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Bruni O, Breda M, Mammarella V, Mogavero MP, Ferri R. Sleep and circadian disturbances in children with neurodevelopmental disorders. Nat Rev Neurol 2025; 21:103-120. [PMID: 39779841 DOI: 10.1038/s41582-024-01052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2024] [Indexed: 01/11/2025]
Abstract
Sleep is essential for brain development and overall health, particularly in children with neurodevelopmental disorders (NDDs). Sleep disruptions can considerably impact brain structure and function, leading to dysfunction of neurotransmitter systems, metabolism, hormonal balance and inflammatory processes, potentially contributing to the pathophysiology of NDDs. This Review examines the prevalence, types and mechanisms of sleep disturbances in children with NDDs, including autism spectrum disorder, attention-deficit hyperactivity disorder and various genetic syndromes. Common sleep disorders in these populations include insomnia, hypersomnia, circadian rhythm disorders, sleep-related breathing disorders and parasomnias, with underlying factors often involving genetic, neurobiological, environmental and neurophysiological influences. Sleep problems such as insomnia, night awakenings and sleep fragmentation are closely linked to both internalizing symptoms such as anxiety and depression, and externalizing behaviours such as hyperactivity and aggression. Assessment of sleep in children with NDDs presents unique challenges owing to communication difficulties, comorbid conditions and altered sensory processing. The Review underscores the importance of further research to unravel the complex interactions between sleep and neurodevelopment, advocating for longitudinal studies and the identification of predictive biomarkers. Understanding and addressing sleep disturbances in NDDs is crucial for improving developmental outcomes and the overall quality of life for affected individuals and their families.
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Affiliation(s)
- Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University of Rome, Rome, Italy.
| | - Maria Breda
- Department of Psychology, Sapienza University of Rome, Rome, Italy
| | | | - Maria Paola Mogavero
- Vita-Salute San Raffaele University, Milan, Italy
- Sleep Disorders Centre, Division of Neuroscience, San Raffaele Scientific Institute, Milan, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
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2
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Tippawanich M, Thampratankul L, Chuthapisith J. Sleep problems among Asian preschool children with neurodevelopmental disorders. Brain Dev 2024; 46:361-367. [PMID: 39406632 DOI: 10.1016/j.braindev.2024.10.001] [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: 06/25/2024] [Revised: 09/29/2024] [Accepted: 10/04/2024] [Indexed: 11/03/2024]
Abstract
BACKGROUND Sleep plays an important role in children's behavior, emotional control, and cognitive development. There is a higher prevalence of sleep problems in children with neurodevelopmental disorders (NDDs) compared to those without disease. There are a few studies regarding sleep problems among Thai preschoolers with NDDs. This study examined sleep problems in preschoolers with NDDs, compared with typically developing children (TD), and studied the association between sleep problems and behavioral problems among preschoolers with NDDs. METHODS Sleep problems in 140 children aged 2 to 6 years with NDDs; autism spectrum disorders, attention deficit/hyperactivity disorder, global developmental delay, and developmental language disorder were evaluated by using the Thai version of Japanese Sleep Questionnaire for Preschoolers (TH-JSQ-P) and compared with 285 TD children at the same age. Behavioral problems in the NDDs group were evaluated by using the Child Behavioral Checklist (CBCL). Sleep and behavioral problem scores were analyzed by adjusted age, sex, underlying diseases, and medications used and compared between the two groups. RESULTS The study found that 48 % of the TD group and 71 % of the NDDs group were identified as having sleep problems. The NDDs group had significantly higher total TH-JSQ-P score and in five subscales, including obstructive sleep apnea, restless leg syndrome-motor, parasomnias, daytime behaviors, and insomnia/circadian rhythm disorders. Total TH-JSQ-P score was found to have a moderate correlation with internalizing and externalizing behavioral problems. CONCLUSION Findings suggest that sleep problems are more common in preschool children with NDDs than in TD children and are associated with internalizing and externalizing behavioral problems.
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Affiliation(s)
- Mantita Tippawanich
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Lunliya Thampratankul
- Division of Pediatric Neurology, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jariya Chuthapisith
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
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3
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Michelini G, Carlisi CO, Eaton NR, Elison JT, Haltigan JD, Kotov R, Krueger RF, Latzman RD, Li JJ, Levin-Aspenson HF, Salum GA, South SC, Stanton K, Waldman ID, Wilson S. Where do neurodevelopmental conditions fit in transdiagnostic psychiatric frameworks? Incorporating a new neurodevelopmental spectrum. World Psychiatry 2024; 23:333-357. [PMID: 39279404 PMCID: PMC11403200 DOI: 10.1002/wps.21225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Features of autism spectrum disorder, attention-deficit/hyperactivity disorder, learning disorders, intellectual disabilities, and communication and motor disorders usually emerge early in life and are associated with atypical neurodevelopment. These "neurodevelopmental conditions" are grouped together in the DSM-5 and ICD-11 to reflect their shared characteristics. Yet, reliance on categorical diagnoses poses significant challenges in both research and clinical settings (e.g., high co-occurrence, arbitrary diagnostic boundaries, high within-disorder heterogeneity). Taking a transdiagnostic dimensional approach provides a useful alternative for addressing these limitations, accounting for shared underpinnings across neurodevelopmental conditions, and characterizing their common co-occurrence and developmental continuity with other psychiatric conditions. Neurodevelopmental features have not been adequately considered in transdiagnostic psychiatric frameworks, although this would have fundamental implications for research and clinical practices. Growing evidence from studies on the structure of neurodevelopmental and other psychiatric conditions indicates that features of neurodevelopmental conditions cluster together, delineating a "neurodevelopmental spectrum" ranging from normative to impairing profiles. Studies on shared genetic underpinnings, overlapping cognitive and neural profiles, and similar developmental course and efficacy of support/treatment strategies indicate the validity of this neurodevelopmental spectrum. Further, characterizing this spectrum alongside other psychiatric dimensions has clinical utility, as it provides a fuller view of an individual's needs and strengths, and greater prognostic utility than diagnostic categories. Based on this compelling body of evidence, we argue that incorporating a new neurodevelopmental spectrum into transdiagnostic frameworks has considerable potential for transforming our understanding, classification, assessment, and clinical practices around neurodevelopmental and other psychiatric conditions.
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Affiliation(s)
- Giorgia Michelini
- Department of Biological and Experimental Psychology, School of Biological and Behavioural Sciences, Queen Mary University of London, London, UK
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California Los Angeles, Los Angeles, CA, USA
| | - Christina O Carlisi
- Division of Psychology and Language Sciences, University College London, London, UK
| | - Nicholas R Eaton
- Department of Psychology, Stony Brook University, Stony Brook, NY, USA
| | - Jed T Elison
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
| | - John D Haltigan
- Department of Psychiatry, Division of Child and Youth Mental Health, University of Toronto, Toronto, ON, Canada
| | - Roman Kotov
- Department of Psychiatry, Stony Brook University, Stony Brook, NY, USA
| | - Robert F Krueger
- Department of Psychology, University of Minnesota, Minneapolis, MN, USA
| | | | - James J Li
- Department of Psychology, University of Wisconsin-Madison, Madison, WI, USA
- Waisman Center, University of Wisconsin-Madison, Madison, WI, USA
| | | | - Giovanni A Salum
- Child Mind Institute, New York, NY, USA
- Universidade Federal do Rio Grande do Sul, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
- Instituto Nacional de Psiquiatria do Desenvolvimento para a Infância e Adolescência, São Paulo, Brazil
| | - Susan C South
- Department of Psychological Sciences, College of Health and Human Sciences, Purdue University, West Lafayette, IN, USA
| | - Kasey Stanton
- Department of Psychology, University of Wyoming, Laramie, WY, USA
| | - Irwin D Waldman
- Department of Psychology, Emory University, Atlanta, GA, USA
| | - Sylia Wilson
- Institute of Child Development, University of Minnesota, Minneapolis, MN, USA
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Valencia ML, Sofela FA, Jongens TA, Sehgal A. Do metabolic deficits contribute to sleep disruption in monogenic intellectual disability syndromes? Trends Neurosci 2024; 47:583-592. [PMID: 39054162 DOI: 10.1016/j.tins.2024.06.006] [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: 03/13/2024] [Revised: 05/28/2024] [Accepted: 06/26/2024] [Indexed: 07/27/2024]
Abstract
Intellectual disability is defined as limitations in cognitive and adaptive behavior that often arise during development. Disordered sleep is common in intellectual disability and, given the importance of sleep for cognitive function, it may contribute to other behavioral phenotypes. Animal models of intellectual disability, in particular of monogenic intellectual disability syndromes (MIDS), recapitulate many disease phenotypes and have been invaluable for linking some of these phenotypes to specific molecular pathways. An emerging feature of MIDS, in both animal models and humans, is the prevalence of metabolic abnormalities, which could be relevant for behavior. Focusing on specific MIDS that have been molecularly characterized, we review sleep, circadian, and metabolic phenotypes in animal models and humans and propose that altered metabolic state contributes to the abnormal sleep/circadian phenotypes in MIDS.
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Affiliation(s)
- Mariela Lopez Valencia
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA
| | - Folasade A Sofela
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA
| | - Thomas A Jongens
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA; Department of Genetics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Autism Spectrum Program of Excellence, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Amita Sehgal
- Chronobiology and Sleep Institute, Perelman Medical School of University of Pennsylvania, Philadelphia, PA, USA; Howard Hughes Medical Institute, Philadelphia, PA, USA.
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5
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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.
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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
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O'Sullivan R, Bissell S, Agar G, Spiller J, Surtees A, Heald M, Clarkson E, Khan A, Oliver C, Bagshaw AP, Richards C. Exploring an objective measure of overactivity in children with rare genetic syndromes. J Neurodev Disord 2024; 16:18. [PMID: 38637764 PMCID: PMC11025271 DOI: 10.1186/s11689-024-09535-y] [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: 07/28/2023] [Accepted: 04/05/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Overactivity is prevalent in several rare genetic neurodevelopmental syndromes, including Smith-Magenis syndrome, Angelman syndrome, and tuberous sclerosis complex, although has been predominantly assessed using questionnaire techniques. Threats to the precision and validity of questionnaire data may undermine existing insights into this behaviour. Previous research indicates objective measures, namely actigraphy, can effectively differentiate non-overactive children from those with attention-deficit hyperactivity disorder. This study is the first to examine the sensitivity of actigraphy to overactivity across rare genetic syndromes associated with intellectual disability, through comparisons with typically-developing peers and questionnaire overactivity estimates. METHODS A secondary analysis of actigraphy data and overactivity estimates from The Activity Questionnaire (TAQ) was conducted for children aged 4-15 years with Smith-Magenis syndrome (N=20), Angelman syndrome (N=26), tuberous sclerosis complex (N=16), and typically-developing children (N=61). Actigraphy data were summarized using the M10 non-parametric circadian rhythm variable, and 24-hour activity profiles were modelled via functional linear modelling. Associations between actigraphy data and TAQ overactivity estimates were explored. Differences in actigraphy-defined activity were also examined between syndrome and typically-developing groups, and between children with high and low TAQ overactivity scores within syndromes. RESULTS M10 and TAQ overactivity scores were strongly positively correlated for children with Angelman syndrome and Smith-Magenis syndrome. M10 did not substantially differ between the syndrome and typically-developing groups. Higher early morning activity and lower evening activity was observed across all syndrome groups relative to typically-developing peers. High and low TAQ group comparisons revealed syndrome-specific profiles of overactivity, persisting throughout the day in Angelman syndrome, occurring during the early morning and early afternoon in Smith-Magenis syndrome, and manifesting briefly in the evening in tuberous sclerosis complex. DISCUSSION These findings provide some support for the sensitivity of actigraphy to overactivity in children with rare genetic syndromes, and offer syndrome-specific temporal descriptions of overactivity. The findings advance existing descriptions of overactivity, provided by questionnaire techniques, in children with rare genetic syndromes and have implications for the measurement of overactivity. Future studies should examine the impact of syndrome-related characteristics on actigraphy-defined activity and overactivity estimates from actigraphy and questionnaire techniques.
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Affiliation(s)
- Rory O'Sullivan
- School of Psychology, University of Birmingham, Birmingham, UK.
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Georgie Agar
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | - Jayne Spiller
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Andrew Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Mary Heald
- Blackpool Teaching Hospitals NHS Foundation Trust, Blackpool, Lancashire, UK
| | | | - Aamina Khan
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
- School of Life & Health Sciences, Aston University, Birmingham, UK
| | | | - Andrew P Bagshaw
- School of Psychology, University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
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Browne EG, King JR, Surtees ADR. Sleep in people with and without intellectual disabilities: a systematic review and meta-analysis. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2024; 68:1-22. [PMID: 37857569 DOI: 10.1111/jir.13093] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/15/2023] [Accepted: 09/01/2023] [Indexed: 10/21/2023]
Abstract
BACKGROUND Sleep problems are regularly reported in people with intellectual disabilities. Recent years have seen a substantial increase in studies comparing sleep in people with intellectual disabilities to control participants, with an increase in the use of validated, objective measures. Emerging patterns of differences in sleep time and sleep quality warrant pooled investigation. METHODS A systematic search was conducted across three databases (Ovid Embase, PsycInfo and Medline) and returned all papers comparing sleep in people with intellectual disabilities to a control group, published since the last meta-analysis on the topic. A quality framework was employed to rate the risk of bias across studies. Separate meta-analyses of sleep duration and sleep quality were conducted. Subgrouping compared findings for those studies with participants with genetic syndromes or neurodevelopmental conditions and those with heterogeneous intellectual disability. RESULTS Thirteen new papers were identified and combined with those from the previous meta-analysis to provide 34 papers in total. Quality of studies was generally rated highly, though sampling provided risk of bias and adaptive functioning was rarely measured. People with intellectual disability associated with genetic syndromes or neurodevelopmental conditions sleep for shorter time periods (standardised mean difference = .26) and experience worse sleep quality (standardised mean difference = .68) than their peers. People with intellectual disability of heterogeneous origin show no difference in sleep time but have poorer sleep quality. There was some evidence that age moderated these effects. CONCLUSIONS People with intellectual disability have poorer sleep than those without. Subtle patterns suggest that aetiology of intellectual disability moderates the topography of these difficulties, with further work needed to differentiate common and distinct mechanisms across groups.
