comparison analyses were used to compare sleep and circadian rhythm parameters of children with higher and lower behavioral difficulties and dominance analysis to rank predictors and address multicollinearity. Children with high irritability had a shorter continuous sleep period compared to those with lower irritability (-60 min, p = 0.04), as well as those with high stereotypic behaviors compared to children with less stereotypies (-75 min, p = 0.006). Objective circadian and sleep disturbances accounted together for, respectively, 17%, 18% and 36% of the variance in social withdrawal, irritability and stereotypic behaviors. The identification of both sleep and circadian rhythm disturbances as explanatory factors for behavioral difficulties warrants their inclusion in the existing behavioral management strategies for children with ASD.
Collapse
Affiliation(s)
- Enise Yavuz-Kodat
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
| | - Eve Reynaud
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Correspondence:
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Neurodevelopmental Psychiatry, Le Vinatier Hospital, 95 Boulevard Pinel, 69678 Bron CEDEX, France;
- Health Services and Performance Research (HESPER), Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Nadège Limousin
- Department of Neurology and Clinical Neurophysiology, University Hospital Bretonneau, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patricia Franco
- Pediatric Sleep, Hôpital Femme-Mère-Enfant, Hospices civils of Lyon, 59 Boulevard Pinel, 69500 Bron, France;
- Lyon Neuroscience Research Center U1028/UMR5292, Claude Bernard University Lyon 1, 43 Boulevard du 11 Novembre 1918, 69622 Villeurbane CEDEX, France
| | - Frédérique Bonnet-Brilhault
- UMR 1253, iBrain, Université de Tours, Inserm, CHRU de Tours, Centre Universitaire de Pédopsychiatrie, 2 Boulevard Tonnellé, 37044 Tours, France;
| | - Patrice Bourgin
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
| | - Carmen M. Schroder
- Centre National de la Recherche Scientifique CNRS UPR 3212, Université de Strasbourg, Institut des Neurosciences Cellulaires et Intégratives, 8 allée du Général Rouvillois, 67000 Strasbourg, France; (E.Y.-K.); (P.B.); (C.M.S.)
- Sleep Disorders Center, International Research Center for ChronoSomnology, Strasbourg University Hospitals, 1 place de l’Hôpital, 67000 Strasbourg, France
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals & University of Strasbourg Medical School, 67000 Strasbourg, France
| |
Collapse
|
19
|
Gorgoni M, Scarpelli S, Reda F, De Gennaro L. Sleep EEG oscillations in neurodevelopmental disorders without intellectual disabilities. Sleep Med Rev 2020; 49:101224. [PMID: 31731102 DOI: 10.1016/j.smrv.2019.101224] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 08/29/2019] [Accepted: 10/15/2019] [Indexed: 02/08/2023]
|
20
|
Murata E, Kato-Nishimura K, Taniike M, Mohri I. Evaluation of the validity of psychological preparation for children undergoing polysomnography. J Clin Sleep Med 2020; 16:167-174. [PMID: 31992404 DOI: 10.5664/jcsm.8158] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
STUDY OBJECTIVES Nocturnal polysomnography (PSG) is an essential diagnostic technique to assess sleep abnormalities, including sleep-disordered breathing (SDB). Although low in invasiveness, it is extremely difficult to conduct PSG with children who are not cooperative with wearing electrodes and sensors. Particularly, it is difficult to conduct PSG on children with autism spectrum disorder (ASD) because they have poor predictive ability, exhibit extreme anxiety about novel and unfamiliar things, and have difficulty understanding verbal instructions. Recently, the usefulness of psychological preparation was reported. The primary aim of this study was to assess the usefulness of psychological preparation for PSG. METHODS The goal of our study was to assess the usefulness of psychological preparation for PSG. A total of 253 children were enrolled in the study: 131 in the control group (19 with ASD) and 122 selected for psychological preparation (51 with ASD). RESULTS In the preparation group, 110 of 122 (90.2%) could undergo regular PSG, a significantly higher percentage than the control group at 104 of 131 (79.4%), P = .018. Regarding hypnotic drugs, in the preparation group 111 of 122 (91.0%) underwent PSG without hypnotic drugs, which was a significantly higher percentage than in the control group at 107 of 131 (81.7%), P = .032. Additionally, 45 of 51 children with ASD in the preparation group (88.2%) could undergo PSG without hypnotic drugs. CONCLUSIONS This study indicated that psychological preparation was effective in facilitating PSG without hypnotic drugs in children who have difficulty cooperating with PSG, including those with ASD.
Collapse
Affiliation(s)
- Emi Murata
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan
| | - Kumi Kato-Nishimura
- Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masako Taniike
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Ikuko Mohri
- United Graduate School of Child Development, Osaka University, Kanazawa University, Hamamatsu University School of Medicine, Chiba University and University of Fukui, Osaka, Japan.,Department of Pediatrics, Osaka University Graduate School of Medicine, Osaka, Japan
| |
Collapse
|
21
|
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: 4.2] [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.
