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Kikuchi K, Michikawa T, Morokuma S, Hamada N, Suetsugu Y, Ikeda S, Nakahara K, Kato K, Ochiai M, Shibata E, Tsuji M, Shimono M, Kawamoto T, Ohga S, Kusuhara K. Sleep quality and temperament in association with autism spectrum disorder among infants in Japan. COMMUNICATIONS MEDICINE 2023; 3:82. [PMID: 37328542 PMCID: PMC10275966 DOI: 10.1038/s43856-023-00314-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/05/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Sleep problems and irritable temperaments are common among infants with autism spectrum disorder (ASD). The prospective association between such sleep problems and irritable temperaments and ASDs needs to be determined for elucidating the mechanism and exploring the future intervention study. Thus, in this study, we investigated whether sleep quality and temperament in 1-month-old infants are associated with the onset of ASD in 3-year-old children. We also assessed its sex-stratified associations. METHODS We conducted a longitudinal study using data from 69,751 mothers and infants from a large-cohort study, the Japan Environment and Children's Study. We examined the prospective association between infant sleep quality and temperament at 1 month of age and ASD diagnosis by 3 years of age. RESULTS Here we show infants with longer daytime sleep have a higher risk of later ASD than those with shorter daytime sleep (risk ratio [RR]: 1.33, 95% confidence interval [CI]: 1.01-1.75). Infants who experienced intense crying have a higher risk of ASD than those who did not (RR: 1.31, 95% CI: 1.00-1.72). There is a difference in sex in the association between a bad mood and later ASD. In particular, female infants experiencing bad moods have a higher risk of ASD than others (RR: 3.59, 95% CI: 1.91-6.75). CONCLUSIONS The study findings provide important information for future intervention to reduce the risk of future ASD.
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Affiliation(s)
- Kimiyo Kikuchi
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takehiro Michikawa
- Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan
| | - Seiichi Morokuma
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.
| | - Norio Hamada
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiko Suetsugu
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Subaru Ikeda
- Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kazushige Nakahara
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Kiyoko Kato
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Masayuki Ochiai
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Eiji Shibata
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Mayumi Tsuji
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Masayuki Shimono
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
| | - Toshihiro Kawamoto
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Shouichi Ohga
- Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan
- Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Koichi Kusuhara
- Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan
- Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan
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2
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Hartman AG, McKendry S, Akcakaya M, Soehner A, Bodison SC, DeAlmeida D, Bendixen R. Characterizing rest-activity rhythms and sleep for children with and without tactile sensitivities: An observational study. Sleep Med 2023; 106:8-16. [PMID: 37030035 PMCID: PMC10159915 DOI: 10.1016/j.sleep.2023.03.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 03/01/2023] [Accepted: 03/23/2023] [Indexed: 03/30/2023]
Abstract
STUDY OBJECTIVES This cross-sectional, observational study aimed to characterize and compare movement-based rest-activity rhythms (RARs) and sleep period variables of children with tactile hypersensitivities (SS) and non-sensitive peers (NSS) to expand the understanding of experienced differences in sleep. METHODS Children (ages 6-10) wore Actigraph GT9X watches for 2 weeks and caregivers completed daily sleep diaries. RARs and sleep period variables (e.g., sleep efficiency, duration, wake after sleep onset) were analyzed and localized means were plotted to visualize average rhythms for each group. Groups were compared using Student's t tests, or non-parametric alternatives, and Hedge's g effect sizes. RESULTS Fifty-three children and their families participated in this study (nSS = 21 nNSS = 32). The groups had similar RARs and sleep period variables. In both groups, sleep efficiency was low (SESS = 78%, SENSS = 77%) and total sleep time was short (TSTSS = 7 hrs 26 mins, TSTNSS- 7 h, 33 min) compared to national recommendations. Despite these similarities, children with SS took noticeably longer to settle down and fall asleep (53 min) than children with NSS (26 min, p = .075, g = 0.95). CONCLUSION This study provides preliminary data describing RAR and sleep period variables in children with and without tactile hypersensitivities. While overall RAR and sleep variables were similar between groups, there is evidence that children with SS spend a longer time transitioning to sleep. Evidence is provided that wrist-worn actigraphy is tolerable and acceptable for children with tactile sensitivities. Actigraphy provides important, movement-based data that should be used in tandem with other measures of sleep health for future studies.
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Affiliation(s)
- Amy G Hartman
- University of Pittsburgh, Department of Psychiatry, United States.
| | - Sarah McKendry
- University of Pittsburgh, Department of Occupational Therapy, United States
| | - Murat Akcakaya
- University of Pittsburgh, Department of Engineering, United States
| | - Adriane Soehner
- University of Pittsburgh, Department of Psychiatry, United States
| | - Stefanie C Bodison
- University of Florida, Department of Occupational Therapy, United States
| | - Dilhari DeAlmeida
- University of Pittsburgh, Department of Health Information Management, United States
| | - Roxanna Bendixen
- Medical University of South Carolina, Division of Occupational Therapy, United States
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3
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Durán-Pacheco G, Silkey M, Johnson M, Liu C, Clinch S, Law K, Loss G. Effect of Children's Autism Spectrum Disorder Severity on Family Strain and Sleep Quality: A Cross-Sectional Online Survey in the U.S. J Autism Dev Disord 2023; 53:1795-1808. [PMID: 35118575 PMCID: PMC10123033 DOI: 10.1007/s10803-022-05457-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/21/2022] [Indexed: 12/13/2022]
Abstract
To better understand the impact of children's autism spectrum disorder (ASD) severity on families, we evaluated pathways through which ASD severity affected child sleep quality, caregiver strain, and caregiver sleep quality. In a cross-sectional analysis through the U.S.-wide Simons Foundation Powering Autism Research for Knowledge (SPARK) cohort. Participants were caregivers of dependents with ASD aged 3-17 years (N = 3150). We found that increased severity strongly affects caregiver strain and child sleep quality. Child sleep quality was a minor mediator of increasing caregiver strain. Caregiver sleep quality depended on ASD severity only through child sleep quality and caregiver strain. Interventions aimed at improving child sleep quality or reducing caregiver strain could positively impact families of children with ASD.