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Affiliation(s)
- E G Browne
- School of Psychology, University of Birmingham, Birmingham, UK
| | - J R King
- School of Psychology, University of Birmingham, Birmingham, UK
| | - A D R Surtees
- School of Psychology, University of Birmingham, Birmingham, UK
- Division of Mental Health, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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8
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Tamir S, Dye TJ, Witt RM. Sleep and Circadian Disturbances in Children With Neurodevelopmental Disorders. Semin Pediatr Neurol 2023; 48:101090. [PMID: 38065637 DOI: 10.1016/j.spen.2023.101090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 09/28/2023] [Indexed: 12/18/2023]
Abstract
Sleep problems are highly prevalent in those with neurodevelopmental disorders (NDDs). We propose this is secondary to multiple factors that directly and indirectly negatively impact sleep and circadian processes in those with NDDs, which in turn, further perturbs development, resulting in a "developmental and sleep/circadian-related encephalopathy." In this review, we discuss select NDDs with known or suspected sleep and circadian phenotypes. We also highlight important considerations when evaluating and treating sleep and circadian disorders in these populations.
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Affiliation(s)
- Sharon Tamir
- University of Cincinnati College of Medicine, Cincinnati, OH; Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Thomas J Dye
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Rochelle M Witt
- Division of Child Neurology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Division of Pulmonary Medicine and the Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Center for Circadian Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH; Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH.
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Agar G, Oliver C, Spiller J, Richards C. The developmental trajectory of sleep in children with Smith-Magenis syndrome compared to typically developing peers: a 3-year follow-up study. SLEEP ADVANCES : A JOURNAL OF THE SLEEP RESEARCH SOCIETY 2023; 4:zpad034. [PMID: 37810798 PMCID: PMC10559836 DOI: 10.1093/sleepadvances/zpad034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 08/15/2023] [Indexed: 10/10/2023]
Abstract
Study Objectives To determine the trajectory of: (i) objective sleep parameters and (ii) caregiver-reported sleep questionnaire scores over 3 years in children with Smith-Magenis syndrome (SMS) compared to age-matched typically developing (TD) controls. We also aimed to (iii) describe individual profiles of change in sleep parameters over time. Methods Week-long, overnight actigraphy and questionnaire data from 13 children with SMS and 13 age-matched TD children were collected at Time 1 and Time 2 (3 years later). Independent samples t-tests, paired samples t-tests, and Bayesian analyses were used to compare sleep parameters and sleep questionnaire scores between groups at each time point and compare data within groups to assess change over time. Results Sleep parameters were consistently more disrupted in the SMS group than the TD group, with significantly reduced sleep efficiency, increased wake after sleep onset and earlier get up times at both time points. This was mirrored in the questionnaire data, with children with SMS evidencing higher scores for overall sleep disturbance, night waking, and daytime sleepiness. While TD sleep parameters demonstrated expected developmental changes over 3 years, in the SMS group sleep parameters and variability between and within children remained largely stable. However, some children with SMS showed substantial variation in sleep parameters over time. Questionnaire scores remained stable over 3 years in both groups. Conclusions Overall, sleep disturbance appears to be a stable feature of SMS, indicative of a divergent sleep trajectory compared to TD peers. Proactive intervention approaches should be considered for poor sleep in SMS.
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Affiliation(s)
- Georgie Agar
- School of Psychology, Aston University, Birmingham, UK
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Jayne Spiller
- School of Psychology, University of Birmingham, Birmingham, UK
- School of Psychology and Vision Sciences, University of Leicester, Leicester, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, UK
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
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Harper L, McAnelly S, Walshe I, Ooms A, Tuffrey-Wijne IM. Behavioural sleep problems in children and adults with intellectual disabilities: An integrative literature review. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2023; 36:916-928. [PMID: 37177858 DOI: 10.1111/jar.13116] [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: 10/01/2022] [Revised: 04/27/2023] [Accepted: 05/02/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND People with intellectual disabilities are more likely to experience sleep problems, which can affect quality of life, physical health, mental health and well-being. METHODS An integrative literature review was conducted to investigate what is known about behavioural sleep disturbances in people with an intellectual disability. The search used the following databases: Scopus, PsycInfo and Cinahl, to find papers published since 2015. RESULTS Within intellectual disability research, sleep appears as a common issue due to its high prevalence, negative relationships with an individual's physical and mental health, their quality of life, and impact of sleep problems on family or carers. The growing evidence base appears to support the use of behavioural, lifestyle and pharmacological interventions to improve sleep in people with an intellectual disability. CONCLUSION A wide array of literature provides evidence that people with intellectual disabilities are affected by and need support with their sleep.
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Affiliation(s)
- Lynette Harper
- Health and Life Sciences, Northumbria University, London, UK
| | - Su McAnelly
- Health and Life Sciences, Northumbria University, London, UK
| | - Ian Walshe
- Health and Life Sciences, Northumbria University, London, UK
| | - Ann Ooms
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
| | - Irene M Tuffrey-Wijne
- Faculty of Health, Science, Social Care and Education, Kingston University, London, UK
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Jenner L, Richards C, Howard R, Moss J. Heterogeneity of Autism Characteristics in Genetic Syndromes: Key Considerations for Assessment and Support. CURRENT DEVELOPMENTAL DISORDERS REPORTS 2023; 10:132-146. [PMID: 37193200 PMCID: PMC10169182 DOI: 10.1007/s40474-023-00276-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2023] [Indexed: 05/18/2023]
Abstract
Purpose of Review Elevated prevalence of autism characteristics is reported in genetic syndromes associated with intellectual disability. This review summarises recent evidence on the behavioural heterogeneity of autism in the following syndromes: Fragile X, Cornelia de Lange, Williams, Prader-Willi, Angelman, Down, Smith-Magenis, and tuberous sclerosis complex. Key considerations for assessment and support are discussed. Recent Findings The profile and developmental trajectory of autism-related behaviour in these syndromes indicate some degree of syndrome specificity which may interact with broader behavioural phenotypes (e.g. hypersociability), intellectual disability, and mental health (e.g. anxiety). Genetic subtype and co-occurring epilepsy within syndromes contribute to increased significance of autism characteristics. Autism-related strengths and challenges are likely to be overlooked or misunderstood using existing screening/diagnostic tools and criteria, which lack sensitivity and specificity within these populations. Summary Autism characteristics are highly heterogeneous across genetic syndromes and often distinguishable from non-syndromic autism. Autism diagnostic assessment practices in this population should be tailored to specific syndromes. Service provisions must begin to prioritise needs-led support.
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Affiliation(s)
- Lauren Jenner
- School of Psychology, University of Surrey, Guildford, England
| | | | - Rachel Howard
- School of Psychology, University of Surrey, Guildford, England
| | - Joanna Moss
- School of Psychology, University of Surrey, Guildford, England
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12
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Hall A, Maw R, Iles-Caven Y, Gregory S, Rai D, Golding J. Associations between autistic traits and early ear and upper respiratory signs: a prospective observational study of the Avon Longitudinal Study of Parents and Children (ALSPAC) geographically defined childhood population. BMJ Open 2023; 13:e067682. [PMID: 37094879 DOI: 10.1136/bmjopen-2022-067682] [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: 04/26/2023] Open
Abstract
OBJECTIVE To determine whether early ear and upper respiratory signs are associated with the development of high levels of autistic traits or diagnosed autism. DESIGN Longitudinal birth cohort: Avon Longitudinal Study of Parents and Children (ALSPAC). SETTING Area centred on the city of Bristol in Southwest England. Eligible pregnant women resident in the area with expected date of delivery between April 1991 and December 1992 inclusive. PARTICIPANTS 10 000+ young children followed throughout their first 4 years. Their mothers completed three questionnaires between 18-42 months recording the frequency of nine different signs and symptoms relating to the upper respiratory system, as well as ear and hearing problems. OUTCOME MEASURES Primary-high levels of autism traits (social communication, coherent speech, sociability, and repetitive behaviour); secondary-diagnosed autism. RESULTS Early evidence of mouth breathing, snoring, pulling/poking ears, ears going red, hearing worse during a cold, and rarely listening were associated with high scores on each autism trait and with a diagnosis of autism. There was also evidence of associations of pus or sticky mucus discharge from ears, especially with autism and with poor coherent speech. Adjustment for 10 environmental characteristics made little difference to the results, and substantially more adjusted associations were at p<0.001 than expected by chance (41 observed; 0.01 expected). For example, for discharge of pus or sticky mucus from ears the adjusted odds ratio (aOR) for autism at 30 months was 3.29 (95% CI 1.85 to 5.86, p<0.001), and for impaired hearing during a cold the aOR was 2.18 (95% CI 1.43 to 3.31, p<0.001). CONCLUSIONS Very young children exhibiting common ear and upper respiratory signs appear to have an increased risk of a subsequent diagnosis of autism or demonstrated high levels of autism traits. Results suggest the need for identification and management of ear, nose and throat conditions in autistic children and may provide possible indicators of causal mechanisms.
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Affiliation(s)
- Amanda Hall
- Life and Health Sciences, Aston University, Birmingham, UK
| | | | | | - Steven Gregory
- Bristol Medical School (PHS), University of Bristol, Bristol, UK
| | - Dheeraj Rai
- Centre for Academic Mental Health, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jean Golding
- Bristol Medical School (PHS), University of Bristol, Bristol, UK
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Hussain A, Acharya A, Bharadwaj T, Genomics UOWCFM, Leal SM, Khaliq A, Mir A, Schrauwen I. A Novel Variant in VPS13B Underlying Cohen Syndrome. BIOMED RESEARCH INTERNATIONAL 2023; 2023:9993801. [PMID: 37090188 PMCID: PMC10115529 DOI: 10.1155/2023/9993801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/15/2023] [Accepted: 03/03/2023] [Indexed: 04/25/2023]
Abstract
Pathogenic variants in vacuolar protein sorting 13 homolog B (VPS13B) cause Cohen syndrome (CS), a clinically diverse neurodevelopmental disorder. We used whole exome and Sanger sequencing to identify disease-causing variants in a Pakistani family with intellectual disability, microcephaly, facial dysmorphism, neutropenia, truncal obesity, speech delay, motor delay, and insomnia. We identified a novel homozygous nonsense variant c.8841G > A: p.(W2947∗) in VPS13B (NM_017890.5) which segregated with the disease. Sleep disturbances are commonly seen in neurodevelopmental disorders and can exacerbate medical issues if left untreated. We demonstrate that individuals with Cohen syndrome may also be affected by sleep disturbances. In conclusion, we expand the genetic and phenotypic features of Cohen syndrome in the Pakistani population.
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Affiliation(s)
- Abrar Hussain
- Human Molecular Genetics Lab, Department of Biological Science, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad 44000, Pakistan
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York 10032, USA
| | - Anushree Acharya
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York 10032, USA
| | - Thashi Bharadwaj
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York 10032, USA
| | | | - Suzanne M. Leal
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York 10032, USA
- Taub Institute for Alzheimer's Disease and the Aging Brain, and the Department of Neurology, Columbia University Medical Center, New York, 10032 NY, USA
| | - Abdul Khaliq
- Human Molecular Genetics Lab, Department of Biological Science, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad 44000, Pakistan
| | - Asif Mir
- Human Molecular Genetics Lab, Department of Biological Science, Faculty of Basic and Applied Sciences, International Islamic University, Islamabad 44000, Pakistan
| | - Isabelle Schrauwen
- Center for Statistical Genetics, Gertrude H. Sergievsky Center, Department of Neurology, Columbia University Medical Center, New York 10032, USA
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14
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Bindels-de Heus KGCB, Hooven-Radstaake MT, Legerstee JS, Hoopen LWT, Dieleman GC, Moll HA, Mous SE, de Wit MCY. Sleep problems in children with Angelman Syndrome: The effect of a behavioral intervention program. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 135:104444. [PMID: 36753818 DOI: 10.1016/j.ridd.2023.104444] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND & AIMS The aim of this study was to investigate the effect of a behavioral intervention on sleep problems, which are significant and an unmet clinical need in children with Angelman Syndrome (AS). METHODS & PROCEDURES Children (2-18 years) with AS and sleep problems were randomized to a behavioral intervention program or a control group. Intervention consisted of a standardized program including home visits, psycho-education, feedback based on direct observation of bedtime routine and video footage of the night and behavioral treatment techniques by a behavioral therapist. Change in sleep duration (primary) and parental sleep, nighttime visits, sleep hygiene, daytime behavior, parental stress and quality of life (secondary) were assessed post-intervention and at follow-up using questionnaires, diary, actigraphy and videosomnography. OUTCOMES & RESULTS The groups, 9 children in each, did not differ at baseline. We found a significant effect of intervention on wake after sleep onset with classical statistical analysis (videosomnography). With single case analysis we found a positive effect on total sleep time (diary and actigraphy) and wake after sleep onset (diary) with a persistent effect on total sleep time (actigraphy) and wake after sleep onset (diary). On secondary outcome there was a significant and persistent effect on sleep hygiene and several quality of life domains. CONCLUSIONS & IMPLICATIONS Behavioral intervention has a positive and persistent effect on sleep problems in children with AS. We advise psycho-education for all parents and use of videosomnography for both evaluation of and feedback on sleep behavior patterns, individual behavioral advice and specific behavioral techniques for children with sleep problems.