Collapse
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
| |
Collapse
|
22
|
Carmassi C, Palagini L, Caruso D, Masci I, Nobili L, Vita A, Dell'Osso L. Systematic Review of Sleep Disturbances and Circadian Sleep Desynchronization in Autism Spectrum Disorder: Toward an Integrative Model of a Self-Reinforcing Loop. Front Psychiatry 2019; 10:366. [PMID: 31244687 PMCID: PMC6581070 DOI: 10.3389/fpsyt.2019.00366] [Citation(s) in RCA: 105] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/13/2019] [Indexed: 12/13/2022] Open
Abstract
Background: A compelling number of studies, conducted in both children and adults, have reported an association between sleep disturbances/circadian sleep alterations and autism spectrum disorder (ASD); however, the data are sparse and the nature of this link is still unclear. The present review aimed to systematically collect the literature data relevant on sleep disturbances and circadian sleep dysrhythmicity related to ASD across all ages and to provide an integrative theoretical framework of their association. Methods: A systematic review of the MEDLINE, PubMed, and Cochrane databases was conducted from November 2018 to February 2019. The search strategies used were MeSH headings and keywords for "sleep-wake circadian rhythms" OR "circadian sleep disorders" OR "sleep-wake pattern" OR "sleep disorders" OR "melatonin" AND "autism spectrum disorder" OR "autism". Results: One hundred and three studies were identified, 15 regarded circadian sleep dysrhythmicity, 74 regarded sleep disturbances, and 17 regarded melatonin alterations in children and adults with ASD. Our findings suggested that autistic subjects frequently present sleep disturbances in particular short sleep duration, low sleep quality/efficiency, and circadian sleep desynchronization such as delayed phases and/or eveningness. Sleep disturbances and circadian sleep alterations have been related to the severity of autistic symptoms. Genetic studies have shown polymorphisms in circadian CLOCK genes and in genes involved in melatonin pathways in subjects with ASD. Conclusions: Sleep disturbances and circadian sleep alterations are frequent in subjects with autistic symptoms. These subjects have shown polymorphisms in clock genes expression and in genes involved in melatonin production. The impairment of circadian sleep regulation may increase the individual's vulnerability to develop symptoms of ASD by altering the sleep regulation in toto, which plays a key role in normal brain development. Even though controversies and "research gaps" are present in literature at this point, we may hypothesize a bidirectional relation between circadian sleep dysfunction and ASD. In particular, circadian sleep dysrhythmicity may predispose to develop ASD symptoms and vice versa within a self-reinforcing feedback loop. By targeting sleep disturbances and circadian sleep dysrhythmicity, we may improve treatment strategies for both children and adults with ASD.
Collapse
Affiliation(s)
- Claudia Carmassi
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Laura Palagini
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Danila Caruso
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Isabella Masci
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| | - Lino Nobili
- Child Neuropsychiatry Unit, IRCCS G. Gaslini Institute, Genova, Italy.,Department of Neuroscience-Rehabilitation-Ophthalmology-Genetics-Child and Maternal Health (DINOGMI), University of Genova, Genova, Italy
| | - Antonio Vita
- Psychiatry Division, Department of Clinical and Experimental Medicine, University of Brescia, Brescia, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Psychiatry Division, University of Pisa, Pisa, Italy
| |
Collapse
|
23
|
Cyclic alternating pattern in infants with congenital hypothyroidism. Brain Dev 2019; 41:66-71. [PMID: 30037585 DOI: 10.1016/j.braindev.2018.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2018] [Revised: 07/04/2018] [Accepted: 07/05/2018] [Indexed: 11/22/2022]
Abstract
Congenital hypothyroidism is defined as thyroid hormone deficiency present at birth which is crucial for brain development. Recently, the cyclic alternating pattern, a rhythm present in electroencephalography recordings in non-Rapid eye movement sleep, has been related to brain development and cognition in different pediatric conditions. Therefore, we evaluated the cyclic alternating pattern rate in infants with congenital hypothyroidism, thyroxine supplementation, and healthy controls. The parameters of the cyclic alternating pattern were evaluated in 19 healthy infants (10 female, mean age 25.5 ± 15.5 months) and 21 infants diagnosed with congenital hypothyroidism (19 female, mean age 24.3 ± 19.0 months). We considered the transient electro-cortical activations (phase A of the cycle) in non-Rapid eye movement sleep and the subdivisions of the A phase in: A1, A2 and A3, based on their frequency content. All subjects were subjected to polysomnography recording in a standard laboratory setting. Sleep data were stored computer following the International 10-20 System. Data showed that congenital hypothyroidism infants exhibited higher frequency of central apnea, hypopnea, and arousals in comparison to controls. Particularly, central apnea index decreased with age in the control group but not in congenital hypothyroidism group. Regarding to cyclic alternating pattern measurements, congenital hypothyroidism infants exhibit a higher frequency in the percentage of A3 subtype (electroencephalographic desynchrony) and conversely a lower percentage of A1 subtype (electroencephalographic synchrony), than healthy infants. An important finding of this study is the positive correlation between A1 mean duration and age, which is bigger in control group than in congenital hypothyroidism group (time duration in control group (0.52 s/month) versus congenital hypothyroidism group (0.1 s/month). Infants with congenital hypothyroidism showed an increase of A3 subtype, of central apnea, and of arousals. The reduction of percentage and mean duration of A1 subtype could be a valuable indicator of sleep development in patients with congenital hypothyroidism and healthy infants.
Collapse
|
24
|
Díaz-Román A, Zhang J, Delorme R, Beggiato A, Cortese S. Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies. EVIDENCE-BASED MENTAL HEALTH 2018; 21:146-154. [PMID: 30361331 PMCID: PMC10270396 DOI: 10.1136/ebmental-2018-300037] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking. OBJECTIVE We conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD. METHODS We searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran's Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger's test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis. FINDINGS: From a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9. DISCUSSION AND CLINICAL IMPLICATIONS A number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.
Collapse
Affiliation(s)
- Amparo Díaz-Román
- Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
| | - Junhua Zhang
- School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University, Yancheng, China
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Richard Delorme
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anita Beggiato
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York City, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
| |
Collapse
|
25
|
Prihodova I, Dudova I, Mohaplova M, Hrdlicka M, Nevsimalova S. Childhood narcolepsy and autism spectrum disorders: four case reports. Sleep Med 2018; 51:167-170. [PMID: 30216768 DOI: 10.1016/j.sleep.2018.07.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 07/10/2018] [Accepted: 07/10/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND Childhood narcolepsy is associated with various emotional, behavioural and cognitive dysfunctions as well as with psychiatric and neurodevelopmental disorders: anxiety, depression, attention deficit hyperactivity disorder and psychosis. A relationship between these conditions is unclear - comorbidity or similar pathophysiological mechanisms can be suggested. OBJECTIVE We reported four children with narcolepsy type 1 (NT1) and autism spectrum disorder (ASD) - Asperger syndrome (AS). RESULTS AND CONCLUSION To the best of our knowledge co-occurrence of NT1 and AS has not been described in the literature as noted in this report.