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Affiliation(s)
| | | | - Michelle Johnson
- Roche Products Ltd., Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK.
| | - Chuang Liu
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - Susanne Clinch
- Roche Products Ltd., Hexagon Place, 6 Falcon Way, Shire Park, Welwyn Garden City, AL7 1TW, UK
| | - Kiely Law
- Kennedy Krieger Institute, Baltimore, MD, USA
- Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Georg Loss
- F. Hoffmann-La Roche Ltd., Basel, Switzerland
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4
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Ji Q, Li SJ, Zhao JB, Xiong Y, Du XH, Wang CX, Lu LM, Tan JY, Zhu ZR. Genetic and neural mechanisms of sleep disorders in children with autism spectrum disorder: a review. Front Psychiatry 2023; 14:1079683. [PMID: 37200906 PMCID: PMC10185750 DOI: 10.3389/fpsyt.2023.1079683] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Accepted: 04/13/2023] [Indexed: 05/20/2023] Open
Abstract
Background The incidence of sleep disorders in children with autism spectrum disorder (ASD) is very high. Sleep disorders can exacerbate the development of ASD and impose a heavy burden on families and society. The pathological mechanism of sleep disorders in autism is complex, but gene mutations and neural abnormalities may be involved. Methods In this review, we examined literature addressing the genetic and neural mechanisms of sleep disorders in children with ASD. The databases PubMed and Scopus were searched for eligible studies published between 2013 and 2023. Results Prolonged awakenings of children with ASD may be caused by the following processes. Mutations in the MECP2, VGAT and SLC6A1 genes can decrease GABA inhibition on neurons in the locus coeruleus, leading to hyperactivity of noradrenergic neurons and prolonged awakenings in children with ASD. Mutations in the HRH1, HRH2, and HRH3 genes heighten the expression of histamine receptors in the posterior hypothalamus, potentially intensifying histamine's ability to promote arousal. Mutations in the KCNQ3 and PCDH10 genes cause atypical modulation of amygdala impact on orexinergic neurons, potentially causing hyperexcitability of the hypothalamic orexin system. Mutations in the AHI1, ARHGEF10, UBE3A, and SLC6A3 genes affect dopamine synthesis, catabolism, and reuptake processes, which can elevate dopamine concentrations in the midbrain. Secondly, non-rapid eye movement sleep disorder is closely related to the lack of butyric acid, iron deficiency and dysfunction of the thalamic reticular nucleus induced by PTCHD1 gene alterations. Thirdly, mutations in the HTR2A, SLC6A4, MAOA, MAOB, TPH2, VMATs, SHANK3, and CADPS2 genes induce structural and functional abnormalities of the dorsal raphe nucleus (DRN) and amygdala, which may disturb REM sleep. In addition, the decrease in melatonin levels caused by ASMT, MTNR1A, and MTNR1B gene mutations, along with functional abnormalities of basal forebrain cholinergic neurons, may lead to abnormal sleep-wake rhythm transitions. Conclusion Our review revealed that the functional and structural abnormalities of sleep-wake related neural circuits induced by gene mutations are strongly correlated with sleep disorders in children with ASD. Exploring the neural mechanisms of sleep disorders and the underlying genetic pathology in children with ASD is significant for further studies of therapy.
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Affiliation(s)
- Qi Ji
- Department of Psychology, Army Medical University, Chongqing, China
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Si-Jia Li
- Department of Psychology, Army Medical University, Chongqing, China
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Jun-Bo Zhao
- Department of Psychology, Army Medical University, Chongqing, China
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Yun Xiong
- Department of Psychology, Army Medical University, Chongqing, China
- College of Basic Medicine, Army Medical University, Chongqing, China
| | - Xiao-Hui Du
- Department of Psychology, Army Medical University, Chongqing, China
| | - Chun-Xiang Wang
- Department of Psychology, Army Medical University, Chongqing, China
| | - Li-Ming Lu
- College of Educational Sciences, Chongqing Normal University, Chongqing, China
| | - Jing-Yao Tan
- College of Educational Sciences, Chongqing Normal University, Chongqing, China
| | - Zhi-Ru Zhu
- Department of Psychology, Army Medical University, Chongqing, China
- *Correspondence: Zhi-Ru Zhu,
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Nic Ghiolla Phadraig A, Smyth S. Sleep mediates the relationship between having an autistic child and poor family functioning. Sleep Med 2023; 101:190-196. [PMID: 36402004 DOI: 10.1016/j.sleep.2022.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 10/13/2022] [Accepted: 10/16/2022] [Indexed: 11/09/2022]
Abstract
Sleep is an important biological necessity, a lack of which can have many cognitive, psychological, social, and physical impacts. Children with autism are known to present with sleep difficulties more frequently than their typically developing peers but despite this, there is relatively little research looking at the impact of sleep on the family. To investigate the effect of sleep on families of autistic and typically developing (TD) children, we conducted a study of sleep disturbances among children, sleep quality of their parents in association with their family function. In our study, 239 parents of autistic children and 227 parents of TD children participated. These parents completed a survey about their child's sleep disturbances, their own sleep quality, and their family function, along with a series of demographic questions. Analyses indicated that autistic children experience more sleep difficulties than TD peers, that children's sleep disturbances are associated with parental sleep quality and that parents of autistic children report decreased sleep quality compared to parents of TD children. Parental sleep quality, and child sleep quality were both found to partially mediate the relationship between autism diagnosis and family function.