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Affiliation(s)
- Karen G C B Bindels-de Heus
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands.
| | - Maartje Ten Hooven-Radstaake
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Radboud University, Dept. of Social Sciences, Nijmegen, the Netherlands
| | - Jeroen S Legerstee
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Leontine W Ten Hoopen
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Gwen C Dieleman
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Henriette A Moll
- Erasmus MC Sophia Children's Hospital, Dept. of Pediatrics, the Netherlands; ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands
| | - Sabine E Mous
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Child, and Adolescent Psychiatry and Psychology, the Netherlands
| | - Marie-Claire Y de Wit
- ENCORE Expertise Center for Neurodevelopmental Disorders, the Netherlands; Erasmus MC Sophia Children's Hospital, Dept. of Neurology and Pediatric Neurology, the Netherlands
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15
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Kim JY, Kim W, Lee KH. The role of microRNAs in the molecular link between circadian rhythm and autism spectrum disorder. Anim Cells Syst (Seoul) 2023; 27:38-52. [PMID: 36860270 PMCID: PMC9970207 DOI: 10.1080/19768354.2023.2180535] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
Circadian rhythm regulates physiological cycles of awareness and sleepiness. Melatonin production is primarily regulated by circadian regulation of gene expression and is involved in sleep homeostasis. If the circadian rhythm is abnormal, sleep disorders, such as insomnia and several other diseases, can occur. The term 'autism spectrum disorder (ASD)' is used to characterize people who exhibit a certain set of repetitive behaviors, severely constrained interests, social deficits, and/or sensory behaviors that start very early in life. Because many patients with ASD suffer from sleep disorders, sleep disorders and melatonin dysregulation are attracting attention for their potential roles in ASD. ASD is caused by abnormalities during the neurodevelopmental processes owing to various genetic or environmental factors. Recently, the role of microRNAs (miRNAs) in circadian rhythm and ASD have gained attraction. We hypothesized that the relationship between circadian rhythm and ASD could be explained by miRNAs that can regulate or be regulated by either or both. In this study, we introduced a possible molecular link between circadian rhythm and ASD. We performed a thorough literature review to understand their complexity.
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Affiliation(s)
- Ji Young Kim
- Department of Molecular Biology, Pusan National University, Busan, Republic of Korea
| | - Wanil Kim
- Department of Biochemistry, College of Medicine, Gyeongsang National University, Jinju-si, Republic of Korea, Wanil Kim Department of Biochemistry, College of Medicine, Gyeongsang National University, Jinju-si, Gyeongsangnam-do52727, Republic of Korea; Kyung-Ha Lee Department of Molecular Biology, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan46241, Republic of Korea
| | - Kyung-Ha Lee
- Department of Molecular Biology, Pusan National University, Busan, Republic of Korea, Wanil Kim Department of Biochemistry, College of Medicine, Gyeongsang National University, Jinju-si, Gyeongsangnam-do52727, Republic of Korea; Kyung-Ha Lee Department of Molecular Biology, Pusan National University, 2, Busandaehak-ro 63beon-gil, Geumjeong-gu, Busan46241, Republic of Korea
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16
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Yilmaz S, Simsek E, Gazeteci Tekin H, Aktan G, Gokben S, Tekgul H. Melatonin Versus Chloral Hydrate for Sleep Electroencephalography Recording in Children: A Comparative Study Using Bispectral Index Monitoring Scores and Electroencephalographic Sleep Stages. J Clin Neurophysiol 2022; 39:625-630. [PMID: 33606431 DOI: 10.1097/wnp.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/23/2020] [Indexed: 10/22/2022] Open
Abstract
PURPOSE To compare the effects of chloral hydrate and melatonin on sleep EEG recordings in children by using standard EEG sleep stages and the bispectral index scores (BIS). METHODS A total of 86 children were randomly assigned to two groups: (1) melatonin group (n = 43) and (2) chloral hydrate group (n = 43). BIS monitoring scores and sleep EEGs were recorded simultaneously. The effect of two drugs on sleep EEG recording was evaluated with sleep stages of EEG and BIS. RESULTS There was no statistically significant difference between the groups with regard to time to sleep onset and the need for a second drug ( P = 0.432; P = 1.000). Eight patients (18.6%) in chloral hydrate group reported side effects while there were no reported side effects in the melatonin group ( P = 0.006). Mean BIS values during EEG recordings were similar in both groups (59.72 ± 18.69 minutes and 66.17 ± 18.44 minutes, respectively, P = 1.000). The average time to achieve N2 sleep was 32.38 minutes in the chloral hydrate group and 43.25 minutes in the melatonin group ( P < 0.001). Both "time spent in wakefulness" and "N1 sleep" were found to be significantly higher in the melatonin group ( P < 0.001 and P = 0.005). BIS scores higher than 75 were found to be suggestive for wakefulness; 75 to 66 for N1, 65 to 46 for N2, and values lower than 46 were found to be indicative for N3 sleep with a good strength of agreement in weighted Kappa analysis (95% confidence interval; weighted Kappa = 0.67). CONCLUSIONS Melatonin is reliable and at least as effective as chloral hydrate for sleep EEG acquisition in children.
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Affiliation(s)
- Sanem Yilmaz
- Division of Pediatric Neurology, Department of Pediatrics, Ege University Children's Hospital, Ege University Medical School, Izmir, Turkey
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17
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Leader G, Whelan S, Chonaill NN, Coyne R, Tones M, Heussler H, Bellgard M, Mannion A. Association between early and current gastro-intestinal symptoms and co-morbidities in children and adolescents with Angelman syndrome. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2022; 66:865-879. [PMID: 36052644 PMCID: PMC9826167 DOI: 10.1111/jir.12975] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Revised: 07/22/2022] [Accepted: 08/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Angelman syndrome (AS) is a neurogenetic disorder that causes severe intellectual disability, expressive language deficits, motor impairment, ataxia, sleep problems, epileptic seizures and a happy disposition. People with AS frequently experience gastrointestinal (GI) symptoms. METHOD This study used data from the Global Angelman Syndrome Registry to explore the relationship between early and current GI symptoms and co-morbidity in children and adolescents with AS (n = 173). Two groups that experienced a high (n = 91) and a low (n = 82) frequency of GI symptoms were examined in relation to feeding and GI history in infancy, sleep and toileting problems, levels of language and communication and challenging behaviours. Predictors of GI symptoms were then investigated using a series of logistic regressions. RESULTS This analysis found that constipation and gastroesophageal reflux affected 84% and 64%, of the sample, respectively. The high frequency of GI symptoms were significantly associated with: 'refusal to nurse', 'vomiting', 'arching', 'difficulty gaining weight', gastroesophageal reflux, 'solid food transition', frequency of night-time urinary continence and sleep hyperhidrosis during infancy. GI symptoms were not significantly associated with sleep, toileting, language or challenging behaviours. Significant predictors of high frequency GI symptoms were gastroesophageal reflux and sleep hyperhidrosis. CONCLUSIONS Future research needs to investigate the association between AS and GI co-morbidity in adults with AS.
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Affiliation(s)
- G. Leader
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - S. Whelan
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - N. N. Chonaill
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - R. Coyne
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
| | - M. Tones
- eResearch OfficeQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - H. Heussler
- Children's Health Queensland Hospital and Health ServiceBrisbaneQueenslandAustralia
| | - M. Bellgard
- eResearch OfficeQueensland University of TechnologyBrisbaneQueenslandAustralia
| | - A. Mannion
- Irish Centre for Autism and Neurodevelopmental Research, School of PsychologyNational University of IrelandGalwayIreland
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Saini L, Mukherjee S, Gunasekaran PK, Malhi P, Saini AG, De D, Padhy S, Ahuja C, Suthar R, Sahu JK, Sankhyan N, Yadav J, Sharawat IK. Sleep Problems in Children With Neurocutaneous Syndromes: A Cross-Sectional Study. J Child Neurol 2022; 37:864-870. [PMID: 35918819 DOI: 10.1177/08830738221114560] [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: 11/17/2022]
Abstract
Introduction: The prevalence and patterns of sleep disturbances in neurocutaneous syndromes are variable and understudied. Methods: Cross-sectional study for 18 months at a tertiary care pediatric hospital, involving 100 children with neurocutaneous syndromes aged between 4 and 10 years using the Children's Sleep Habits Questionnaire-Abbreviated. Results: In 100 children with neurocutaneous syndromes, 47 (47%) had significant sleep problems. In subgroup analysis, 7 of 17 children with neurofibromatosis 1, 24 of 63 children with tuberous sclerosis complex, 10 of 12 children with Sturge-Weber syndrome, 2 of 3 children with linear nevus sebaceous syndrome, and each of the children with hypomelanosis of Ito, McCune-Albright syndrome, megalencephaly-capillary malformation syndrome, and unclassified neurocutaneous syndrome had significant sleep problems. Conclusion: The prevalence of sleep problems in our study population was not more than that observed in the general pediatric population. Prospective multicentric studies are needed to comprehend sleep problems in children with neurocutaneous syndromes.
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Affiliation(s)
- Lokesh Saini
- Department of Pediatrics, 410775All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Swetlana Mukherjee
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | | | - Prahbhjot Malhi
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Arushi Gahlot Saini
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Dipankar De
- Department of Dermatology, Venereology and Leprosy, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Susanta Padhy
- Department of Psychiatry, 410730All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
| | - Chirag Ahuja
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Renu Suthar
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jitendra Kumar Sahu
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Naveen Sankhyan
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Jaivinder Yadav
- Department of Pediatrics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Indar Kumar Sharawat
- Department of Pediatrics, 442339All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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19
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Garayzábal E, Hidalgo I, Miranda de Souza ALD, da Silva NC, Giacheti CM, Pinato L. Sleep disturbances and behavior in Smith-Magenis syndrome. RESEARCH IN DEVELOPMENTAL DISABILITIES 2022; 128:104286. [PMID: 35779287 DOI: 10.1016/j.ridd.2022.104286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 05/04/2022] [Accepted: 06/09/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The Smith-Magenis syndrome (SMS) shows a collection of neurodevelopmental problems including mild to moderate intellectual disability, change-related anxiety, impulsivity, speech delay, Attention-Deficit/Hyperactivity Disorder (ADH) and sleep disturbances. Sleep disorders, when present, have been treated in several populations with consecutive improvements in cognitive and behavioral aspects. AIMS To better understand the existing relationships between sleep disturbances and behavioral problems in SMS syndrome this study describes the sleep and behavior problems in the SMS and explores the possible relation between both. METHODS AND PROCEDURES 17 individuals with SMS (50% males; 11.2 ± 4.9 years old) and 12 individuals with typical development (50% male; 11.1 ± 4.4 years old) were investigated using the Sleep Disturbance Scale for Children and the Child Behavior Checklist. RESULTS A high percentage (60%) of individuals with SMS have an indication of sleep disorders, being the most frequent disorders the sleep-wake transition disorders, and disorders of initiating and maintaining sleep with sleep latency higher than acceptable and total sleep time below acceptable. More than 94% of the SMS group presented clinical or borderline scores on the total behavioral problems scale. The most common behavioral problems were Externalizing Problems, Thought and Attention, ADH and Aggressive problems. There was a positive correlation between disorders of initiating and maintaining sleep, sleep-wake transition disorders, disorders of arousal, disorders of excessive somnolence and behavioral problems. CONCLUSIONS AND IMPLICATIONS The worse the sleep disturbances investigated, the more severe the behavioral problems characteristics reinforcing the importance to address the sleep problems in the treatment of SMS individuals.
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Affiliation(s)
- Elena Garayzábal
- Departamento de Lingüística General, Facultad de Filosofía y Letras, Universidad Autónoma de Madrid, 28049 Madrid, Spain.
| | - Irene Hidalgo
- Departamento de Filología Española, Facultad de Filosofía y Letras, Universidad Autónoma de Madrid, 28049 Madrid, Spain; Facultad de Ciencias de la Salud, Universidad de Castilla La Mancha, 45600 Talavera de la Reina, Spain; Centro Universitario de Educación Superior (CUNIMAD), 28040 Madrid, Spain.
| | | | - Nathani Cristina da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
| | - Celia Maria Giacheti
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
| | - Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil.