Collapse
|
26
|
The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities. J Clin Med 2018; 7:jcm7050102. [PMID: 29751511 PMCID: PMC5977141 DOI: 10.3390/jcm7050102] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 12/20/2022] Open
Abstract
Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.
Collapse
|
27
|
Johnson CR, Smith T, DeMand A, Lecavalier L, Evans V, Gurka M, Swiezy N, Bearss K, Scahill L. Exploring sleep quality of young children with autism spectrum disorder and disruptive behaviors. Sleep Med 2018; 44:61-66. [PMID: 29530371 PMCID: PMC5853135 DOI: 10.1016/j.sleep.2018.01.008] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 01/17/2018] [Accepted: 01/18/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND PURPOSE Sleep disturbances in autism spectrum disorder (ASD) are common and may impair daytime functioning as well as add to parental burden. In this well characterized sample of young children with ASD and disruptive behaviors, we examine the association of age and IQ in sleep disturbances using the Child Sleep Habits Questionnaire modified for ASD (CSHQ-ASD). We also test whether children with poor sleep have greater daytime behavioral problems than those with better sleep. Finally, we examine whether parental stress is higher in children with greater disruptive behaviors and sleep disturbances. PARTICIPANTS AND METHODS One hundred and seventy-seven children with complete data out of 180 (mean age 4.7) with ASD participated in a randomized clinical trial. Parents completed the CSHQ-ASD and several other measures at study enrollment. The sample was divided into "poor sleepers" (upper quartile on the total score of the CSHQ-ASD) and "good sleepers" (lower quartile) for comparisons. Analyses were conducted to evaluate group differences on age, IQ, daytime disruptive behavior, social disability and parental stress. RESULTS The two groups of young children with ASD, good sleepers versus poor sleepers, were not different on age or cognitive level. Children in the poor sleeping group had significantly higher daytime behavioral problems including irritability, hyperactivity, social withdrawal and stereotypical behaviors. Parents in this group reported significantly higher levels of stress. CONCLUSIONS The finding of no age difference between good and poor sleepers in young children with ASD and disruptive behaviors suggests that sleep problems are unlikely to resolve as might be expected in typically developing children. Likewise, the good and poor sleepers did not significantly differ in IQ. These findings add strong support for the need to screen for sleep disturbances in all children with ASD, regardless of age and cognitive level. Poor sleepers exhibited significantly greater daytime behavioral problems and parents of children in this group reported significantly higher levels of stress. Above and beyond the co-occurring disruptive behavior, poor sleep quality appears to pose substantial additive burden on child and parents.
Collapse
Affiliation(s)
- Cynthia R Johnson
- University of Florida, Department of Clinical & Health Psychology, USA.
| | | | | | | | - Victoria Evans
- University of Florida, Department of Clinical & Health Psychology, USA
| | - Matthew Gurka
- University of Florida, Department of Clinical & Health Psychology, USA
| | | | - Karen Bearss
- Seattle Children's Hospital & University of Washington, USA
| | - Lawrence Scahill
- Marcus Autism Center, Children's Healthcare of Atlanta & Emory University, USA
| |
Collapse
|
28
|
Esbensen AJ, Hoffman EK, Beebe DW, Byars KC, Epstein J. Links between sleep and daytime behaviour problems in children with Down syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2018; 62:115-125. [PMID: 29282827 PMCID: PMC5775033 DOI: 10.1111/jir.12463] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Revised: 10/11/2017] [Accepted: 11/29/2017] [Indexed: 05/27/2023]
Abstract
BACKGROUND In the general population, sleep problems have an impact on daytime performance. Despite sleep problems being common among children with Down syndrome, the impact of sleep problems on daytime behaviours in school-age children with Down syndrome is an understudied topic. Our study examined the relationship between parent-reported and actigraphy-measured sleep duration and sleep quality with parent and teacher reports of daytime behaviour problems among school-age children with Down syndrome. METHOD Thirty school-age children with Down syndrome wore an actigraph watch for a week at home at night. Their parent completed ratings of the child's sleep during that same week. Their parent and teacher completed a battery of measures to assess daytime behaviour. RESULTS Parent reports of restless sleep behaviours on the Children's Sleep Habits Questionnaire, but not actigraph-measured sleep efficiency, was predictive of parent and teacher behavioural concerns on the Nisonger Child Behaviour Rating Form and the Vanderbilt ADHD Rating Scales. Actigraph-measured sleep period and parent-reported sleep duration on the Children's Sleep Habits Questionnaire was predictive of daytime parent-reported inattention. Actigraph-measured sleep period was predictive of parent-reported hyperactivity/impulsivity. CONCLUSION The study findings suggest that sleep problems have complex relationships to both parent-reported and teacher-reported daytime behaviour concerns in children with Down syndrome. These findings have implications for understanding the factors impacting behavioural concerns and their treatment in school-age children with Down syndrome.
Collapse
Affiliation(s)
- A J Esbensen
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - E K Hoffman
- Division of Developmental and Behavioral Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - D W Beebe
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - K C Byars
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - J Epstein
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
29
|
Tye C, Runicles AK, Whitehouse AJO, Alvares GA. Characterizing the Interplay Between Autism Spectrum Disorder and Comorbid Medical Conditions: An Integrative Review. Front Psychiatry 2018; 9:751. [PMID: 30733689 PMCID: PMC6354568 DOI: 10.3389/fpsyt.2018.00751] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Accepted: 12/19/2018] [Indexed: 12/18/2022] Open
Abstract
Co-occurring medical disorders and associated physiological abnormalities in individuals with autism spectrum disorder (ASD) may provide insight into causal pathways or underlying biological mechanisms. Here, we review medical conditions that have been repeatedly highlighted as sharing the strongest associations with ASD-epilepsy, sleep, as well as gastrointestinal and immune functioning. We describe within each condition their prevalence, associations with behavior, and evidence for successful treatment. We additionally discuss research aiming to uncover potential aetiological mechanisms. We then consider the potential interaction between each group of conditions and ASD and, based on the available evidence, propose a model that integrates these medical comorbidities in relation to potential shared aetiological mechanisms. Future research should aim to systematically examine the interactions between these physiological systems, rather than considering these in isolation, using robust and sensitive biomarkers across an individual's development. A consideration of the overlap between medical conditions and ASD may aid in defining biological subtypes within ASD and in the development of specific targeted interventions.