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Affiliation(s)
| | - Sinéad Smyth
- School of Psychology, Dublin City University, Ireland.
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6
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De Laet A, Piccardi ES, Begum-Ali J, Charman T, Johnson MH, Jones EJH, Bedford R, Gliga T. Neuronal gating of tactile input and sleep in 10-month-old infants at typical and elevated likelihood for autism spectrum disorder. Sci Rep 2022; 12:14188. [PMID: 35986046 PMCID: PMC9391390 DOI: 10.1038/s41598-022-18018-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 05/04/2022] [Indexed: 12/23/2022] Open
Abstract
Sleep problems in Autism Spectrum Disorder (ASD) emerge early in development, yet the origin remains unclear. Here, we characterise developmental trajectories in sleep onset latency (SOL) and night awakenings in infants at elevated likelihood (EL) for ASD (who have an older sibling with ASD) and infants at typical likelihood (TL) for ASD. Further, we test whether the ability to gate tactile input, using an EEG tactile suppression index (TSI), associates with variation in SOL and night awakenings. Parent-reported night awakenings and SOL from 124 infants (97 at EL for ASD) at 5, 10 and 14 months were analyzed using generalized estimating equations. Compared to TL infants, infants at EL had significantly more awakenings and longer SOL at 10 and 14 months. The TSI predicted SOL concurrently at 10 months, independent of ASD likelihood status, but not longitudinally at 14 months. The TSI did not predict night awakenings concurrently or longitudinally. These results imply that infants at EL for ASD wake up more frequently during the night and take longer to fall asleep from 10 months of age. At 10 months, sensory gating predicts SOL, but not night awakenings, suggesting sensory gating differentially affects neural mechanisms of sleep initiation and maintenance.
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Affiliation(s)
- Anna De Laet
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK.
| | - Elena Serena Piccardi
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK
- School of Psychology, Department of Psychological Sciences, University of East London, London, UK
| | - Jannath Begum-Ali
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Tony Charman
- Psychology Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Mark H Johnson
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK
- Department of Psychology, University of Cambridge, Cambridge, UK
| | - Emily J H Jones
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | | | - Teodora Gliga
- School of Psychology, University of East Anglia, Norwich Research Park, Norwich, NR4 7TJ, UK
- Centre for Brain and Cognitive Development, Department of Psychological Sciences, Birkbeck, University of London, London, UK
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7
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Sahu M, Tripathi R, Jha NK, Jha SK, Ambasta RK, Kumar P. Cross talk mechanism of disturbed sleep patterns in neurological and psychological disorders. Neurosci Biobehav Rev 2022; 140:104767. [PMID: 35811007 DOI: 10.1016/j.neubiorev.2022.104767] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/20/2022] [Accepted: 07/01/2022] [Indexed: 11/25/2022]
Abstract
The incidence and prevalence of sleep disorders continue to increase in the elderly populace, particularly those suffering from neurodegenerative and neuropsychiatric disorders. This not only affects the quality of life but also accelerates the progression of the disease. There are many reasons behind sleep disturbances in such patients, for instance, medication use, nocturia, obesity, environmental factors, nocturnal motor disturbances and depressive symptoms. This review focuses on the mechanism and effects of sleep dysfunction in neurodegenerative and neuropsychiatric disorders. Wherein we discuss disturbed circadian rhythm, signaling cascade and regulation of genes during sleep deprivation. Moreover, we explain the perturbation in brainwaves during disturbed sleep and the ocular perspective of neurodegenerative and neuropsychiatric manifestations in sleep disorders. Further, as the pharmacological approach is often futile and carries side effects, therefore, the non-pharmacological approach opens newer possibilities to treat these disorders and widens the landscape of treatment options for patients.
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Affiliation(s)
- Mehar Sahu
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Rahul Tripathi
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India
| | - Saurabh Kumar Jha
- Department of Biotechnology, School of Engineering & Technology (SET) Sharda University, UP, India.
| | - Rashmi K Ambasta
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India
| | - Pravir Kumar
- Molecular Neuroscience and Functional Genomics Laboratory, Delhi Technological University (Formerly Delhi College of Engineering), Delhi, India.