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20
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Belli A, Breda M, Di Maggio C, Esposito D, Marcucci L, Bruni O. Children with neurodevelopmental disorders: how do they sleep? Curr Opin Psychiatry 2022; 35:345-351. [PMID: 35165244 DOI: 10.1097/yco.0000000000000790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW In this review we summarized the available evidence on sleep disorders in children with neurodevelopmental disorders (NDDs) in particular: intellectual disability (including some genetic conditions such as Prader-Willi Syndrome, Smith-Magenis Syndrome), Autism spectrum disorder, attention-deficit/hyperactivity disorder (ADHD), Developmental Coordination Disorder, language disorders, and specific learning disorders. RECENT FINDINGS Children with NDDs frequently suffer from sleep disturbances, with a higher prevalence than that of the general pediatric population. SUMMARY These problems tend to be chronic and may cause additional cognitive and behavioral difficulties, often affecting the whole family's well-being. Sleep behaviors are also related to other important developmental skills, such as attention and listening. Investigating sleep disorders in children with NDDs is therefore crucial in clinical practice. For a systematic approach in clinical practice, we propose the use of a short and easy to remember sleep screening tool.
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Affiliation(s)
- Arianna Belli
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences
| | - Maria Breda
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences
| | - Chiara Di Maggio
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences
- PhD Program in Behavioral Neuroscience, Department of Psychology
| | - Dario Esposito
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences
| | - Lavinia Marcucci
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University of Rome, Rome, Italy
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21
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Scheper M, Romagnolo A, Besharat ZM, Iyer AM, Moavero R, Hertzberg C, Weschke B, Riney K, Feucht M, Scholl T, Petrak B, Maulisova A, Nabbout R, Jansen AC, Jansen FE, Lagae L, Urbanska M, Ferretti E, Tempes A, Blazejczyk M, Jaworski J, Kwiatkowski DJ, Jozwiak S, Kotulska K, Sadowski K, Borkowska J, Curatolo P, Mills JD, Aronica E. miRNAs and isomiRs: Serum-Based Biomarkers for the Development of Intellectual Disability and Autism Spectrum Disorder in Tuberous Sclerosis Complex. Biomedicines 2022; 10:biomedicines10081838. [PMID: 36009385 PMCID: PMC9405248 DOI: 10.3390/biomedicines10081838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 07/22/2022] [Accepted: 07/28/2022] [Indexed: 11/16/2022] Open
Abstract
Tuberous sclerosis complex (TSC) is a rare multi-system genetic disorder characterized by a high incidence of epilepsy and neuropsychiatric manifestations known as tuberous-sclerosis-associated neuropsychiatric disorders (TANDs), including autism spectrum disorder (ASD) and intellectual disability (ID). MicroRNAs (miRNAs) are small regulatory non-coding RNAs that regulate the expression of more than 60% of all protein-coding genes in humans and have been reported to be dysregulated in several diseases, including TSC. In the current study, RNA sequencing analysis was performed to define the miRNA and isoform (isomiR) expression patterns in serum. A Receiver Operating Characteristic (ROC) curve analysis was used to identify circulating molecular biomarkers, miRNAs, and isomiRs, able to discriminate the development of neuropsychiatric comorbidity, either ASD, ID, or ASD + ID, in patients with TSC. Part of our bioinformatics predictions was verified with RT-qPCR performed on RNA isolated from patients’ serum. Our results support the notion that circulating miRNAs and isomiRs have the potential to aid standard clinical testing in the early risk assessment of ASD and ID development in TSC patients.
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Affiliation(s)
- Mirte Scheper
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (A.R.); (A.M.I.)
| | - Alessia Romagnolo
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (A.R.); (A.M.I.)
| | - Zein Mersini Besharat
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (Z.M.B.); (E.F.)
| | - Anand M. Iyer
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (A.R.); (A.M.I.)
- Internal Medicine, Erasmus MC, 3015 GD Rotterdam, The Netherlands
| | - Romina Moavero
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, 00133 Rome, Italy; (R.M.); (P.C.)
- Child Neurology Unit, Neuroscience Department, Bambino Gesù Children’s Hospital, IRCCS, 00165 Rome, Italy
| | - Christoph Hertzberg
- Diagnose-und Behandlungszentrum für Kinder, Vivantes-Klinikum Neukölln, 12351 Berlin, Germany;
| | - Bernhard Weschke
- Department of Neuropediatrics, Charité University Medicine Berlin, 13353 Berlin, Germany;
| | - Kate Riney
- Faculty of Medicine, The University of Queensland, Herston, QLD 4029, Australia;
- Neurosciences Unit, Queensland Children’s Hospital, South Brisbane, QLD 4101, Australia
| | - Martha Feucht
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, “Member of ERN EpiCARE”, 1090 Vienna, Austria; (M.F.); (T.S.)
| | - Theresa Scholl
- Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, “Member of ERN EpiCARE”, 1090 Vienna, Austria; (M.F.); (T.S.)
| | - Borivoj Petrak
- Motol University Hospital, Charles University, 15000 Prague, Czech Republic; (B.P.); (A.M.)
| | - Alice Maulisova
- Motol University Hospital, Charles University, 15000 Prague, Czech Republic; (B.P.); (A.M.)
| | - Rima Nabbout
- Reference Centre for Rare Epilepsies, Department of Pediatric Neurology, Necker Enfants Malades University Hospital, APHP, Member of ERN EpiCARE, Université de Paris, 149 Rue de Sèvres, 75015 Paris, France;
| | - Anna C. Jansen
- Department of Translational Neurosciences, University of Antwerp, 2000 Antwerp, Belgium;
| | - Floor E. Jansen
- Department of Child Neurology, Brain Center University Medical Center, Member of ERN EpiCare, 3584 BA Utrecht, The Netherlands;
| | - Lieven Lagae
- Department of Development and Regeneration Section Pediatric Neurology, University Hospitals KU Leuven, 3000 Leuven, Belgium;
| | - Malgorzata Urbanska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.U.); (S.J.); (K.K.); (K.S.); (J.B.)
| | - Elisabetta Ferretti
- Department of Experimental Medicine, Sapienza University of Rome, 00161 Rome, Italy; (Z.M.B.); (E.F.)
| | - Aleksandra Tempes
- International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland; (A.T.); (M.B.); (J.J.)
| | - Magdalena Blazejczyk
- International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland; (A.T.); (M.B.); (J.J.)
| | - Jacek Jaworski
- International Institute of Molecular and Cell Biology, 02-109 Warsaw, Poland; (A.T.); (M.B.); (J.J.)
| | | | - Sergiusz Jozwiak
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.U.); (S.J.); (K.K.); (K.S.); (J.B.)
- Department of Child Neurology, Medical University of Warsaw, 02-097 Warsaw, Poland
| | - Katarzyna Kotulska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.U.); (S.J.); (K.K.); (K.S.); (J.B.)
| | - Krzysztof Sadowski
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.U.); (S.J.); (K.K.); (K.S.); (J.B.)
| | - Julita Borkowska
- Department of Neurology and Epileptology, The Children’s Memorial Health Institute, 04-730 Warsaw, Poland; (M.U.); (S.J.); (K.K.); (K.S.); (J.B.)
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Systems Medicine Department, Tor Vergata University, 00133 Rome, Italy; (R.M.); (P.C.)
| | - James D. Mills
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (A.R.); (A.M.I.)
- Department of Clinical and Experimental Epilepsy, UCL Queen Square Institute of Neurology, London WC1E 6BT, UK
- Chalfont Centre for Epilepsy, Chalfont St Peter SL9 0RJ, UK
- Correspondence: (J.D.M.); (E.A.)
| | - Eleonora Aronica
- Department of (Neuro)Pathology Amsterdam Neuroscience, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (M.S.); (A.R.); (A.M.I.)
- Correspondence: (J.D.M.); (E.A.)
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Agar G, Oliver C, Richards C. Direct assessment of overnight parent-child proximity in children with behavioral insomnia: Extending models of operant and classical conditioning. Behav Sleep Med 2022; 21:254-272. [PMID: 35796281 DOI: 10.1080/15402002.2022.2076681] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
INTRODUCTION Explanatory models of behavioral insomnia typically draw on operant learning theory with behavioral techniques focused on altering parent-child interactions to improve sleep. However, there are no data describing parent-child interactions overnight beyond parent report. In this study we used radio frequency identification technology to quantify parent-child proximity overnight in two groups at elevated risk of behavioral insomnia, Angelman syndrome (AS) and Smith-Magenis syndrome (SMS). MATERIALS AND METHODS Nineteen children aged 4-15 years (8 with AS, 11 with SMS) participated in a week-long at-home assessment of sleep and overnight parent-child proximity. Sleep parameters were recorded using the Philips Actiwatch 2 and proximity data were recorded using custom-built radio frequency identification watches. RESULTS Three patterns of proximity data between parent-child dyads overnight were evident: "checking" (six with AS, five with SMS), "co-sleeping" (four with SMS) and those who had "no proximity" overnight (two with AS, two with SMS). In the AS group, 25.45% of actigraphy-defined wakes resulted in a parent-child interaction. In the SMS group, 39.34% of wakes resulted in a parent-child interaction. Children who interacted with their parents when settling to sleep were not significantly more likely to interact at waking. DISCUSSION The novel application of radio frequency identification technology is a feasible method for studying overnight parent-child proximity. Profiles of proximity between participants that are not closely aligned with operant models of behavioral insomnia were evident. These results have significant implications for the etiology of poor sleep and the application of behavioral sleep interventions.
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Affiliation(s)
- Georgie Agar
- School of Psychology, University of Birmingham, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Birmingham, UK
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23
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Approches thérapeutiques des troubles du sommeil et des rythmes chez l’enfant avec TSA. Encephale 2022; 48:294-303. [DOI: 10.1016/j.encep.2021.08.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 07/12/2021] [Accepted: 08/20/2021] [Indexed: 12/27/2022]
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24
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Questionnaire-based assessment of sleep disorders in an adult population of Tuberous Sclerosis Complex. Sleep Med 2022; 92:81-87. [DOI: 10.1016/j.sleep.2022.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 02/17/2022] [Accepted: 03/03/2022] [Indexed: 11/23/2022]
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25
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Vanclooster S, Bissell S, van Eeghen AM, Chambers N, De Waele L, Byars AW, Capal JK, Cukier S, Davis P, Flinn J, Gardner-Lubbe S, Gipson T, Heunis TM, Hook D, Kingswood JC, Krueger DA, Kumm AJ, Sahin M, Schoeters E, Smith C, Srivastava S, Takei M, Waltereit R, Jansen AC, de Vries PJ. The research landscape of tuberous sclerosis complex-associated neuropsychiatric disorders (TAND)-a comprehensive scoping review. J Neurodev Disord 2022; 14:13. [PMID: 35151277 PMCID: PMC8853020 DOI: 10.1186/s11689-022-09423-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Tuberous sclerosis complex (TSC)-associated neuropsychiatric disorders (TAND) is an umbrella term for the behavioural, psychiatric, intellectual, academic, neuropsychological and psychosocial manifestations of TSC. Although TAND affects 90% of individuals with TSC during their lifetime, these manifestations are relatively under-assessed, under-treated and under-researched. We performed a comprehensive scoping review of all TAND research to date (a) to describe the existing TAND research landscape and (b) to identify knowledge gaps to guide future TAND research. METHODS The study was conducted in accordance with stages outlined within the Arksey and O'Malley scoping review framework. Ten research questions relating to study characteristics, research design and research content of TAND levels and clusters were examined. RESULTS Of the 2841 returned searches, 230 articles published between 1987 and 2020 were included (animal studies = 30, case studies = 47, cohort studies = 153), with more than half published since the term TAND was coined in 2012 (118/230; 51%). Cohort studies largely involved children and/or adolescents (63%) as opposed to older adults (16%). Studies were represented across 341 individual research sites from 45 countries, the majority from the USA (89/341; 26%) and the UK (50/341; 15%). Only 48 research sites (14%) were within low-middle income countries (LMICs). Animal studies and case studies were of relatively high/high quality, but cohort studies showed significant variability. Of the 153 cohort studies, only 16 (10%) included interventions. None of these were non-pharmacological, and only 13 employed remote methodologies (e.g. telephone interviews, online surveys). Of all TAND clusters, the autism spectrum disorder-like cluster was the most widely researched (138/230; 60%) and the scholastic cluster the least (53/200; 27%). CONCLUSIONS Despite the recent increase in TAND research, studies that represent participants across the lifespan, LMIC research sites and non-pharmacological interventions were identified as future priorities. The quality of cohort studies requires improvement, to which the use of standardised direct behavioural assessments may contribute. In human studies, the academic level in particular warrants further investigation. Remote technologies could help to address many of the TAND knowledge gaps identified.