Collapse
Affiliation(s)
- Charlotte Tye
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Abigail K Runicles
- Child & Adolescent Psychiatry, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, United Kingdom
| | - Andrew J O Whitehouse
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| | - Gail A Alvares
- Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.,Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, QLD, Australia
| |
Collapse
|
30
|
Köse S, Yılmaz H, Ocakoğlu FT, Özbaran NB. Sleep problems in children with autism spectrum disorder and intellectual disability without autism spectrum disorder. Sleep Med 2017; 40:69-77. [PMID: 29221782 DOI: 10.1016/j.sleep.2017.09.021] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Revised: 08/31/2017] [Accepted: 09/02/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate the sleep problems and their correlations in children with autism spectrum disorder (ASD), intellectual disability without ASD (ID), and typically developing children (TDC). METHODS This study included 142 children (48 with ASD, 46 with ID, 48 with TDC) aged between 2 and 18 years old. Parents of the children completed the Childhood Sleep Habits Questionnaire (CSHQ) in order to evaluate sleep disturbances. The sociodemographic and clinical information were noted on a data form for each child. RESULTS The mean total score of CSHQ was 41.56, 47.89 and 51.78 respectively in TDC, ASD and ID groups. While the total CSHQ score was significantly lower in TDC, there was no significant difference between ID and ASD groups (p = 0.09). It was revealed that children having a neurodevelopmental disorder had a 2.8-fold increased risk of sleep disturbance, history of sleep disorder in the parents had a 3.1-fold increased risk, psychiatric comorbidity in the child had a 3.3-fold increased risk, and co-sleeping with parents had 13.1-fold increased risk. However, in the binary regression analysis, co-sleeping with parents and family history of sleep problems significantly increased the risk of sleep disturbance. CONCLUSION Sleep disturbances are more frequent in children with ASD and ID than TDC. Co-sleeping with parents and family history of sleep problems increase the risk of sleep disturbances. Thus, behavioral techniques especially focusing on co-sleeping problems and focusing on parents' sleep habits may improve the sleep disturbances in children with ID and ASD.
Collapse
Affiliation(s)
- Sezen Köse
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| | - Helin Yılmaz
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey.
| | - F Tuna Ocakoğlu
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| | - N Burcu Özbaran
- Ege University School of Medicine, Department of Child and Adolescent Psychiatry, Turkey
| |
Collapse
|
31
|
Meyer C, Ferrari GJ, Barbosa DG, Andrade RD, Pelegrini A, Felden ÉPG. ANALYSIS OF DAYTIME SLEEPINIESS IN ADOLESCENTS BY THE PEDIATRIC DAYTIME SLEEPINESS SCALE: A SYSTEMATIC REVIEW. ACTA ACUST UNITED AC 2017; 35:351-360. [PMID: 28977300 PMCID: PMC5606183 DOI: 10.1590/1984-0462/;2017;35;3;00015] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 01/26/2017] [Indexed: 01/25/2023]
Abstract
Objective: To systematically review the use of the Pediatric Daytime Sleepiness Scale (PDSS) in the analysis of daytime sleepiness in children and adolescents. Data source: The electronic databases PubMed and SciELO were consulted between 2003 and 2015. As inclusion criterion, studies were considered in English, Spanish and Portuguese, original articles of any type of design, articles with a sample of children and/or adolescents, articles that used the PDSS. Duplicate articles, articles with no relation to the theme, articles with another investigated population, and articles that the parents answered the instrument for their children were excluded. To find the material with these features, the terms “Daytime sleepiness” AND “adolescents” and “Daytime sleepiness” AND “children” were used in the searches. In addition, the descriptor “Pediatric Daytime Sleepiness Scale” was used to filter more specifically. Data synthesis: Initially, 986 studies related to daytime sleepiness were identified. Considering the inclusion criteria, we analyzed 26 studies composed of 18,458 subjects aged 0 to 37 years. The diurnal sleepiness score ranged from 6.7±0.6 to 25.7±0.6 points. In general, all included studies investigated other sleep variables in addition to daytime sleepiness, such as: sleep duration, sleep quality, sleep hygiene or sleep disorders (narcolepsy and cataplexy), respiratory disorders, neurological and developmental disorders. Conclusions: There was a moderate use of PDSS to evaluate daytime sleepiness. This instrument allows the monitoring of factors that influence excessive daytime sleepiness in children and adolescents.
Collapse
Affiliation(s)
- Carolina Meyer
- Universidade do Estado de Santa Catarina, Florianópolis, SC, Brasil
| | | | | | | | | | | |
Collapse
|
32
|
DSM-5 Changes in Attention Deficit Hyperactivity Disorder and Autism Spectrum Disorder: Implications for Comorbid Sleep Issues. CHILDREN-BASEL 2017; 4:children4080062. [PMID: 28749421 PMCID: PMC5575584 DOI: 10.3390/children4080062] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/18/2017] [Revised: 07/07/2017] [Accepted: 07/26/2017] [Indexed: 11/17/2022]
Abstract
Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are the most common neurodevelopmental disorders. Despite significant comorbidity, the previous diagnostic criteria prohibited the simultaneous diagnosis of both disorders. Sleep problems are highly prevalent in both disorders; however, these have been studied independently for ADHD and ASD. In the context of revised criteria in the Diagnostic Statistical Manual of Mental Disorders 5th edition (DSM-5) that allows combined diagnosis of ADHD and ASD, this short review presents an overview of relationship between sleep problems, ADHD and ASD, as well as conceptualizing the shared pathophysiology. The practical considerations for clinical management of sleep problems in combination with ADHD and ASD are also discussed.