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8
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Hartman AG, McKendry S, Soehner A, Bodison S, Akcakaya M, DeAlmeida D, Bendixen R. Characterizing Sleep Differences in Children With and Without Sensory Sensitivities. Front Psychol 2022; 13:875766. [PMID: 35814144 PMCID: PMC9257069 DOI: 10.3389/fpsyg.2022.875766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/03/2022] [Indexed: 01/28/2023] Open
Abstract
Objectives Individuals register and react to daily sensory stimuli differently, which influences participation in occupations. Sleep is a foundational nightly occupation that impacts overall health and development in children. Emerging research suggests that certain sensory processing patterns, specifically sensory sensitivities, may have a negative impact on sleep health in children. In this study, we aimed to (i) characterize sleep in children with and without sensory sensitivities and (ii) examine the relationship between sensory processing patterns (using the Sensory Profile-2) and sleep using validated parent- and child-reported questionnaires. We hypothesized that children with sensory sensitivities will exhibit more difficulties with sleep. Methods We recruited 22 children (ages 6-10) with sensory sensitivities (SS) and 33 children without sensory sensitivities (NSS) to complete validated sleep and sensory processing questionnaires: the Children's Sleep Habits Questionnaire (CSHQ), Sleep Self-Report (SSR), and Sensory Profile-2. Results Children with SS had significantly more sleep behaviors reported by both parents (p < 0.001, g = 1.11) and children (p < 0.001, g = 1.17) compared to children with NSS. Specifically, children with SS had higher frequencies of sleep anxiety (p = 0.004, g = 0.79), bedtime resistance (p = 0.001, g = 0.83), and sleep onset delay (p = 0.003, g = 0.95). Spearman's ρ correlations indicated significant positive correlations between parent- and child-reported sleep. Children with SS showed a larger association and greater variability between sleep and sensory processing compared to their peers. Significant positive correlations between parent-reported sleep behaviors and sensory sensitive and avoiding patterns were identified for both children with SS and NSS. Child-reported sleep behaviors were most strongly associated with sensitive and avoiding patterns for children with NSS and seeking patterns for children with SS. Conclusion We present evidence that sleep is impacted for children with SS to a greater extent than children with NSS. We also identified that a child's sensory processing pattern may be an important contributor to sleep problems in children with and without sensory sensitivities. Sleep concerns should be addressed within routine care for children with sensory sensitivities. Future studies will inform specific sleep intervention targets most salient for children with SS and other sensory processing patterns.
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Affiliation(s)
- Amy G. Hartman
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Sarah McKendry
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
| | - Adriane Soehner
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States
| | - Stefanie Bodison
- Department of Occupational Therapy, University of Florida, Gainesville, FL, United States
| | - Murat Akcakaya
- Department of Electrical and Computer Engineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Dilhari DeAlmeida
- Department of Health Information Management, University of Pittsburgh, Pittsburgh, PA, United States
| | - Roxanna Bendixen
- Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, PA, United States
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9
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Bartakovicova K, Kemenyova P, Belica I, Janik Szapuova Z, Stebelova K, Waczulikova I, Ostatnikova D, Babinska K. Sleep Problems and 6-Sulfatoxymelatonin as Possible Predictors of Symptom Severity, Adaptive and Maladaptive Behavior in Children with Autism Spectrum Disorder. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137594. [PMID: 35805248 PMCID: PMC9265882 DOI: 10.3390/ijerph19137594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 06/13/2022] [Accepted: 06/18/2022] [Indexed: 02/01/2023]
Abstract
In children with autism spectrum disorder (ASD), sleep disturbances are a frequent comorbidity with an adverse effect on their behavior and functioning. It was suggested that melatonin deficit is at least partly responsible for the sleep problems. The study aimed to investigate, in a sample of 56 children with ASD aged 2.8–13.3 years, if the sleep problems and melatonin secretion can serve as predictors of adaptive functioning and severity of the ASD core symptoms. We demonstrated that, after adjustment for age, the Sleep score assessed by the Children’s Sleep Habits Questionnaire predicts the Adaptive behavior composite score only in children younger than 6 years, and the preferred predictive model is for the domain Socialization. The age-adjusted Sleep score predicted Externalizing and Internalizing maladaptive behavior, with a near-zero contribution of age to the relationship between the Internalizing maladaptive behavior and Sleep score. After adjustment for age, the reduced night-time melatonin secretion predicted a higher severity of ASD symptoms in the domain Social affect and the Calibrated Severity Score, but not the sleep problems. Our results emphasize the importance of assessing sleep problems as a modifiable predictor of behavior in children with ASD and support the hypothesis about the role of melatonin in pathophysiology of ASD.
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Affiliation(s)
- Kristina Bartakovicova
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
| | - Petra Kemenyova
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
| | - Ivan Belica
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
- Research Institute for Child Psychology and Pathopsychology, 831 05 Bratislava, Slovakia
| | - Zofia Janik Szapuova
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
| | - Katarina Stebelova
- Department of Animal Physiology and Ethology, Faculty of Natural Sciences, Comenius University, 842 15 Bratislava, Slovakia;
| | - Iveta Waczulikova
- Department of Nuclear Physics and Biophysics, Faculty of Mathematics, Physics and Informatics, Comenius University, 842 48 Bratislava, Slovakia;
| | - Daniela Ostatnikova
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
| | - Katarina Babinska
- Academic Research Centre for Autism, Institute of Physiology, Faculty of Medicine in Bratislava, Comenius University, 813 72 Bratislava, Slovakia; (K.B.); (P.K.); (I.B.); (Z.J.S.); (D.O.)
- Correspondence: ; Tel.: +421-902278652
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10
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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.