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Affiliation(s)
- Stephanie Vanclooster
- Department of Public Health, Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | - Stacey Bissell
- Cerebra Network for Neurodevelopmental Disorders, University of Birmingham, Birmingham, UK
| | - Agnies M. van Eeghen
- Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
- TAND Expert Centre, ‘s Heeren Loo, Hoofddorp, The Netherlands
| | - Nola Chambers
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
| | - Liesbeth De Waele
- Department of Paediatric Neurology, University Hospitals Leuven, Leuven, Belgium
- Department of Development and Regeneration, KU Leuven, Leuven, Belgium
| | - Anna W. Byars
- Department of Pediatrics, Division of Neurology, Cincinnati Children’s Hospital Medical Center/University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Jamie K. Capal
- Department of Neurology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Sebastián Cukier
- Argentine Program for Children, Adolescents and Adults with Autism Spectrum Disorders (PANAACEA), Buenos Aires, Argentina
| | - Peter Davis
- Department of Neurology, Harvard Medical School & Boston Children’s Hospital, Boston, MA USA
| | | | | | - Tanjala Gipson
- Department of Pediatrics, University of Tennessee Health Sciences Center, Memphis, TN USA
- Le Bonheur Children’s Hospital and Boling Center for Developmental Disabilities, Memphis, TN USA
| | - Tosca-Marie Heunis
- Department of Public Health, Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
| | | | | | - Darcy A. Krueger
- TSC Clinic Cincinnati Children’s Hospital Medical Center, Cincinnati, OH USA
- Department of Pediatrics, Clinical Pediatrics and Neurology, University of Cincinnati College of Medicine, Cincinnati, OH USA
| | - Aubrey J. Kumm
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
| | - Mustafa Sahin
- Department of Neurology, Translational Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA USA
| | | | | | - Shoba Srivastava
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
- Tuberous Sclerosis Alliance India, Mumbai, India
| | - Megumi Takei
- Japanese Society of Tuberous Sclerosis Complex, Tokyo, Japan
| | - Robert Waltereit
- Child and Adolescent Psychiatry, University Medical Center Göttingen, Georg-August University, Göttingen, Germany
| | - Anna C. Jansen
- Department of Public Health, Mental Health and Wellbeing Research Group, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Pediatrics, Pediatric Neurology Unit, Antwerp University Hospital, Edegem, Belgium
| | - Petrus J. de Vries
- Division of Child & Adolescent Psychiatry, Centre for Autism Research in Africa (CARA), University of Cape Town, Cape Town, South Africa
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Agar G, Bissell S, Wilde L, Over N, Williams C, Richards C, Oliver C. Caregivers' experience of sleep management in Smith-Magenis syndrome: a mixed-methods study. Orphanet J Rare Dis 2022; 17:35. [PMID: 35120534 PMCID: PMC8815225 DOI: 10.1186/s13023-021-02159-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Accepted: 12/19/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Smith-Magenis syndrome (SMS) is a rare genetic syndrome associated with a unique profile of early morning waking and daytime sleepiness. Children with SMS evidence high rates of self-injury and aggression and have a preference for adult over peer attention, with strong motivation to interact with a particular caregiver. In addition, people with SMS have lower adaptive functioning skills relative to cognitive abilities and demonstrate high levels of impulsivity. Taken together, these factors may result in individuals being awake overnight requiring vigilant caregiver supervision. Despite these complexities, no study has described the strategies caregivers take to keep their children with SMS safe overnight or considered the impact of these experiences on caregivers or the wider family. METHODS The current study used a mixed-methods approach to consider sleep management strategies and challenges for caregivers of people with SMS at different ages. Caregivers completed an international online survey about sleep management and related difficulties, use of interventions and access to services and support. Semi-structured interviews were conducted with 14 caregivers in the UK to increase understanding of caregiver experiences and priorities for change in the UK context. Interviews were transcribed verbatim and coded using thematic analysis. RESULTS Evidence from the online survey (n = 40) revealed wide-ranging impacts of poor sleep on the person with SMS and the wider family. Only 5% of caregivers reported that the sleep problems had no impact on their child, and 76% reported a moderately or extremely significant impact on themselves. For some individual caregivers, sleep management difficulties improved over time whereas for others no change was reported. Weekly respite emerged as the ideal provision for 49% of caregivers, although only 14% had access to this. The majority of caregivers (54%) received no respite. Thematic analysis of qualitative interviews revealed interactions between aspects of the behavioural phenotype of SMS which may contribute to complex and unusual presentations in relation to sleep management and safety. CONCLUSIONS Caregivers' priorities for sleep management and support were delineated, with key implications for services in terms of the use of SMS-sensitive strategies and respite provision.
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Affiliation(s)
- Georgie Agar
- School of Psychology, University of Birmingham, 52 Pritchatts Road Edgbaston, Birmingham, B15 2TT, UK.
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK.
| | - Stacey Bissell
- School of Psychology, University of Birmingham, 52 Pritchatts Road Edgbaston, Birmingham, B15 2TT, UK
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
| | | | - Nigel Over
- The Smith-Magenis Syndrome (SMS) Foundation UK, Livingston, UK
| | - Caitlin Williams
- School of Psychology, University of Birmingham, 52 Pritchatts Road Edgbaston, Birmingham, B15 2TT, UK
- Centre for Educational Development Appraisal and Research, University of Warwick, Coventry, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, 52 Pritchatts Road Edgbaston, Birmingham, B15 2TT, UK
- Cerebra Network for Neurodevelopmental Disorders, Birmingham, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, 52 Pritchatts Road Edgbaston, Birmingham, B15 2TT, UK
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Moavero R, Voci A, La Briola F, Matricardi S, Toldo I, Mancardi MM, Negrin S, Messana T, Mazzone L, Valeriani M, Curatolo P, Bruni O. Sleep disorders and neuropsychiatric disorders in a pediatric sample of tuberous sclerosis complex: a questionnaire-based study. Sleep Med 2021; 89:65-70. [PMID: 34915263 DOI: 10.1016/j.sleep.2021.11.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE AND BACKGROUND Sleep disorders (SD) are very common in childhood, especially in certain genetic syndromes. Tuberous Sclerosis Complex (TSC) is a genetic syndromesassociated with a high rate of SD, although these are still under-recognized. The aim of this study was to assess the prevalence of SD in TSC, and to evaluate the relationship between sleep, epilepsy and TSC-associated neuropsychiatric disorders (TAND). METHODS We administered the Sleep Disturbance Scale for Children (SDSC) and the Epworth Sleepiness Scale for Children and Adolescents (ESS-CHAD) to parents of 177 children with TSC referring to different Italian centers. We also collected information on epilepsy and TAND. RESULTS SDSC score was positive in 59.3% of patients, being positive in 30.4% of patients without and in 63.6% of those with epilepsy (p = 0.005). However, in a multivariate logistic model considering antiseizure medications and nocturnal seizures, epilepsy ceased to be a significant risk factor for positive SDSC (OR = 2.4; p = 0.17). As for TAND, SDSC was positive in 67.9% of patients with and in 32.5% of those without TAND (p < 0.001). After adding in a multivariate logistic model active epilepsy, age, and pharmacotherapies, TAND continued to be a significant risk factor for positive SDSC (p = 0.01, OR = 1.11). CONCLUSIONS Our results revealed a high prevalence of SD in children with TSC. Epilepsy didn't increase the risk for SD, while a very strong association was found with TAND. An early detection of SD is of utmost importance in order to plan an individualized treatment, that in some cases might also ameliorate behavior and attention.
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Affiliation(s)
- Romina Moavero
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy; Child Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Alessandra Voci
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Francesca La Briola
- Child Neuropsychiatry Unit - Epilepsy Center, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Sara Matricardi
- Child Neurology and Psychiatry Unit, Children's Hospital "G. Salesi", Ospedali Riuniti Ancona, Via Corridoni 11, 60123, Ancona, Italy
| | - Irene Toldo
- Pediatric Neurology and Neurophysiology Unit, Department of Woman's and Child Health, Padua University Hospital, Via N. Giustiniani 3, 35128, Padua, Italy
| | - Maria Margherita Mancardi
- Unit of Child Neuropsichiatry, Department of Clinical and Surgical Neurosciences and Rehabilitation, IRCCS Gaslini, Via Gerolamo Gaslini 5, 16147, Genova, Italy
| | - Susanna Negrin
- Epilepsy and Clinical Neurophysiology Unit, Scientific Institute, IRCCS Eugenio Medea, Conegliano, Treviso, Italy
| | - Tullio Messana
- IRCCS Istituto Delle Scienze Neurologiche, UOC Neuropsichiatria Dell'età Pediatrica, Via Altura 3, 40139, Bologna, Italy
| | - Luigi Mazzone
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Massimiliano Valeriani
- Child Neurology Unit, Neuroscience Department, Bambino Gesù Children's Hospital, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy; Center for Sensory-Motor Interaction, Aalborg University, Fredrik Bajers Vej 7 D3, Aalborg, D-9220, Denmark
| | - Paolo Curatolo
- Child Neurology and Psychiatry Unit, Tor Vergata University of Rome, Via Montepellier 1, 00133, Rome, Italy
| | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy
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28
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Bakke KA, Howlin P, Helverschou SB. Hyperactive behaviour in Angelman syndrome: the association with sleep problems and age of epilepsy onset. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2021; 65:666-674. [PMID: 33951249 DOI: 10.1111/jir.12842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 03/12/2021] [Accepted: 03/31/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND Sleep problems are common in many neurodevelopmental disorders, but little is known about how sleep is related to behavioural symptoms in Angelman syndrome (AS) or other genetic disorders. Hyperactive behaviour, sleep problems and epilepsy seem to be more common in AS than in other genetic conditions associated with severe intellectual disability. We hypothesised that both more sleep problems and earlier onset of epileptic seizures would predict more symptoms of hyperactivity. Hence, the aim of the project was to explore the association between hyperactive behaviour, sleep problems and age of epilepsy onset in individuals with AS. METHOD All known parents/guardians (n = 115) of individuals with AS in Norway were invited to participate in this descriptive correlational study. Fifty-six individuals (49%) responded, and 42 people (25 male and 17 female; mean age 18.5 years, range 2-57 years) with genetically verified AS were included. Scores for 'hyperactivity' and 'sleep problems' were derived from questionnaire data. Information on epilepsy was obtained from medical records. RESULTS 'Hyperactivity' was positively correlated with 'total sleep problems' (r = 0.46, P = 0.002) and negatively correlated with 'age of epilepsy onset' (r = -0.47, P = 0.01). 'Age of epilepsy onset' was not correlated with 'total sleep problems'. An overall multiple regression model with 'hyperactivity' as the dependent variable and 'age of epilepsy onset' and 'total sleep problems' as covariates was significant (R2 = 0.39, F = 8.16, P = 0.002). Hence, hyperactivity in AS could be predicted from both age of epilepsy onset and current sleep problems. CONCLUSIONS Sleep problems may increase hyperactivity symptoms in individuals with AS. The association between hyperactivity and sleep problems in AS indicates that both should be investigated together as part of routine clinical assessment and intervention for either area of difficulty. Younger age of epilepsy onset was associated with more hyperactivity in AS, which may be related to encephalopathic effects of seizures and epilepsy.
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Affiliation(s)
- K A Bakke
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
| | - P Howlin
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - S B Helverschou
- NevSom, Department of Rare Disorders, Oslo University Hospital, Oslo, Norway
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30
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Zambrelli E, Turner K, Peron A, Leidi A, La Briola F, Vignoli A, Canevini MP. Sleep and behavior in children and adolescents with tuberous sclerosis complex. Am J Med Genet A 2021; 185:1421-1429. [PMID: 33650172 DOI: 10.1002/ajmg.a.62123] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/10/2020] [Accepted: 01/09/2021] [Indexed: 11/10/2022]
Abstract
Sleep disorders are frequent in tuberous sclerosis complex (TSC) during the developmental age but are not well characterized. Forty-six TSC patients and 46 healthy age- and sex-matched controls were enrolled. Their parents completed the Sleep Disturbances Scale for Children (SDSC) and the Child Behavior Checklist (CBCL). A total of 17.4% of the TSC patients obtained a total pathologic score at the SDSC versus 4.4% in the control group (p = 0.024). 45.7% of individuals with TSC reported a pathologic score in at least one of the factors. We found a statistically significant difference between the TSC cohort and healthy controls for most of the CBCL scales scores. A significant relationship was found between the Total SDSC score and the Total CBCL score (R-square = 0.387, p < 0.0001), between the Total SDSC score and the Internalizing and Externalizing areas scores (R-square = 0.291, p < 0.0001 and R-square = 0.350, p < 0.0001, respectively) of the CBCL. Sleep disorders are more frequent in TSC than in the general population and correlate with behavior. The use of SDSC and CBCL is proposed as part of the surveillance of TSC patients in the developmental age.
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Affiliation(s)
- Elena Zambrelli
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Katherine Turner
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Angela Peron
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy.,Human Pathology and Medical Genetics Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Department of Pediatrics, Division of Medical Genetics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Alessia Leidi
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Francesca La Briola
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy
| | - Aglaia Vignoli
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
| | - Maria Paola Canevini
- Epilepsy Center-Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo e Carlo, San Paolo Hospital, Milan, Italy.,Department of Health Sciences, University of Milan, Milan, Italy
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA
| | - Roey Ringel
- Department of Pediatrics, Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA,Columbia College, Columbia University, New York, NY, USA
| | - Kara Gross Margolis
- Department of Pediatrics, Morgan Stanley Children's Hospital, Columbia University Irving Medical Center, 622 West 168th Street, New York, NY 10025, USA; Institute of Human Nutrition, Columbia University Irving Medical Center, 630 West 168th Street, PH1512E, New York, NY 10032, USA.