Collapse
|
33
|
Primeau M, Gershon A, Talbot L, Cotto I, Lotspeich L, Hardan A, Hallmayer J, O'Hara R. Individuals with Autism Spectrum Disorders Have Equal Success Rate But Require Longer Periods of Systematic Desensitization than Control Patients to Complete Ambulatory Polysomnography. J Clin Sleep Med 2017; 12:357-62. [PMID: 26564388 DOI: 10.5664/jcsm.5584] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 10/02/2015] [Indexed: 11/13/2022]
Abstract
STUDY OBJECTIVES Polysomnography (PSG) is the gold standard for the assessment of sleep, yet the extensive apparatus required for monitoring with PSG can be difficult to tolerate, particularly in children. Clinical populations, such as those with anxiety or tactile sensitivity, may have even greater difficulty tolerating the PSG equipment. This study evaluated an innovative protocol for obtaining full PSG in individuals diagnosed autism spectrum disorders (ASD) or developmental delay (DD), as well as typically developing controls (TD). The primary aim was to assess whether this protocol was equally successful for obtaining PSG between these groups. METHODS One hundred sixty-one individuals were recruited for participation; 93 with a diagnosis of ASD, 23 with a diagnosis of DD, and 45 TD. The participants and families were instructed on a procedure of systematic desensitization to the ambulatory PSG equipment; PSG was performed in the home of the participant. RESULTS PSG was successfully attained in 144 (89.4%) participants. There was no difference in completion rate by diagnosis (p = 0.1), though younger age (p = 0.018) and duration of desensitization (p = 0.024) did predict PSG failure. Further, it was found that individuals with ASD took longer to desensitize to the equipment (16.08 d), than those with DD (8.04 d) or TD (0.98 d). CONCLUSIONS Systematic desensitization to PSG equipment, in combination with PSG completed in the home, allows for individuals with ASD to be equally successful in completing PSG, though they do take longer to acclimate to the equipment.
Collapse
Affiliation(s)
- Michelle Primeau
- Palo Alto Medical Foundation, Department of Sleep Medicine, Sunnyvale, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Anda Gershon
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Lisa Talbot
- San Francisco VA Medical Center, San Francisco, CA
| | - Isabelle Cotto
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Linda Lotspeich
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA
| | - Antonio Hardan
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford, CA
| | - Joachim Hallmayer
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,Stanford University Department of Psychiatry and Behavioral Sciences, Child and Adolescent Psychiatry, Stanford, CA
| | - Ruth O'Hara
- Stanford University Department of Psychiatry and Behavioral Sciences, Stanford, CA.,San Francisco VA Medical Center, San Francisco, CA.,Mental Illness Research, Education, and Clinical Center (MIRECC): VISN 21: Sierra Pacific Network, Department of Veterans Affairs, Palo Alto, CA
| |
Collapse
|
34
|
Baglioni C, Nanovska S, Regen W, Spiegelhalder K, Feige B, Nissen C, Reynolds CF, Riemann D. Sleep and mental disorders: A meta-analysis of polysomnographic research. Psychol Bull 2016; 142:969-990. [PMID: 27416139 PMCID: PMC5110386 DOI: 10.1037/bul0000053] [Citation(s) in RCA: 535] [Impact Index Per Article: 66.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Investigating sleep in mental disorders has the potential to reveal both disorder-specific and transdiagnostic psychophysiological mechanisms. This meta-analysis aimed at determining the polysomnographic (PSG) characteristics of several mental disorders. Relevant studies were searched through standard strategies. Controlled PSG studies evaluating sleep in affective, anxiety, eating, pervasive developmental, borderline and antisocial personality disorders, attention-deficit-hyperactivity disorder (ADHD), and schizophrenia were included. PSG variables of sleep continuity, depth, and architecture, as well as rapid-eye movement (REM) sleep were considered. Calculations were performed with the "Comprehensive Meta-Analysis" and "R" software. Using random effects modeling, for each disorder and each variable, a separate meta-analysis was conducted if at least 3 studies were available for calculation of effect sizes as standardized means (Hedges' g). Sources of variability, that is, sex, age, and mental disorders comorbidity, were evaluated in subgroup analyses. Sleep alterations were evidenced in all disorders, with the exception of ADHD and seasonal affective disorders. Sleep continuity problems were observed in most mental disorders. Sleep depth and REM pressure alterations were associated with affective, anxiety, autism and schizophrenia disorders. Comorbidity was associated with enhanced REM sleep pressure and more inhibition of sleep depth. No sleep parameter was exclusively altered in 1 condition; however, no 2 conditions shared the same PSG profile. Sleep continuity disturbances imply a transdiagnostic imbalance in the arousal system likely representing a basic dimension of mental health. Sleep depth and REM variables might play a key role in psychiatric comorbidity processes. Constellations of sleep alterations may define distinct disorders better than alterations in 1 single variable. (PsycINFO Database Record
Collapse
Affiliation(s)
- Chiara Baglioni
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Svetoslava Nanovska
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Wolfram Regen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Kai Spiegelhalder
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Bernd Feige
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | - Christoph Nissen
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| | | | - Dieter Riemann
- Department of Clinical Psychology and Psychophysiology, Center for Mental Disorders, University of Freiburg Medical Center, Germany
| |
Collapse
|
35
|
Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study. Child Psychiatry Hum Dev 2016; 47:248-58. [PMID: 26072264 DOI: 10.1007/s10578-015-0561-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.