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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
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Gao L, Wang C, Song XR, Tian L, Qu ZY, Han Y, Zhang X. The Sensory Abnormality Mediated Partially the Efficacy of Repetitive Transcranial Magnetic Stimulation on Treating Comorbid Sleep Disorder in Autism Spectrum Disorder Children. Front Psychiatry 2022; 12:820598. [PMID: 35140641 PMCID: PMC8818693 DOI: 10.3389/fpsyt.2021.820598] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 12/15/2021] [Indexed: 12/22/2022] Open
Abstract
Sleep disorder emerges as a common comorbidity in children with autism spectrum disorder (ASD), and the interaction between the core symptoms of ASD and its sleep disorder remains unclear. Repetitive transcranial magnetic stimulation (rTMS) was used on the bilateral dorsolateral prefrontal cortex (DLPFC) to investigate the efficacy of rTMS on the core symptoms of ASD and comorbid sleep problems as well as the mediation role of the ASD symptoms between rTMS intervention and sleep improvement. A total of 41 Chinese children with ASD and who met the criteria in the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders were recruited, and 39 of them (mean age: 9.0 ± 4.4 years old; the male-female ratio was 3.9: 1) completed the study with the stimulating protocol of high frequency on the left DLPFC and low frequency on the right DLPFC. They were all assessed three times (before, at 4 weeks after, and at 8 weeks after the stimulation) by the Children's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), Childhood Autism Rating Scale, Repetitive Behavior Questionnaire-2, and Short Sensory Profile (SSP). The repeated-measures ANOVA showed that the main effect of "intervention time" of CSHQ (F = 25.103, P < 0.001), SSP (F = 6.345, P = 0.003), and SDQ (F = 9.975, P < 0.001) was statistically significant. By Bayesian mediation analysis, we only found that the total score of SSP mediated the treating efficacy of rTMS on CSHQ (αβ = 5.11 ± 1.51, 95% CI: 2.50-8.41). The percentage of mediation effect in total effect was 37.94%. Our results indicated the treating efficacy of rTMS modulation on bilateral DLPFC for both autistic symptoms and sleep disturbances. The sensory abnormality of ASD mediated the improvement of rTMS on sleep problems of ASD.
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Affiliation(s)
- Lei Gao
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Chen Wang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xiao-rong Song
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Li Tian
- Department of Cerebral Functional Therapy, Tianjin Anding Hospital (Tianjin Mental Health Center), Tianjin, China
| | - Zhi-yi Qu
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Yu Han
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
| | - Xin Zhang
- Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China
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Daytime sleepiness and emotional and behavioral disturbances in Prader-Willi syndrome. Eur J Pediatr 2022; 181:2491-2500. [PMID: 35316366 PMCID: PMC9110445 DOI: 10.1007/s00431-022-04439-2] [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: 11/07/2021] [Revised: 02/11/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
Individuals with Prader-Willi syndrome (PWS) often have excessive daytime sleepiness and emotional/behavioral disturbances. The objective of this study was to examine whether daytime sleepiness was associated with these emotional/behavioral problems, independent of nighttime sleep-disordered breathing, or the duration of sleep. Caregivers of individuals with PWS (aged 3 to 25 years) completed the Pediatric Sleep Questionnaire (PSQ), Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD), and the parent version of the Developmental Behavior Checklist (DBC-P). Sleep adequacy was adjusted for age by computing sleep duration against age-specific recommendations. The associations between ESS-CHAD and the total DBC and its subscale scores were evaluated by linear regression, adjusted for sleep-related breathing difficulties, sleep adequacy, and body mass index (BMI). There were 54 responses for individuals with PWS (including 22 males) aged 4.4-24.0 (mean 12.5) years. Daytime sleepiness predicted a substantial proportion of the variance in total DBC-P scores in the unadjusted model (28%; β = 0.028; p < 0.001) and when adjusted for sleep adequacy, BMI, and sleep-related breathing difficulties (29%; β = 0.023; p = 0.007). This relationship was not moderated by BMI Z-scores, but the relationship was more prominent for children younger than 12 years than for children older than 12 years.Conclusions: These findings provide preliminary novel evidence that daytime sleepiness may drive the expression of emotional/behavioral disturbances, and should be explored as a potential modifiable risk factor for these disturbances in PWS, particularly pre-adolescent children.
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Foldes ST, Jensen AR, Jacobson A, Vassall S, Foldes E, Guthery A, Brown D, Levine T, Tyler WJ, Frye RE. Transdermal Electrical Neuromodulation for Anxiety and Sleep Problems in High-Functioning Autism Spectrum Disorder: Feasibility and Preliminary Findings. J Pers Med 2021; 11:1307. [PMID: 34945779 PMCID: PMC8704341 DOI: 10.3390/jpm11121307] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Autism spectrum disorder (ASD) is associated with anxiety and sleep problems. We investigated transdermal electrical neuromodulation (TEN) of the cervical nerves in the neck as a safe, effective, comfortable and non-pharmacological therapy for decreasing anxiety and enhancing sleep quality in ASD. METHODS In this blinded, sham-controlled study, seven adolescents and young adults with high-functioning ASD underwent five consecutive treatment days, one day of the sham followed by four days of subthreshold TEN for 20 min. Anxiety-provoking cognitive tasks were performed after the sham/TEN. Measures of autonomic nervous system activity, including saliva α-amylase and cortisol, electrodermal activity, and heart rate variability, were collected from six participants. RESULTS Self-rated and caretaker-rated measures of anxiety were significantly improved with TEN treatment as compared to the sham, with effect sizes ranging from medium to large depending on the rating scale. Sleep scores from caretaker questionnaires also improved, but not significantly. Performance on two of the three anxiety-provoking cognitive tasks and heart rate variability significantly improved with TEN stimulation as compared to the sham. Four of the seven (57%) participants were responders, defined as a ≥ 30% improvement in self-reported anxiety. Salivary α-amylase decreased with more TEN sessions and decreased from the beginning to the end of the session on TEN days for responders. TEN was well-tolerated without significant adverse events. CONCLUSIONS This study provides preliminary evidence that TEN is well-tolerated in individuals with ASD and can improve anxiety.