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32
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Agar G, Brown C, Sutherland D, Coulborn S, Oliver C, Richards C. Sleep disorders in rare genetic syndromes: a meta-analysis of prevalence and profile. Mol Autism 2021; 12:18. [PMID: 33632309 PMCID: PMC7908701 DOI: 10.1186/s13229-021-00426-w] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 02/16/2021] [Indexed: 11/22/2022] Open
Abstract
Background Sleep disorders are common in people with intellectual disability (ID) and autism, with growing evidence of diverse sleep profiles across ID associated genetic syndromes. Documenting the prevalence and profile of specific sleep disorders in syndromes will quantify syndrome-driven ‘risk’, inform prognosis and enhance understanding of aetiology of sleep disorders. Method Following PRISMA guidelines for meta-analysis, we searched Ovid PsycINFO, Ovid MEDLINE, Ovid Embase, Web of Science and PubMed Central with use of syndrome-specific keywords and 60 sleep-related search terms. We screened and extracted papers that reported sleep disorder prevalence data for five or more individuals within a genetic syndrome, and applied quality criteria to produce a quality-effects prevalence model of six types of sleep disorder across nineteen syndromes. Relative risk estimates were calculated for the prevalence of each sleep disorder in each syndrome. Results Two hundred and seventy three papers were identified, generating 463 prevalence estimates for Angelman, CHARGE, Cornelia de Lange, Down, fragile X, Prader–Willi, Rett, Smith–Magenis and Williams syndromes, mucopolysaccharidoses (MPS disorders), neurofibromatosis and tuberous sclerosis complex. Prevalence estimates were higher in genetic syndromes than published equivalents for typically developing individuals, with few exceptions. Between-syndrome differences for some disorders were evident; sleep-disordered breathing was most prevalent in MPS disorders (72–77%), while excessive daytime sleepiness was highest in Smith–Magenis syndrome (60%). Conversely, insomnia, which was reported at a higher rate than TD estimates in all syndromes except fragile X, was not associated with specific genetic risk. This suggests insomnia could emerge because of the individual’s environment or associated developmental delay, rather than any specific genetic syndromes. Limitations Due to the broad scope of the meta-analysis, only syndromes previously identified as reporting preliminary sleep research were included. Other syndromes may also experience elevated prevalence rates of specific types of sleep disorder. Only English language papers were included. Conclusions Differing prevalence rates between types of sleep disorder suggest differing causal mechanisms, such as cranio-facial morphology in Down and Prader–Willi syndromes and the build-up of mucopolysaccharides in MPS disorders. Priorities for clinical assessment and intervention for sleep disorders are discussed.
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Affiliation(s)
- Georgie Agar
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.
| | - Chloe Brown
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK.,South West Yorkshire Partnership NHS Foundation Trust, Wakefield, WF1 3SP, UK
| | - Daniel Sutherland
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Sean Coulborn
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Chris Oliver
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
| | - Caroline Richards
- School of Psychology, University of Birmingham, Birmingham, B15 2TT, UK
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Winsor AA, Richards C, Bissell S, Seri S, Liew A, Bagshaw AP. Sleep disruption in children and adolescents with epilepsy: A systematic review and meta-analysis. Sleep Med Rev 2021; 57:101416. [PMID: 33561679 DOI: 10.1016/j.smrv.2021.101416] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/07/2020] [Accepted: 09/07/2020] [Indexed: 01/20/2023]
Abstract
This systematic review and meta-analysis aims to assess and quantify putative differences in sleep architecture, sleep efficiency, sleep timing and broadly-defined sleep difficulties between children with and without epilepsy. Databases were searched systematically, and studies identified in PubMed, EMBASE, PsychINFO and Medline. The meta-analysis included 19 studies comparing a total of 901 children with epilepsy to 1470 healthy children. Relative to healthy children, children with epilepsy experienced reduced sleep time, sleeping on average 34 mins less across self-report, actigraphy, 24-h video-EEG and polysomnography measures. They had more sleep difficulties specifically in the domains of night waking, parasomnias and sleep disordered breathing. The analysis also revealed a significantly increased percentage of N2 sleep and decreased sleep efficiency in children with epilepsy compared to healthy children. These results illustrate that children with epilepsy are vulnerable to more sleep difficulties compared to healthy children. This suggests that screening for sleep difficulties should be an integral part in a diagnosis of epilepsy to ensure that clinically relevant sleep difficulties are identified and treated. Such an approach may ultimately aid in the development of treatment strategies which can contribute to improvements in both developmental and diagnostic outcomes for children with epilepsy.
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Affiliation(s)
- Alice A Winsor
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK.
| | | | | | - Stefano Seri
- Birmingham Children's Hospital, Birmingham Women's and Children's Hospital NHS Foundation, UK
| | - Ashley Liew
- Evelina London Children's Hospital, South London and Maudsley NHS Foundation Trust, University of Warwick, University of Birmingham, UK
| | - Andrew P Bagshaw
- Centre for Human Brain Health, University of Birmingham, UK; School of Psychology, University of Birmingham, UK
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Chan F, Liu J. Molecular regulation of brain metabolism underlying circadian epilepsy. Epilepsia 2021; 62 Suppl 1:S32-S48. [PMID: 33395505 DOI: 10.1111/epi.16796] [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] [Received: 05/22/2020] [Revised: 12/01/2020] [Accepted: 12/01/2020] [Indexed: 12/13/2022]
Abstract
Extensive study has demonstrated that epilepsy occurs with greater frequency at certain times in the 24-h cycle. Although these findings implicate an overlap between the circadian rhythm and epilepsy, the molecular and cellular mechanisms underlying this circadian regulation are poorly understood. Because the 24-h rhythm is generated by the circadian molecular system, it is not surprising that this system comprised of many circadian genes is implicated in epilepsy. We summarized evidence in the literature implicating various circadian genes such as Clock, Bmal1, Per1, Rev-erb⍺, and Ror⍺ in epilepsy. In various animal models of epilepsy, the circadian oscillation and the steady-state level of these genes are disrupted. The downstream pathway of these genes involves a large number of metabolic pathways associated with epilepsy. These pathways include pyridoxal metabolism, the mammalian target of rapamycin pathway, and the regulation of redox state. We propose that disruption of these metabolic pathways could mediate the circadian regulation of epilepsy. A greater understanding of the cellular and molecular mechanism of circadian regulation of epilepsy would enable us to precisely target the circadian disruption in epilepsy for a novel therapeutic approach.
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Affiliation(s)
- Felix Chan
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island, USA
| | - Judy Liu
- Department of Molecular Biology, Cell Biology, and Biochemistry, Brown University, Providence, Rhode Island, USA.,Department of Neurology, Warren Alpert Medical School, Brown University, Providence, Rhode Island, USA
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Halstead EJ, Joyce A, Sullivan E, Tywyn C, Davies K, Jones A, Dimitriou D. Sleep Disturbances and Patterns in Children With Neurodevelopmental Conditions. Front Pediatr 2021; 9:637770. [PMID: 33738270 PMCID: PMC7961155 DOI: 10.3389/fped.2021.637770] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 02/01/2021] [Indexed: 01/19/2023] Open
Abstract
Background: Children with neurodevelopmental conditions (NDC) often experience sleep problems which are long-lasting and more complex than typically developing children. These sleep problems impact their families and there is little guidance for management specifically for sleep for families of children with neurodevelopmental conditions. The present study aims to use parental report to evaluate sleep disturbances and sleep patterns in a large sample of children with NDC. We aim to identify associations with age, diagnosis, and medication groups. Methods: Data on 601 children aged between 2 and 17 years was analyzed from a UK non-profit service for sleep for families of children with NDC. Parents/carers completed the children's sleep habit questionnaire, a 7 day sleep diary, and information on child age, diagnosis, and medication. Parents also reported previous sleep management techniques they had tried. Results: Overall, we found differences between age, diagnosis, and medication use groups for sleep disturbances and sleep diary parameters in these populations. Sensory conditions were associated with high night time waking duration. Parents reported their child's short sleep duration was the most common problem for them. Conclusions: Key areas for further research are outlined including the long term considerations for parental presence at bedtime for sleep anxiety, melatonin use and efficacy, and consideration for interventions to reduce daytime fatigue in children aged 7-11 years old.
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Affiliation(s)
- Elizabeth J Halstead
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Anna Joyce
- Faculty of Humanities, Arts and Social Sciences, School of Psychotherapy & Psychology, Regent's University London, London, United Kingdom
| | - Emma Sullivan
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Carwyn Tywyn
- Cerebra, For Brain Injured Children and Young People, Carmarthen, United Kingdom
| | - Kyle Davies
- Cerebra, For Brain Injured Children and Young People, Carmarthen, United Kingdom
| | - Alexandra Jones
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, Psychology & Human Development Department, University College London, Institute of Education, London, United Kingdom
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36
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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: 5.0] [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.
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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
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Baltzan M, Yao C, Rizzo D, Postuma R. Dream enactment behavior: review for the clinician. J Clin Sleep Med 2020; 16:1949-1969. [PMID: 32741444 PMCID: PMC8034224 DOI: 10.5664/jcsm.8734] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 07/24/2020] [Accepted: 07/24/2020] [Indexed: 12/12/2022]
Abstract
NONE Dream enactment behavior commonly occurs on occasion in normal children and adults. Disruptive and frequent dream enactment behavior may come to the attention of the clinician either as the primary reason for consultation or as a prominent characteristic of a patient with other sleep disorders. Questioning patients with chronic neurologic and psychiatric disorders may also reveal previously unrecognized behavior. In the absence of sleep pathology, process of dream enactment likely begins with active, often emotionally charged dream content that may occasionally break through the normal REM sleep motor suppressive activity. Disrupted sleep resulting from many possible causes, such as circadian disruption, sleep apnea, or medications, may also disrupt at least temporarily the motor-suppressive activity in REM sleep, allowing dream enactment to occur. Finally, pathological neurological damage in the context of degenerative, autoimmune, and infectious neurological disorders may lead to chronic recurrent and severe dream enactment behavior. Evaluating the context, frequency, and severity of dream enactment behavior is guided first and foremost by a structured approach to the sleep history. Physical exam and selected testing support the clinical diagnosis. Understanding the context and the likely cause is essential to effective therapy.
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Affiliation(s)
- Marc Baltzan
- Faculty of Medicine, Department of Epidemiology Biostatistics and Occupational Health, McGill University, Montréal, Canada
- Centre Intégré Universitaire des Soins et Services Sociaux du Nord de L’île de Montréal, Montréal, Canada
- Mount Sinai Hospital, Centre Intégré Universitaire des Soins et Services Sociaux du Centre-ouest de L’île de Montréal, Montréal, Canada
- Institut de Médecine du Sommeil, Montréal, Canada
| | - Chun Yao
- Integrated Program in Neuroscience, McGill University, Montréal, Canada
- Research Institute of McGill University Health Centre, Montréal, Canada
| | - Dorrie Rizzo
- Faculty of Medicine, Department of Family Medicine, McGill University, Montréal, Canada
- Lady Davis Institute for Medical Research, Centre Intégré Universitaire des Soins et Services Sociaux de l’ouest de l’île, Montréal, Canada
| | - Ron Postuma
- Research Institute of McGill University Health Centre, Montréal, Canada
- Department of Neurology and Neurosurgery, McGill University, Montréal, Canada
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Humbert J, Salian S, Makrythanasis P, Lemire G, Rousseau J, Ehresmann S, Garcia T, Alasiri R, Bottani A, Hanquinet S, Beaver E, Heeley J, Smith ACM, Berger SI, Antonarakis SE, Yang XJ, Côté J, Campeau PM. De Novo KAT5 Variants Cause a Syndrome with Recognizable Facial Dysmorphisms, Cerebellar Atrophy, Sleep Disturbance, and Epilepsy. Am J Hum Genet 2020; 107:564-574. [PMID: 32822602 PMCID: PMC7477011 DOI: 10.1016/j.ajhg.2020.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 07/21/2020] [Indexed: 12/11/2022] Open
Abstract
KAT5 encodes an essential lysine acetyltransferase, previously called TIP60, which is involved in regulating gene expression, DNA repair, chromatin remodeling, apoptosis, and cell proliferation; but it remains unclear whether variants in this gene cause a genetic disease. Here, we study three individuals with heterozygous de novo missense variants in KAT5 that affect normally invariant residues, with one at the chromodomain (p.Arg53His) and two at or near the acetyl-CoA binding site (p.Cys369Ser and p.Ser413Ala). All three individuals have cerebral malformations, seizures, global developmental delay or intellectual disability, and severe sleep disturbance. Progressive cerebellar atrophy was also noted. Histone acetylation assays with purified variant KAT5 demonstrated that the variants decrease or abolish the ability of the resulting NuA4/TIP60 multi-subunit complexes to acetylate the histone H4 tail in chromatin. Transcriptomic analysis in affected individual fibroblasts showed deregulation of multiple genes that control development. Moreover, there was also upregulated expression of PER1 (a key gene involved in circadian control) in agreement with sleep anomalies in all of the individuals. In conclusion, dominant missense KAT5 variants cause histone acetylation deficiency with transcriptional dysregulation of multiples genes, thereby leading to a neurodevelopmental syndrome with sleep disturbance, cerebellar atrophy, and facial dysmorphisms, and suggesting a recognizable syndrome.
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Affiliation(s)
- Jonathan Humbert
- St-Patrick Research Group in Basic Oncology, Laval University Cancer Research Center, Axe Oncologie du Centre de Recherche du Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec City, QC G1R 3S3, Canada
| | - Smrithi Salian
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Periklis Makrythanasis
- Biomedical Research Foundation of the Academy of Athens, Athens 115 27, Greece; Department of Genetic Medicine and Development, University of Geneva Medical School and Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Gabrielle Lemire
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Justine Rousseau
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Sophie Ehresmann
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Thomas Garcia
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada
| | - Rami Alasiri
- Rosalind and Morris Goodman Cancer Research Centre, Department of Medicine, McGill University, Montreal, QC H3A 1A3, Canada
| | - Armand Bottani
- Service of Genetic Medicine, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Sylviane Hanquinet
- Unit of Pediatric Radiology, Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Erin Beaver
- Mercy Kids Genetics, St. Louis, MO 63141, USA
| | | | - Ann C M Smith
- Office of the Clinical Director, National Human Genome Research Institute, National Institutes of Health, Bethesda, MD 20894, USA
| | - Seth I Berger
- Children's National Health System, Washington, DC 20010, USA
| | - Stylianos E Antonarakis
- Department of Genetic Medicine and Development, University of Geneva Medical School and Geneva University Hospitals, 1211 Geneva, Switzerland
| | - Xiang-Jiao Yang
- Rosalind and Morris Goodman Cancer Research Centre, Department of Medicine, McGill University, Montreal, QC H3A 1A3, Canada
| | - Jacques Côté
- St-Patrick Research Group in Basic Oncology, Laval University Cancer Research Center, Axe Oncologie du Centre de Recherche du Centre Hospitalier Universitaire de Quebec-Université Laval, Quebec City, QC G1R 3S3, Canada
| | - Philippe M Campeau
- Sainte-Justine Hospital Research Center, University of Montreal, Montreal, QC H3T 1C5, Canada.