Collapse
|
36
|
Sleep differences among children with autism spectrum disorders and typically developing peers: a meta-analysis. J Dev Behav Pediatr 2015; 36:166-77. [PMID: 25741949 DOI: 10.1097/dbp.0000000000000140] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Sleep problems such as difficulties in sleep initiation, nighttime awakening, and shortened sleep time are often subjectively reported in children with autism spectrum disorder (ASD). However, results of objective studies have been mixed. Our goal was to evaluate the existing data from objective measures using a systematic approach to identify and describe the differences in sleep parameters by comparing total sleep time (TST), sleep latency (SL), and sleep efficiency (SE) in children with ASD with those of typically developing (TD) peers. METHODS Studies that used objective measures such as actigraphy or polysomnography (PSG) to describe the sleep parameters of TST, SL, and SE in children with ASD compared with children with TD were identified. A meta-analysis was performed for the 10 studies that met inclusion criteria with evaluation of differences in means using random effects models. A total of 343 children with ASD and 221 children with TD were included. Assessments for sources of heterogeneity and publication bias were undertaken. RESULTS TST for children with ASD was on average 32.8 minutes less per day (95% confidence interval [CI]: 16.6-49.0 minutes) than their TD peers. Average SL was 10.9 minutes longer (95% CI: 6.7-15.0 minutes), and average SE was 1.9% less (95% CI: 0.7%-3.1%) than their TD peers. Notable heterogeneity was found within studies for TST, and mild heterogeneity was found for SE. Concurrent intellectual disability was a moderator of TST. Children with ASD and normal intelligence had a small and nonsignificant decrease in TST as compared with TD peers, whereas those with ASD and intellectual disability (ID) had a significant decrease in TST as compared with TD peers. The magnitude of the difference in mean SL and SE increased as compared with TD peers as age increased. Studies that used PSG and those that did not include children on medications were more likely to report mean decreases in SE. CONCLUSIONS Children with ASD have small but measurable objective differences in their sleep parameters that are consistent with subjective reporting. Children with ASD have shorter TST, longer SL periods, and decreased SE as compared with TD peers. Concurrent ID, medication use, method of data collection, and age of subjects significantly moderated these results. The decrease in TST in children with ASD and normal intelligence was not significant as compared with TD peers, suggesting that ID may help explain the shortened TST in children with ASD.
Collapse
|
37
|
Hollway JA, Aman MG, Butter E. Correlates and risk markers for sleep disturbance in participants of the Autism Treatment Network. J Autism Dev Disord 2014; 43:2830-43. [PMID: 23624832 DOI: 10.1007/s10803-013-1830-y] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
We explored possible cognitive, behavioral, emotional, and physiological risk markers for sleep disturbance in children with autism spectrum disorders. Data from 1,583 children in the Autism Treatment Network were analyzed. Approximately 45 potential predictors were analyzed using hierarchical regression modeling. As medication could confound findings, it was included in the analyses as a covariate. Results revealed that anxiety, autism symptom severity, sensory sensitivities, and GI problems were associated with sleep disturbance. IQ positively predicted sleep disturbance, and children with Asperger's Disorder were more vulnerable than others. The amount of variance in sleep outcomes explained by predictor variables was modest (i.e., R (2) from .104 to .201). Predictor variables were evaluated in the context of a bidirectional theoretical framework.
Collapse
Affiliation(s)
- Jill A Hollway
- The Nisonger Center, UCEDD, Department of Psychology, Intellectual and Developmental Disabilities, The Ohio State University, 1581 Dodd Drive, Columbus, OH, 43210, USA,
| | | | | |
Collapse
|
38
|
Humphreys JS, Gringras P, Blair PS, Scott N, Henderson J, Fleming PJ, Emond AM. Sleep patterns in children with autistic spectrum disorders: a prospective cohort study. Arch Dis Child 2014; 99:114-8. [PMID: 24061777 PMCID: PMC3913218 DOI: 10.1136/archdischild-2013-304083] [Citation(s) in RCA: 113] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Revised: 07/16/2013] [Accepted: 07/31/2013] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To investigate longitudinal sleep patterns in children with autistic spectrum disorders (ASDs). STUDY DESIGN Prospective longitudinal study using Avon Longitudinal Study of Parents and Children, an English cohort born in 1991-1992. Parental reports of sleep duration were collected by questionnaires at 8 time points from 6 months to 11 years. Children with an ASD diagnosis at age 11 years (n=73) were identified from health and education records. RESULTS From aged 30 months to 11 years old, children with ASD slept for 17-43 min less each day than contemporary controls. No significant difference in total sleep duration was found in infancy, but from 30 months of age children with ASD slept less than their peers, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy. The reduction in total sleep was wholly due to changes in night rather than daytime sleep duration. Night-time sleep duration was shortened by later bedtimes and earlier waking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age. Age-specific decreases of >1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age (p=0.04) and from 30 months to 42 months (p=0.02). CONCLUSIONS Sleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.
Collapse
|
39
|
Matsuoka M, Nagamitsu S, Iwasaki M, Iemura A, Yamashita Y, Maeda M, Kitani S, Kakuma T, Uchimura N, Matsuishi T. High incidence of sleep problems in children with developmental disorders: results of a questionnaire survey in a Japanese elementary school. Brain Dev 2014; 36:35-44. [PMID: 23305729 DOI: 10.1016/j.braindev.2012.12.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Revised: 10/29/2012] [Accepted: 12/09/2012] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The aim of the present school-based questionnaire was to analyze the sleep problems of children with developmental disorders, such as pervasive developmental disorder and attention deficit hyperactivity disorder. METHODS The sleep problems of 43 children with developmental disorders were compared with those of 372 healthy children (control group). All children attended one public elementary school in Kurume, Japan; thus, the study avoided the potential bias associated with hospital-based surveys (i.e. a high prevalence of sleep disturbance) and provided a more complete picture of the children's academic performance and family situation compared with a control group under identical conditions. Children's sleep problems were measured with the Japanese version of the Children's Sleep Habits Questionnaire (CSHQ). RESULTS Children with developmental disorders had significantly higher total CSHQ scores, as well as mean scores on the parasomnias and sleep breathing subscales, than children in the control group. The total CSHQ score, bedtime resistance, sleep onset delay, and daytime sleepiness worsened with increasing age in children with developmental disorders; in contrast, these parameters were unchanged or became better with age in the control group. In children with developmental disorders, there was a significant association between a higher total CSHQ score and lower academic performance, but no such association was found in the control group. For both groups, children's sleep problems affected their parents' quality of sleep. There were no significant differences in physical, lifestyle, and sleep environmental factors, or in sleep/wake patterns, between the two groups. CONCLUSIONS Children with developmental disorders have poor sleep quality, which may affect academic performance. It is important for physicians to be aware of age-related differences in sleep problems in children with developmental disorders. Further studies are needed to identify the association between sleep quality and school behavioral performance.