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Affiliation(s)
- Stephen T. Foldes
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
- Division of Neurology, Barrow Neurologic Institute, Phoenix, AZ 85013, USA
- School of Biological and Health Sciences, Arizona State University, Tempe, AZ 85287, USA;
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, USA
| | - Amanda R. Jensen
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
| | - Austin Jacobson
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
| | - Sarah Vassall
- Division of Psychology, Vanderbilt University, Nashville, TN 37240, USA;
| | - Emily Foldes
- Speech and Hearing Science, Arizona State University, Tempe, AZ 85287, USA;
| | - Ann Guthery
- Division of Psychiatry, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (A.G.); (T.L.)
| | - Danni Brown
- Division of Research, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (S.T.F.); (A.J.); (D.B.)
| | - Todd Levine
- Division of Psychiatry, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA; (A.G.); (T.L.)
| | - William James Tyler
- School of Biological and Health Sciences, Arizona State University, Tempe, AZ 85287, USA;
| | - Richard E. Frye
- Department of Child Health, University of Arizona College of Medicine Phoenix, Phoenix, AZ 85004, USA
- Section on Neurodevelopmental Disorders, Division of Neurology, Barrow Neurologic Institute at Phoenix Children’s Hospital, Phoenix, AZ 85016, USA;
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Black B. Sleep and Autism: An impactful and complex relationship that requires a personalized medicine approach. Sleep 2021; 44:6320054. [PMID: 34255079 DOI: 10.1093/sleep/zsab178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Benjamin Black
- University of Missouri, Department of Child Health, Columbia, MO, United States of America
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Melatonin Treatment and Adequate Sleep Hygiene Interventions in Children with Autism Spectrum Disorder: A Randomized Controlled Trial. J Autism Dev Disord 2021; 52:2784-2793. [PMID: 34181143 DOI: 10.1007/s10803-021-05139-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/07/2021] [Indexed: 02/02/2023]
Abstract
Robust clinical evidence has not been available for melatonin, a drug commonly administered for treating sleep problems of children with autism spectrum disorder (ASD). In a phase 3 randomized, placebo-controlled clinical trial, we administered 1-mg melatonin (n = 65), 4-mg melatonin (n = 65), or placebo (n = 66) to196 children with ASD once daily before bedtime under adequate sleep hygiene interventions. The primary outcome was sleep onset latency (SOL) assessed with the electronic sleep diary. SOL shortened significantly in the 1- and 4-mg melatonin groups compared to the placebo group (- 22.0, - 28.0, and - 5.0 min, respectively; p < 0.0001 each). This therapeutic regimen of melatonin is a reasonable clinical approach to cope with ASD-emergent difficulties in children with ASD.
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Romeo DM, Brogna C, Belli A, Lucibello S, Cutrona C, Apicella M, Mercuri E, Mariotti P. Sleep Disorders in Autism Spectrum Disorder Pre-School Children: An Evaluation Using the Sleep Disturbance Scale for Children. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:95. [PMID: 33498988 PMCID: PMC7911676 DOI: 10.3390/medicina57020095] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 11/28/2022]
Abstract
Background and Objectives: Sleep disorders are common in children with Autism Spectrum Disorder (ASD). The aims of this study were to describe the incidence and characteristics of sleep disorders using a questionnaire completed by the caregiver in a sample of preschool-aged children with ASD and to identify possible differences in a control group of peers. Materials and Methods: Sleep disorders were investigated with the Sleep Disturbance Scale for Children (SDSC) in a population of pre-school-aged (3-5 years) ASD children and in a control group. The Autism Diagnostic Observation Schedule-second ed. (ADOS-2) was further used to assess autism symptom severity. A total of 84 children (69 males; mean age 3.9 ± 0.8 years) with a diagnosis of ASD and 84 healthy controls (65 males; mean age of 3.7 ± 0.8 years) that were matched for age and sex were enrolled. Results: ASD children reported significantly higher (pathological) scores than the control group on the SDSC total scores and in some of the factor scores, such as Difficulty in Initiating and Maintaining Sleep (DIMS), disorders of excessive somnolence (DOES), and sleep hyperhidrosis. A total of 18% of ASD children had a pathological SDSC total T-score, and 46% had an abnormal score on at least one sleep factor; DIMS, parasomnias, and DOES showed the highest rates among the sleep factors. Younger children (3 years) reported higher scores in DIMS and sleep hyperhidrosis than older ones (4 and 5 years). No specific correlation was found between ADOS-2 and SDSC scores. Conclusions: Pre-school children with ASD showed a high incidence of sleep disorders with different distributions of specific sleep factors according to their age. We suggest a screening assessment of sleep disorders using the SDSC in these children with a more in-depth evaluation for those reporting pathological scores on the questionnaire.
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Affiliation(s)
- Domenico M. Romeo
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.M.); (P.M.)
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Claudia Brogna
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
- Neuropsichiatria Infantile, ASL Avellino, 83100 Avellino, Italy
| | - Arianna Belli
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Simona Lucibello
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Costanza Cutrona
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Massimo Apicella
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Eugenio Mercuri
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.M.); (P.M.)