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Mongrain V, van Doesburg NH, Rypens F, Fallet-Bianco C, Maassen J, Dufort-Gervais J, Côté L, Major P. A case report of severe tuberous sclerosis complex detected in utero and linked to a novel duplication in the TSC2 gene. BMC Neurol 2020; 20:324. [PMID: 32873234 PMCID: PMC7460776 DOI: 10.1186/s12883-020-01905-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 08/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disease severity is tremendously variable in tuberous sclerosis complex (TSC). In contrast with the detailed guidelines available for TSC diagnosis and management, clinical practice lacks adequate tools to evaluate the prognosis, especially in the case of in utero diagnosis. In addition, the correlation between genotypes and phenotypes remains a challenge, in part due to the large number of mutations linked to TSC. In this report, we describe a case of severe TSC diagnosed in utero and associated with a specific mutation in the gene tuberous sclerosis complex 2 (TSC2). CASE PRESENTATION A mother was referred for a thorough investigation following the observation by ultrasound of cardiac abnormalities in her fetus. The mother was healthy and reported frequent, intense and long-lasting hiccups/spasms in the fetus. The fetus of gestational age 33 weeks and 4 days was found to have multiple cardiac tumors with cardiac ultrasound. Brain magnetic resonance imaging (MRI) performed in utero revealed the presence of sub-ependymal nodules and of abnormal signals disseminated in the white matter, in the cerebral cortex and in the cerebellum. Following diagnosis of definite TSC, pregnancy interruption was chosen by the parents. Genetic testing of the fetus exposed a duplication in exon 41 of TSC2 (c.5169dupA), which was absent in the parents. The autopsy ascertained the high severity of brain damage characterized by an extensive disorganisation of white and grey matter in most cerebral lobes. CONCLUSIONS This case presentation is the first to depict the association between a de novo TSC2 c.5169dupA and multi-organ manifestation together with indications of a particularly high disease severity. This report can help physicians to perform early clinical diagnosis of TSC and to evaluate the prognosis.
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Affiliation(s)
- Valérie Mongrain
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada. .,Center for Advanced Research in Sleep Medicine, Recherche CIUSSS-NIM (site Hôpital du Sacré-Coeur de Montréal), 5400 Gouin West blvd., Montreal, QC, H4J1C5, Canada.
| | - Nicolaas H van Doesburg
- Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Françoise Rypens
- Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Catherine Fallet-Bianco
- Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Justine Maassen
- Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Julien Dufort-Gervais
- Center for Advanced Research in Sleep Medicine, Recherche CIUSSS-NIM (site Hôpital du Sacré-Coeur de Montréal), 5400 Gouin West blvd., Montreal, QC, H4J1C5, Canada
| | - Lucie Côté
- Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada
| | - Philippe Major
- Department of Neuroscience, Université de Montréal, Montreal, QC, Canada. .,Centre intégré de diagnostic prénatal (CIDP) and Pediatric Neurology Service, Centre Hospitalier Universitaire (CHU) Ste-Justine, 3175 Chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T1C5, Canada.
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40
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Composite Sleep Problems Observed Across Smith-Magenis Syndrome, MBD5-Associated Neurodevelopmental Disorder, Pitt-Hopkins Syndrome, and ASD. J Autism Dev Disord 2020; 51:1852-1865. [PMID: 32845423 DOI: 10.1007/s10803-020-04666-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Caregivers of preschool and elementary school age children with Smith-Magenis syndrome (SMS), MBD5-associated neurodevelopmental disorder (MAND), and Pitt-Hopkins syndrome (PTHS) were surveyed to assess sleep disturbance and to identify disorder-specific sleep problems. Because of overlapping features of these rare genetic neurodevelopmental syndromes, data were compared to reports of sleep disturbance in children with autism spectrum disorder (ASD). While similarities were observed with ASD, specific concerns between disorders differed, including mean nighttime sleep duration, daytime sleepiness, night wakings, parasomnias, restless sleep, and bedwetting. Overall, sleep disturbance in PTHS is significant but less severe than in SMS and MAND. The complexity of these conditions and the challenges of underlying sleep disturbance indicate the need for more support, education, and ongoing management of sleep for these individuals.
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de Vries PJ, Belousova E, Benedik MP, Carter T, Cottin V, Curatolo P, Dahlin M, D'Amato L, Beaure d'Augères G, Ferreira JC, Feucht M, Fladrowski C, Hertzberg C, Jozwiak S, Lawson JA, Macaya A, Marques R, Nabbout R, O'Callaghan F, Qin J, Sander V, Sauter M, Shah S, Takahashi Y, Touraine R, Youroukos S, Zonnenberg B, Kingswood JC, Jansen AC. Tuberous Sclerosis Complex-Associated Neuropsychiatric Disorders (TAND): New Findings on Age, Sex, and Genotype in Relation to Intellectual Phenotype. Front Neurol 2020; 11:603. [PMID: 32733359 PMCID: PMC7358578 DOI: 10.3389/fneur.2020.00603] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 05/25/2020] [Indexed: 11/30/2022] Open
Abstract
Background: Knowledge is increasing about TSC-Associated Neuropsychiatric Disorders (TAND), but little is known about the potentially confounding effects of intellectual ability (IA) on the rates of TAND across age, sex, and genotype. We evaluated TAND in (a) children vs. adults, (b) males vs. females, and (c) TSC1 vs. TSC2 mutations, after stratification for levels of IA, in a large, international cohort. Methods: Individuals of any age with a documented visit for TSC in the 12 months prior to enrolment were included. Frequency and percentages of baseline TAND manifestations were presented by categories of IA (no intellectual disability [ID, intelligence quotient (IQ)>70]; mild ID [IQ 50–70]; moderate-to-profound ID [IQ<50]). Chi-square tests were used to test associations between ID and TAND manifestations. The association between TAND and age (children vs. adults), sex (male vs. female), and genotype (TSC1 vs. TSC2) stratified by IA levels were examined using the Cochran–Mantel–Haenszel tests. Results: Eight hundred and ninety four of the 2,211 participants had formal IQ assessments. There was a significant association (P < 0.05) between levels of IA and the majority of TAND manifestations, except impulsivity (P = 0.12), overactivity (P = 0.26), mood swings (P = 0.08), hallucinations (P = 0.20), psychosis (P = 0.06), depressive disorder (P = 0.23), and anxiety disorder (P = 0.65). Once controlled for IA, children had higher rates of overactivity, but most behavioral difficulties were higher in adults. At the psychiatric level, attention deficit hyperactivity disorder (ADHD) was seen at higher rates in children while anxiety and depressive disorders were observed at higher rates in adults. Compared to females, males showed significantly higher rates of impulsivity and overactivity, as well as autism spectrum disorder (ASD) and ADHD. No significant age or sex differences were observed for academic difficulties or neuropsychological deficits. After controlling for IA no genotype-TAND associations were observed, except for higher rates of self-injury in individuals with TSC2 mutations. Conclusions: Findings suggest IA as risk marker for most TAND manifestations. We provide the first evidence of male preponderance of ASD and ADHD in individuals with TSC. The study also confirms the association between TSC2 and IA but, once controlling for IA, disproves the previously reported TSC2 association with ASD and with most other TAND manifestations.
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Affiliation(s)
- Petrus J de Vries
- Division of Child and Adolescent Psychiatry, University of Cape Town, Cape Town, South Africa
| | - Elena Belousova
- Research and Clinical Institute of Pediatrics, Pirogov Russian National Research Medical University, Moscow, Russia
| | | | - Tom Carter
- TSA Tuberous Sclerosis Association, Nottingham, United Kingdom
| | - Vincent Cottin
- Hôpital Louis Pradel, Claude Bernard University Lyon 1, Lyon, France
| | | | - Maria Dahlin
- Astrid Lindgren Childrens Hospital, Stockholm, Sweden
| | | | | | | | - Martha Feucht
- Universitätsklinik für Kinder-und Jugendheilkunde, Affiliated Partner of the ERN EpiCARE, Vienna, Austria
| | - Carla Fladrowski
- Associazione Sclerosi Tuberosa ONLUS, Milan, Italy.,European Tuberous Sclerosis Complex Association, Dattein, Germany
| | | | - Sergiusz Jozwiak
- Department of Child Neurology, Medical University of Warsaw, Warsaw, Poland.,Department of Neurology and Epileptology, The Children's Memorial Health Institute, Warsaw, Poland
| | - John A Lawson
- The Tuberous Sclerosis Multidisciplinary Management Clinic, Sydney Children's Hospital, Randwick, NSW, Australia
| | - Alfons Macaya
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Ruben Marques
- Novartis Farma S.p.A., Origgio, Italy.,Institute of Biomedicine (IBIOMED), University of Leon, León, Spain
| | - Rima Nabbout
- Department of Pediatric Neurology, Necker Enfants Malades Hospital, Paris Descartes University, Paris, France
| | - Finbar O'Callaghan
- Clinical Neurosciences Section, Institute of Child Health, University College London, London, United Kingdom
| | - Jiong Qin
- Department of Pediatrics, Peking University People's Hospital (PKUPH), Beijing, China
| | | | | | - Seema Shah
- Novartis Healthcare Pvt. Ltd., Hyderabad, India
| | - Yukitoshi Takahashi
- National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, NHO, Shizuoka, Japan
| | - Renaud Touraine
- Department of Genetics, CHU-Hôpital Nord, Saint-Étienne, France
| | | | | | - John C Kingswood
- Cardiology Clinical Academic Group, Molecular and Clinical Sciences Research Centre, St Georges University of London, London, United Kingdom
| | - Anna C Jansen
- Pediatric Neurology Unit, Department of Pediatrics, UZ Brussel VUB, Brussels, Belgium
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Neurodevelopmental Consequences of Pediatric Cancer and Its Treatment: The Role of Sleep. Brain Sci 2020; 10:brainsci10070411. [PMID: 32630162 PMCID: PMC7408401 DOI: 10.3390/brainsci10070411] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 06/15/2020] [Accepted: 06/22/2020] [Indexed: 02/07/2023] Open
Abstract
Cognitive impairment is frequent in pediatric cancer, and behavioral and psychological disturbances often also affect children who have survived cancer problems. Furthermore, pediatric tumors are also often associated with sleep disorders. The interrelationship between sleep disorders, neurodevelopmental disorders and pediatric cancer, however, is still largely unexplored. In this narrative review we approach this important aspect by first considering studies on pediatric cancer as a possible cause of neurodevelopmental disorders and then describing pediatric cancer occurring as a comorbid condition in children with neurodevelopmental disorders. Finally, we discuss the role of sleep disorders in children with cancer and neurodevelopmental disorders. Even if the specific literature approaching directly the topic of the role of sleep in the complex relationship between pediatric cancer and neurodevelopmental disorders was found to be scarce, the available evidence supports the idea that in-depth knowledge and correct management of sleep disorders can definitely improve the health and quality of life of children with cancer and of their families.
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Abstract
Gastrointestinal disorders are one of the most common medical conditions that are comorbid with autism spectrum disorders. These comorbidities can cause greater severity in autism spectrum disorder symptoms, other associated clinical manifestations, and lower quality of life if left untreated. Clinicians need to understand how these gastrointestinal issues present and apply effective therapies. Effective treatment of gastrointestinal problems in autism spectrum disorder may result in marked improvements in autism spectrum disorder behavioral outcomes. This article discusses the gastrointestinal disorders commonly associated with autism spectrum disorders, how they present, and studied risk factors.
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Affiliation(s)
- Moneek Madra
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
| | - Roey Ringel
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Columbia College, Columbia University, New York, New York
| | - Kara G. Margolis
- Morgan Stanley Children’s Hospital, Department of Pediatrics, Columbia University Irving Medical Center, New York, New York,Institute of Human Nutrition, Columbia University Irving Medical Center, New York, New York
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44
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Abstract
Smith-Magenis syndrome is a genetic disorder caused by a microdeletion involving the retinoic acid-induced 1 (RAI1) gene that maps on the short arm of chromosome 17p11.2 or a pathogenic mutation of RAI1. Smith-Magenis syndrome affects patients through numerous congenital anomalies, intellectual disabilities, behavioral challenges, and sleep disturbances. The sleep abnormalities associated with Smith-Magenis syndrome can include frequent nocturnal arousals, early morning awakenings, and sleep attacks during the day. The sleep problems associated with Smith-Magenis syndrome are attributed to haploinsufficiency of the RAI1 gene. One consequence of reduced function of RAI1, and characteristic of Smith-Magenis syndrome, is an inversion of melatonin secretion resulting in a diurnal rather than nocturnal pattern. Treatment of sleep problems in people with Smith-Magenis syndrome generally involves a combination of sleep hygiene techniques, supplemental melatonin, and/or other medications, such as melatonin receptor agonists, β1-adrenergic antagonists, and stimulant medications, to improve sleep outcomes. Improvement in sleep has been shown to improve behavioral outcomes, which in turn improves the quality of life for both patients and their caregivers.