Collapse
Affiliation(s)
- Michiko Matsuoka
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan; Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan; Department of Neuropsychiatry, Kurume University Graduate School of Medicine, Fukuoka, Japan
| | - Shinichiro Nagamitsu
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Mizue Iwasaki
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Akiko Iemura
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Yushiro Yamashita
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan
| | - Masaharu Maeda
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Shingo Kitani
- Department of Biostatistics, Kurume University Graduate School of Medicine, Fukuoka, Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center, Kurume University School of Medicine, Fukuoka, Japan
| | - Naohisa Uchimura
- Department of Neuropsychiatry, Kurume University School of Medicine, Fukuoka, Japan
| | - Toyojiro Matsuishi
- Department of Pediatrics and Child Health, Kurume University School of Medicine, Fukuoka, Japan.
| |
Collapse
|
40
|
Ferini-Strambi L, Galbiati A, Marelli S. Sleep microstructure and memory function. Front Neurol 2013; 4:159. [PMID: 24130550 PMCID: PMC3795358 DOI: 10.3389/fneur.2013.00159] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/26/2013] [Indexed: 11/13/2022] Open
|
41
|
Urbain C, Galer S, Van Bogaert P, Peigneux P. Pathophysiology of sleep-dependent memory consolidation processes in children. Int J Psychophysiol 2013; 89:273-83. [DOI: 10.1016/j.ijpsycho.2013.06.022] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2013] [Revised: 06/13/2013] [Accepted: 06/17/2013] [Indexed: 11/30/2022]
|
42
|
Sleep deprivation and neurobehavioral functioning in children. Int J Psychophysiol 2013; 89:259-64. [DOI: 10.1016/j.ijpsycho.2013.06.019] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2012] [Revised: 05/11/2013] [Accepted: 06/14/2013] [Indexed: 11/19/2022]
|
43
|
Novelli L, Ferri R, Bruni O. Sleep cyclic alternating pattern and cognition in children: a review. Int J Psychophysiol 2013; 89:246-51. [PMID: 23911606 DOI: 10.1016/j.ijpsycho.2013.07.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 07/20/2013] [Accepted: 07/22/2013] [Indexed: 10/26/2022]
Abstract
Several studies have been recently focused on the relationship between sleep cyclic alternating pattern (CAP) and daytime cognitive performance, supporting the idea that the CAP slow components may play a role in sleep-related cognitive processes. Based on the results of these reports, it can be hypothesized that the analysis of CAP might be helpful in characterizing sleep microstructure patterns of different phenotypes of intellectual disability and a series of studies has been carried out that are reviewed in this paper. First the studies exploring the correlations between CAP and cognitive performance in normal adults and children are described; then, those analyzing the correlation between CAP and cognitive patterns of several developmental conditions with neurocognitive dysfunction (with or without mental retardation) are reported in detail in order to achieve a unitary view of the role of CAP in these conditions that allows to detect a particular "sleep microstructure phenotype" of children with neurologic/neuropsychiatric disorders.
Collapse
Affiliation(s)
- Luana Novelli
- Centre for Pediatric Sleep Disorders, Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
| | | | | |
Collapse
|
44
|
Kotagal S, Broomall E. Sleep in children with autism spectrum disorder. Pediatr Neurol 2012; 47:242-51. [PMID: 22964437 DOI: 10.1016/j.pediatrneurol.2012.05.007] [Citation(s) in RCA: 133] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Accepted: 05/21/2012] [Indexed: 12/13/2022]
Abstract
Children with autism spectrum disorder demonstrate an increased prevalence of difficulties with sleep initiation and maintenance. The consequences may include alterations in daytime behavior, memory, and learning in patients, and significant stress in caretakers. The dysregulation of melatonin synthesis, sensitization to environmental stimuli, behavioral insomnia syndromes, delayed sleep phase syndrome, rapid eye movement sleep behavior disorder, and comorbid anxiety, depression, and epilepsy comprise common etiologic factors. The clinical assessment of sleep problems in this population and a management algorithm are presented.
Collapse
Affiliation(s)
- Suresh Kotagal
- Division of Child Neurology, Mayo Clinic, Rochester, Minnesota 55902, USA.
| | | |
Collapse
|
45
|
Taylor MA, Schreck KA, Mulick JA. Sleep disruption as a correlate to cognitive and adaptive behavior problems in autism spectrum disorders. RESEARCH IN DEVELOPMENTAL DISABILITIES 2012; 33:1408-17. [PMID: 22522199 DOI: 10.1016/j.ridd.2012.03.013] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2012] [Accepted: 03/06/2012] [Indexed: 05/14/2023]
Abstract
Sleep problems associated with autism spectrum disorders (ASD) have been well documented, but less is known about the effects of sleep problems on day-time cognitive and adaptive performance in this population. Children diagnosed with autism or pervasive developmental disorder-not otherwise specified (PDD-NOS) (N = 335) from 1 to 10 years of age (M = 5.5 years) were evaluated for the relationships of Behavioral Evaluation of Disorders of Sleep (BEDS; Schreck, 1998) scores to measures of intelligence and adaptive behavior. Results suggested that children who slept fewer hours per night had lower overall intelligence, verbal skills, overall adaptive functioning, daily living skills, socialization skills, and motor development. Children who slept fewer hours at night with waking during the night had more communication problems. Breathing related sleep problems and fewer hours of sleep related most often to problems with perceptual tasks. The results indicate that quality of sleep--especially sleep duration--may be related to problems with day-time cognitive and adaptive functioning in children with autism and PDD-NOS. However, future research must be conducted to further understand these relationships.