- Pediatric Neurology Unit, Università Cattolica del Sacro Cuore, 00168 Rome, Italy; (C.B.); (A.B.); (S.L.); (C.C.); (M.A.)
| | - Paolo Mariotti
- Pediatric Neurology Unit, Fondazione Policlinico Universitario A. Gemelli, IRCCS, 00168 Rome, Italy; (E.M.); (P.M.)
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Appleyard K, Schaughency E, Taylor B, Sayers R, Haszard J, Lawrence J, Taylor R, Galland B. Sleep and Sensory Processing in Infants and Toddlers: A Cross-Sectional and Longitudinal Study. Am J Occup Ther 2020; 74:7406205010p1-7406205010p12. [PMID: 33275561 DOI: 10.5014/ajot.2020.038182] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Typically developing children who are sensitive to sensory stimulation appear to have more sleep difficulties than children with average sensory sensitivities; however, at what age sleep difficulties emerge and whether they extend to children outside of sleep clinics are unclear. OBJECTIVE To investigate cross-sectional and longitudinal relationships between sleep and sensory processing in typically developing infants and toddlers. DESIGN Observational; cross-sectional and longitudinal. SETTING Community. PARTICIPANTS Children (N = 160) enrolled in a larger four-armed randomized controlled trial of overweight prevention in infancy (40 randomly selected from each arm). OUTCOMES AND MEASURES Parent-reported sleep patterns at ages 6 mo, 1 yr, 2 yr, and 2.5 yr. Sensory Processing Measure-Preschool questionnaire covering five sensory systems and higher level functions: praxis and social participation at age 2.5 yr. Relationships between sleep and sensory variables were analyzed using multiple linear regression models. RESULTS More problematic sleep at age 2.5 yr was associated with more difficulties in social-relational skills (p < .001), a finding supported by the longitudinal data. Longer settling times were associated with higher vision (p = .036) and touch (p = .028) sensitivities at age 2.5 yr; in the longitudinal data (ages 6 mo-2.5 yr), longer settling times were associated with more sensitive hearing (p = .042). CONCLUSIONS AND RELEVANCE Results support a link between sleep patterns and sensory processing difficulties in toddlers that, in some, can emerge in infancy. Practitioners should be alert to this association in young children presenting with sensory sensitivity or sleep challenges. WHAT THIS ARTICLE ADDS Study findings illustrate that bedtime challenges in typically developing toddlers could be related to sensory processing. A possible way to assist more sensitive children in settling to sleep is to pay attention to visual, tactile, and auditory stimuli that potentially interfere with sleep onset.
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Affiliation(s)
- Katie Appleyard
- Katie Appleyard, PhD, is Assistant Research Fellow, Department of Women's and Children's Health and Department of Psychology, University of Otago, Dunedin, Otago, New Zealand
| | - Elizabeth Schaughency
- Elizabeth Schaughency, PhD, is Senior Lecturer, Department of Psychology, University of Otago, Dunedin, Otago, New Zealand
| | - Barry Taylor
- Barry Taylor, MBChB, FRACP, is Professor and Pediatrician, Department of Women's and Children's Health, University of Otago, Dunedin, Otago, New Zealand
| | - Rachel Sayers
- Rachel Sayers, MHealSc, is Assistant Research Fellow, Department of Women's and Children's Health, University of Otago, Dunedin, Otago, New Zealand
| | - Jillian Haszard
- Jillian Haszard, PhD, is Biostatistician, Department of Women's and Children's Health and Department of Human Nutrition, University of Otago, Dunedin, Otago, New Zealand
| | - Julie Lawrence
- Julie Lawrence, PhD, is Research Fellow, Department of Women's and Children's Health, University of Otago, Dunedin, Otago, New Zealand
| | - Rachael Taylor
- Rachael Taylor, PhD, is Research Professor, Department of Medicine, University of Otago, Dunedin, Otago, New Zealand
| | - Barbara Galland
- Barbara Galland, PhD, is Research Associate Professor, Department of Women's and Children's Health, University of Otago, Dunedin, Otago, New Zealand;
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Karthikeyan R, Cardinali DP, Shakunthala V, Spence DW, Brown GM, Pandi-Perumal SR. Understanding the role of sleep and its disturbances in Autism spectrum disorder. Int J Neurosci 2020; 130:1033-1046. [PMID: 31903819 DOI: 10.1080/00207454.2019.1711377] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Several studies have established a positive relationship between sleep difficulties and symptomatology in ASD children. The rationale for this review is to describe and discuss the sleep difficulties, which are one of the significant complications associated with autism spectrum disorder (ASD). PURPOSE Many types of sleep disorders have been reported in ASD individuals, but still lack a comprehensive study and in-depth analysis. Despite the contribution of sleep problems to the overall symptoms of ASD, the symptoms of disturbed sleep experienced by many affected patients have only recently started to receive attention from clinicians and family members. MATERIALS AND METHODS This narrative overview has been prepared based on searching standard research databases with specific keywords; b. Additional search was made using the bibliographies of the retrieved articles; and c. author's collection of relevant peer-reviewed articles. Once selected, manuscripts are then compared and summarized based on the author's perspective. Results are based on a qualitative rather than a quantitative level. RESULTS This article highlights the role of sleep in the brain and neural development of children and emphasizes that the intensity of sleep problems is associated with an increased occurrence of ASD symptoms. It also suggests the significance of treating sleep problems in ASD individuals. CONCLUSIONS The review provides broader perspectives and a better understanding of sleep problems in pathophysiology, mechanism, and management with respect to ASD individuals. Finally, the implications for clinical practice and future agendas have also been discussed.