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Affiliation(s)
- Kevin A Kaplan
- Department of Pediatrics at Baylor College of Medicine, Houston, TX, USA.
- Section of Pediatric Pulmonary at Texas Children's Hospital, Houston, TX, USA.
- Section of Sleep Medicine at Texas Children's Hospital, Houston, TX, USA.
| | - Sarah H Elsea
- Department of Molecular and Human Genetics at Baylor College of Medicine, Houston, TX, USA
| | - Lorraine Potocki
- Department of Molecular and Human Genetics at Baylor College of Medicine, Houston, TX, USA
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Cook IA, Wilson AC, Peters JM, Goyal MN, Bebin EM, Northrup H, Krueger D, Leuchter AF, Sahin M. EEG Spectral Features in Sleep of Autism Spectrum Disorders in Children with Tuberous Sclerosis Complex. J Autism Dev Disord 2020; 50:916-923. [PMID: 31811616 DOI: 10.1007/s10803-019-04326-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tuberous sclerosis complex (TSC) is a multisystem disorder with increased prevalence of autism spectrum disorders (ASDs). This project aimed to characterize the autism phenotype of TSC and identify biomarkers of risk for ASD. Because abnormalities of EEG during sleep are tied to neurodevelopment in children, we compared electroencephalographic (EEG) measures during Stage II sleep in TSC children who either did (ASD+) or did not (ASD-) exhibit symptoms of ASD over 36-month follow up. Relative alpha band power was significantly elevated in the ASD+ group at 24 months of age with smaller differences at younger ages, suggesting this may arise from differences in brain development. These findings suggest that EEG features could enhance the detection of risk for ASD.
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Affiliation(s)
- Ian A Cook
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, #57-456, Los Angeles, CA, 90024, USA.,Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.,Department of Bioengineering, UCLA Henry Samueli School of Engineering at Applied Science, 760 Westwood Plaza, Los Angeles, CA, 90024, USA
| | - Andrew C Wilson
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, #57-456, Los Angeles, CA, 90024, USA
| | - Jurriaan M Peters
- Division of Epilepsy and Clinical Neurophysiology, Department of Neurology, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA
| | - Monisha N Goyal
- Department of Neurology, University of Alabama at Birmingham, 1600 7th Avenue S, Birmingham, AL, 35233, USA
| | - E Martina Bebin
- Department of Neurology, University of Alabama at Birmingham, 1600 7th Avenue S, Birmingham, AL, 35233, USA
| | - Hope Northrup
- Department of Pediatrics, McGovern Medical School, University of Texas Health Science Center at Houston, 1941 East Road, 3.126 BBSB, Houston, TX, 77054, USA
| | - Darcy Krueger
- Department of Neurology and Rehabilitation Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, MLC 7004, Cincinnati, OH, 45229, USA
| | - Andrew F Leuchter
- Neuromodulation Division, UCLA Semel Institute for Neuroscience and Human Behavior, 760 Westwood Plaza, #57-456, Los Angeles, CA, 90024, USA. .,Department of Psychiatry & Biobehavioral Sciences, UCLA David Geffen School of Medicine, 760 Westwood Plaza, Los Angeles, CA, 90024, USA.
| | - Mustafa Sahin
- Department of Neurology, Harvard Medical School, Harvard University, 300 Longwood Avenue, Boston, MA, 02115, USA.,Boston Children's Hospital, F.M. Kirby Neurobiology Center, 300 Longwood Avenue, Boston, MA, 02115, USA
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Moulding HA, Bartsch U, Hall J, Jones MW, Linden DE, Owen MJ, van den Bree MBM. Sleep problems and associations with psychopathology and cognition in young people with 22q11.2 deletion syndrome (22q11.2DS). Psychol Med 2020; 50:1191-1202. [PMID: 31144615 DOI: 10.1017/s0033291719001119] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Young people with 22q11.2 deletion syndrome (22q11.2DS) are at high risk for neurodevelopmental disorders. Sleep problems may play a role in this risk but their prevalence, nature and links to psychopathology and cognitive function remain undescribed in this population. METHOD Sleep problems, psychopathology, developmental coordination and cognitive function were assessed in 140 young people with 22q11.2DS (mean age = 10.1, s.d. = 2.46) and 65 unaffected sibling controls (mean age = 10.8, s.d.SD = 2.26). Primary carers completed questionnaires screening for the children's developmental coordination and autism spectrum disorder. RESULTS Sleep problems were identified in 60% of young people with 22q11.2DS compared to 23% of sibling controls (OR 5.00, p < 0.001). Two patterns best-described sleep problems in 22q11.2DS: restless sleep and insomnia. Restless sleep was linked to increased ADHD symptoms (OR 1.16, p < 0.001) and impaired executive function (OR 0.975, p = 0.013). Both patterns were associated with elevated symptoms of anxiety disorder (restless sleep: OR 1.10, p = 0.006 and insomnia: OR 1.07, p = 0.045) and developmental coordination disorder (OR 0.968, p = 0.0023, and OR 0.955, p = 0.009). The insomnia pattern was also linked to elevated conduct disorder symptoms (OR 1.53, p = 0.020). CONCLUSIONS Clinicians and carers should be aware that sleep problems are common in 22q11.2DS and index psychiatric risk, cognitive deficits and motor coordination problems. Future studies should explore the physiology of sleep and the links with the neurodevelopment in these young people.
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Affiliation(s)
- H A Moulding
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
| | - U Bartsch
- School Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, BS8 1TD, UK
- Lilly UK, Erl Wood Manor, Windlesham, Surrey, GU20 6PH, UK
| | - J Hall
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
- Neuroscience and Mental Health Research Institute, Cardiff University, Hadyn Ellis Building, Maindy Road, Cardiff, CF24 4HQ, UK
| | - M W Jones
- School Physiology, Pharmacology & Neuroscience, University of Bristol, Biomedical Sciences Building, University Walk, BS8 1TD, UK
| | - D E Linden
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
- Cardiff University Brain Research Imaging Centre, Maindy Road, Cardiff, CF24 4HQ, UK
| | - M J Owen
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
| | - M B M van den Bree
- MRC Centre for Neuropsychiatric Genetics and Genomics and Division of Psychological Medicine and Clinical Neurosciences, Cardiff University School of Medicine, Hadyn Ellis Building, Maindy Road, Cathays, Cardiff, CF24 4HQ, UK
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Agar G, Oliver C, Trickett J, Licence L, Richards C. Sleep disorders in children with Angelman and Smith-Magenis syndromes: The assessment of potential causes of disrupted settling and night time waking. RESEARCH IN DEVELOPMENTAL DISABILITIES 2020; 97:103555. [PMID: 31838315 DOI: 10.1016/j.ridd.2019.103555] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Revised: 11/27/2019] [Accepted: 12/04/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Sleep problems are common in Smith-Magenis (SMS) and Angelman syndromes (AS). Effectiveness of interventions depends on appropriate assessment, complicated by compromised self-report and health and behaviour difficulties. Studying settling and waking in these syndromes could inform assessment. AIMS To describe settling and waking behaviours in children at high-risk of sleep and health problems, using direct observation. METHODS AND PROCEDURES Video and actigraphy data were collected for 12 participants with AS (Mean age = 8.02, SD = 2.81) and 11 with SMS (Mean age = 8.80, SD = 2.18). Settling (30 min prior to sleep onset) and night waking were coded for nineteen behaviours relating to pain, challenging behaviour and caregiver interaction. Lag sequential analyses were conducted for pain-related behaviours. OUTCOMES AND RESULTS Percentage of time spent in behaviours was calculated. Parent-child interactions (0.00-9.93 %) and challenging behaviours (0 %) were rare at settling and waking in both groups. In the AS group, pain-related behaviours were more likely to occur before waking than by chance (p < 0.001). CONCLUSIONS AND IMPLICATIONS Findings highlight the importance of considering pain as a cause of sleep problems in AS. The principle and methodology could be extended to individuals with ID experiencing sleep problems.
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Affiliation(s)
- Georgie Agar
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK.
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Jayne Trickett
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Lucy Licence
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, University of Birmingham, UK; School of Psychology, 52 Pritchatts Road, University of Birmingham, UK
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Trickett J, Oliver C, Heald M, Denyer H, Surtees A, Clarkson E, Gringras P, Richards C. Multi-Method Assessment of Sleep in Children With Angelman Syndrome: A Case-Controlled Study. Front Psychiatry 2019; 10:874. [PMID: 31849727 PMCID: PMC6895248 DOI: 10.3389/fpsyt.2019.00874] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 11/06/2019] [Indexed: 11/25/2022] Open
Abstract
Objectives: To assess sleep quality and timing in children with Angelman syndrome (AS) with sleep problems using questionnaires and actigraphy and contrast sleep parameters to those of typically developing (TD) children matched for age and sex. Methods: Week-long actigraphy assessments were undertaken with children with AS (n = 20) with parent-reported sleep difficulties and compared with age and sex matched TD controls. The presence of severe sleep problems was assessed using the modified Simonds and Parraga sleep questionnaire. Sleep hygiene was measured using the Family Inventory of Sleep Habits. Results: Actigraphy and parent-completed sleep diary data indicated that children with AS had significantly earlier bedtimes (p = .003, Cohen d = .47) and poorer sleep efficiency (78%, p = .04, d = .33) than TD children (84%). No significant differences in total sleep time, sleep onset latency or wake after sleep onset were found between the two groups. The expected relationship between later bedtimes and increasing age found for the TD group (p < .001, β.78) was not evidenced for the AS group (p = .09, β.39). Considerable inter-individual and night to night variation in actigraphy assessed total sleep time and wake after sleep onset was found for children with AS compared to TD children. Parent report indicated that a greater proportion of children with AS had severe night waking problems compared to TD children (81 versus 5%). No significant differences in sleep hygiene and excessive daytime sleepiness were found between the two groups (p > .05). Conclusions: This study reports the largest objective dataset of sleep quality parameters in children with AS. Sleep quality in this group was characterised by poor efficiency and significant intra- and inter-individual variability that warrants further investigation. This variability should inform assessment and intervention for sleep in children with AS, as averages of total sleep, even across a 7 day period may not capture the difficulties with night waking highlighted by parental questionnaire report.
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Affiliation(s)
- Jayne Trickett
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
| | - Mary Heald
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Hayley Denyer
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Andrew Surtees
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham, United Kingdom
| | - Emma Clarkson
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
- The Huntercombe Group, Worcestershire, United Kingdom
| | - Paul Gringras
- Evelina London Children’s Sleep Medicine Department Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham, United Kingdom
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Trickett J, Oliver C, Heald M, Denyer H, Surtees A, Clarkson E, Gringras P, Richards C. Sleep in children with Smith–Magenis syndrome: a case–control actigraphy study. Sleep 2019; 43:5601233. [DOI: 10.1093/sleep/zsz260] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2019] [Revised: 09/18/2019] [Indexed: 11/15/2022] Open
Abstract
Abstract
Study Objectives
The objectives of the study were (1) to compare both actigraphy and questionnaire-assessed sleep quality and timing in children with Smith–Magenis syndrome (SMS) to a chronologically age-matched typically developing (TD) group and (2) to explore associations between age, nocturnal and diurnal sleep quality, and daytime behavior.
Methods
Seven nights of actigraphy data were collected from 20 children with SMS (mean age 8.70; SD 2.70) and 20 TD children. Daily parent/teacher ratings of behavior and sleepiness were obtained. Mixed linear modeling was used to explore associations between total sleep time and daytime naps and behavior.
Results
Sleep in children with SMS was characterized by shorter total sleep time (TST), extended night waking, shorter sleep onset, more daytime naps, and earlier morning waking compared to the TD group. Considerable inter-daily and inter-individual variability in sleep quality was found in the SMS group, so caution in generalizing results is required. An expected inverse association between age and TST was found in the TD group, but no significant association was found for the SMS group. No between-group differences in sleep hygiene practices were identified. A bidirectional negative association between TST and nap duration was found for the SMS group. In the SMS group, increased afternoon sleepiness was associated with increased irritability (p = .007) and overactivity (p = .005).
Conclusion
These findings evidence poor sleep quality in SMS and the need to implement evidence-based interventions in this population.
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Affiliation(s)
- Jayne Trickett
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
- Department of Health Sciences, College of Life Sciences, University of Leicester, Leicester
| | - Chris Oliver
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
| | - Mary Heald
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
- Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham
| | - Hayley Denyer
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
- Great Ormond Street Institute of Child Health, University College London, London
| | - Andrew Surtees
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
- Forward Thinking Birmingham, Birmingham Women’s and Children’s NHS Foundation Trust, Birmingham
| | | | - Paul Gringras
- Evelina London Children’s Sleep Department, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Caroline Richards
- Cerebra Centre for Neurodevelopmental Disorders, School of Psychology, University of Birmingham, Birmingham
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Lord C. Taking Sleep Difficulties Seriously in Children With Neurodevelopmental Disorders and ASD. Pediatrics 2019; 143:peds.2018-2629. [PMID: 30745434 DOI: 10.1542/peds.2018-2629] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- Catherine Lord
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
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