Collapse
Affiliation(s)
- Matthew A Taylor
- The Ohio State University, Nationwide Children’s Hospital Developmental Assessment Program, 187 West Schrock Road, Westerville, OH 43081, USA.
| | | | | |
Collapse
|
46
|
Pereira AM, Bruni O, Ferri R, Palmini A, Nunes ML. The impact of epilepsy on sleep architecture during childhood. Epilepsia 2012; 53:1519-25. [DOI: 10.1111/j.1528-1167.2012.03558.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
|
47
|
Pereira AM, Bruni O, Ferri R, Nunes ML. Sleep instability and cognitive status in drug-resistant epilepsies. Sleep Med 2012; 13:536-41. [DOI: 10.1016/j.sleep.2011.12.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Revised: 11/27/2011] [Accepted: 12/10/2011] [Indexed: 11/24/2022]
|
48
|
Bruni O, Kohler M, Novelli L, Kennedy D, Lushington K, Martin J, Ferri R. The role of NREM sleep instability in child cognitive performance. Sleep 2012; 35:649-56. [PMID: 22547891 PMCID: PMC3321424 DOI: 10.5665/sleep.1824] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
STUDY OBJECTIVES Based on recent reports of the involvement of cyclic alternating pattern (CAP) in cognitive functioning in adults, we investigated the association between CAP parameters and cognitive performance in healthy children. DESIGN Polysomnographic assessment and standardized neurocognitive testing in healthy children. SETTINGS Sleep laboratory. PARTICIPANTS Forty-two children aged 7.6 ± 2.7 years, with an even distribution of body mass percentile (58.5 ± 25.5) and SES reflective of national norms. MEASUREMENTS Analysis of sleep macrostructure following the R&K criteria and of cyclic alternating pattern (CAP). The neurocognitive tests were the Stanford Binet Intelligence Scale (5(th) edition) and a Neuropsychological Developmental Assessment (NEPSY) RESULTS: Fluid reasoning ability was positively associated with CAP rate, particularly during SWS and with A1 total index and A1 index in SWS. Regression analysis, controlling for age and SES, showed that CAP rate in SWS and A1 index in SWS were significant predictors of nonverbal fluid reasoning, explaining 24% and 22% of the variance in test scores, respectively. CONCLUSION This study shows that CAP analysis provides important insights on the role of EEG slow oscillations (CAP A1) in cognitive performance. Children with higher cognitive efficiency showed an increase of phase A1 in total sleep and in SWS.
Collapse
Affiliation(s)
- Oliviero Bruni
- Centre for Paediatric Sleep Disorders, Department of Developmental Neurology and Psychiatry, Sapienza University, Rome, Italy.
| | | | | | | | | | | | | |
Collapse
|
49
|
Verrillo E, Bizzarri C, Bruni O, Ferri R, Pavone M, Cappa M, Cutrera R. Effects of replacement therapy on sleep architecture in children with growth hormone deficiency. Sleep Med 2012; 13:496-502. [PMID: 22437138 DOI: 10.1016/j.sleep.2011.09.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2011] [Revised: 08/20/2011] [Accepted: 09/07/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Children with GH deficiency (GHD) show a general decrease in electroencephalographic (EEG) arousability represented by a significant global decrease in Cyclic Alternating Pattern (CAP). The aim of the present study was to evaluate if sleep structure is influenced by GH substitutive therapy by analyzing the classical sleep architecture parameters and sleep microstructure by means of CAP. SUBJECTS AND METHODS Laboratory polysomnographic sleep recordings were obtained from five children affected by GHD (two girls and three boys; mean age: 4.6 ± 3.1 years), at baseline and after GH therapy, and from 10 normal healthy children (four girls and six boys, mean age: 5.6 ± 2.2 years). RESULTS Compared to controls, GHD subjects showed a reduced total sleep time with increased wakefulness and a consequent decrease in sleep efficiency; GH therapy was associated with an increase of the awakenings/hour and a large effect size was evident for sleep latency, sleep efficiency, and stage N3, which were decreased, and for stage W, which was increased. CAP appeared to be globally reduced and all phase A subtypes and CAP cycle showed a longer duration in GHD children vs. controls. GH substitutive treatment was followed by an increase in CAP rate (total, in N2, and in N3); additionally, A1 index was also significantly increased, especially during stage N3, with a very large effect size. On the other hand, A2 and A3 index and CAP cycle mean duration were reduced. CONCLUSION Sleep stage architecture seems to be influenced by the GH status, but the analysis of sleep microstructure by means of CAP reveals an enhancement of EEG slow oscillations in GHD patients (demonstrated by an increase in CAP rate and A1 index during N3) after the start of GH replacement therapy. These findings deserve to be verified in a larger trial.
Collapse
Affiliation(s)
- Elisabetta Verrillo
- Respiratory Unit, Bambino Gesù Children's Hospital and Research Institute, Rome, Italy
| | | | | | | | | | | | | |
Collapse
|
50
|
Hollway JA, Aman MG. Sleep correlates of pervasive developmental disorders: a review of the literature. RESEARCH IN DEVELOPMENTAL DISABILITIES 2011; 32:1399-1421. [PMID: 21570809 DOI: 10.1016/j.ridd.2011.04.001] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2011] [Revised: 04/01/2011] [Accepted: 04/02/2011] [Indexed: 05/30/2023]
Abstract
Sleep disturbance is a significant problem in the general pediatric population, and it occurs even more frequently in children with pervasive developmental disorders (PDDs). Much time and energy have been spent examining the characteristics that predispose children to insomnia and it is likely that equivalent factors influence sleep in PDDs. Though similarly affected, it is the unique set of characteristics incumbent in a diagnosis of PDD that has additive effects and increases the likelihood for developing other predisposing factors and subsequent sleep loss. This review summarized research that has explored the behavioral, cognitive, and emotional correlates of sleep disturbance in children with PDDs. The literature provided 38 sleep studies that used either subjective or objective sleep measures. Of these, 17 met criteria for inclusion. Studies were evaluated for their attempts at matching their study samples and adjusting for possible confounding variables. The results revealed that the combined effects of autism symptom severity, internalizing behavior, and externalizing behavior, were the main predisposing factors for the development of insomnia. Other factors included medical conditions, epilepsy, and medication use (likely a proxy for behavior difficulty and even sleep disorder). A bidirectional theoretical framework for sleep disturbance in children with PDDs has been posited as a conceptual guide for future study. Recommendations for future study designs are included.
Collapse
Affiliation(s)
- Jill A Hollway
- The Nisonger Center, The Ohio State University, Columbus, OH 43210, United States.
| | | |
Collapse
|