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Affiliation(s)
- Ramanujam Karthikeyan
- Department of Animal Behavior & Physiology, School of Biological Sciences, Madurai Kamaraj University, Madurai, Tamil Nadu, India
| | - Daniel P Cardinali
- Faculty of Medical Sciences, Pontificia Universidad Católica Argentina, Buenos Aires, Argentina
| | - Venkat Shakunthala
- Department of Zoology, University of Mysuru, Manasagangotri, Karnataka, India
| | - David Warren Spence
- Independent Researcher, Department of Sleep Medicine, Toronto, Ontario, Canada
| | - Gregory M Brown
- Molecular Brain Science, Centre for Addiction and Mental Health, Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
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Pinato L, Galina Spilla CS, Markus RP, da Silveira Cruz-Machado S. Dysregulation of Circadian Rhythms in Autism Spectrum Disorders. Curr Pharm Des 2020; 25:4379-4393. [DOI: 10.2174/1381612825666191102170450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
Background:
The alterations in neurological and neuroendocrine functions observed in the autism
spectrum disorder (ASD) involves environmentally dependent dysregulation of neurodevelopment, in interaction
with multiple coding gene defects. Disturbed sleep-wake patterns, as well as abnormal melatonin and glucocorticoid
secretion, show the relevance of an underlying impairment of the circadian timing system to the behavioral
phenotype of ASD. Thus, understanding the mechanisms involved in the circadian dysregulation in ASD could
help to identify early biomarkers to improve the diagnosis and therapeutics as well as providing a significant
impact on the lifelong prognosis.
Objective:
In this review, we discuss the organization of the circadian timing system and explore the connection
between neuroanatomic, molecular, and neuroendocrine responses of ASD and its clinical manifestations. Here
we propose interconnections between circadian dysregulation, inflammatory baseline and behavioral changes in
ASD. Taking into account, the high relevancy of melatonin in orchestrating both circadian timing and the maintenance
of physiological immune quiescence, we raise the hypothesis that melatonin or analogs should be considered
as a pharmacological approach to suppress inflammation and circadian misalignment in ASD patients.
Strategy:
This review provides a comprehensive update on the state-of-art of studies related to inflammatory
states and ASD with a special focus on the relationship with melatonin and clock genes. The hypothesis raised
above was analyzed according to the published data.
Conclusion:
Current evidence supports the existence of associations between ASD to circadian dysregulation,
behavior problems, increased inflammatory levels of cytokines, sleep disorders, as well as reduced circadian
neuroendocrine responses. Indeed, major effects may be related to a low melatonin rhythm. We propose that
maintaining the proper rhythm of the circadian timing system may be helpful to improve the health and to cope
with several behavioral changes observed in ASD subjects.
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Affiliation(s)
- Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Caio Sergio Galina Spilla
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Regina Pekelmann Markus
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
| | - Sanseray da Silveira Cruz-Machado
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
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20
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Wang Y, Lin J, Zeng Y, Liu Y, Li Y, Xia K, Zhao J, Shen Y, Ou J. Effects of Sleep Disturbances on Behavioral Problems in Preschool Children With Autism Spectrum Disorder. Front Psychiatry 2020; 11:559694. [PMID: 33633594 PMCID: PMC7900493 DOI: 10.3389/fpsyt.2020.559694] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 12/22/2020] [Indexed: 01/30/2023] Open
Abstract
Study Objectives: This study aims to identify the characteristic sleep disturbances that affect behavioral problems in children with autism spectrum disorder (ASD), providing a potential direction for sleep and behavioral intervention in ASD. Methods: The data of 513 children with ASD and 246 typically developing (TD) children aged between 2 and 5 years old were collected. The behavior performance of preschool children was assessed using the Child Behavior Checklist for 1.5-5.0 years old. The Children's Sleep Habits Questionnaire (CSHQ) was used to measure the sleep status of the children, and the Social Responsiveness Scale was used to measure the severity of disorder. Linear regression analysis was performed to examine the effects of sleep disturbances on behavioral problems, and independent-sample t-test was performed to compare the mean of the samples. Results: Compared to TD children, children with ASD had longer sleep onset delay and more night awakenings. The parasomnias score (a subscale of the CSHQ) was significantly associated with the internalizing (β = 0.113, P = 0.010), externalizing (β = 0.128, P = 0.006), and total problems (β = 0.143, P = 0.001) of children with ASD, while this association was not significant in TD children. "Bed wetting" and "restless and moves a lot" (two items in the CSHQ under parasomnia) significantly only affected the overall behavioral score in children with ASD (P < 0.05). Conclusion: Parasomnias, especially bed wetting and restlessness, are specifically associated with the behavioral problems of children with ASD rather than TD children.
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Affiliation(s)
- Ying Wang
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jingjing Lin
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Ying Zeng
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yanan Liu
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Yamin Li
- Second Xiangya Hospital, Central South University, Changsha, China
| | - Kun Xia
- State Key Laboratory of Medical Genetics, Central South University, Changsha, China
| | - Jingping Zhao
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Yidong Shen
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Jianjun Ou
- Department of Psychiatry, National Clinical Research Center for Mental Disorders, China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
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