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da Silva NC, Giacheti CM, do Couto MCH, de Jesus SS, Ribeiro EM, Verçosa IMC, Pinato L. Association between Sleep and Language Development in Children with Congenital Zika Syndrome. Viruses 2024; 16:1003. [PMID: 39066166 PMCID: PMC11281447 DOI: 10.3390/v16071003] [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] [Received: 05/02/2024] [Revised: 05/29/2024] [Accepted: 05/30/2024] [Indexed: 07/28/2024] Open
Abstract
AIM Congenital Zika Virus Syndrome (CZS) presents notable hurdles to neurodevelopment, with language development emerging as a crucial aspect. This study investigates sleep patterns and language skills in children with CZS, aiming to explore the potential synchronization of sleep development with their neurodevelopment. METHOD We studied cross-sectionally 135 children with CZS aged 0 to 48 months, investigating sleep using the BISQ Questionnaire. Language development was assessed using the Early Language Milestone Scale, while motor development and cognitive and social ability were assessed using the Bayley Scales of Infant and Young Child Development 3rd edition. We also studied longitudinally a cohort of 16 children (initially aged 0 to 12 months) whom we followed for four years, assessing at one-year intervals. RESULTS Sleep disturbances and language deficits were highly frequent in this population. In the 0-12 months group, a late bedtime and frequent nighttime awakenings were associated with poorer auditory expressive skills. At 13-24 months, nighttime awakenings were associated with poorer auditory expressive skills, while among 25-36-month-olds decreased auditory receptive skills were associated with longer sleep onset latency and reduced nighttime sleep duration. CONCLUSION The brain alterations caused by Zika virus infection affect both sleep disturbances and delays in language development. It is possible that sleep disturbance may be a mediating factor in the pathway between CZS and delayed language development, as the three analyzed language skills showed a correlation with sleep parameters.
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Affiliation(s)
- Nathani C. da Silva
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marília 17525-900, Brazil; (N.C.d.S.); (C.M.G.); (M.C.H.d.C.); (S.S.d.J.)
| | - Celia M. Giacheti
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marília 17525-900, Brazil; (N.C.d.S.); (C.M.G.); (M.C.H.d.C.); (S.S.d.J.)
| | - Maria C. H. do Couto
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marília 17525-900, Brazil; (N.C.d.S.); (C.M.G.); (M.C.H.d.C.); (S.S.d.J.)
| | - Stefany S. de Jesus
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marília 17525-900, Brazil; (N.C.d.S.); (C.M.G.); (M.C.H.d.C.); (S.S.d.J.)
| | | | - Islane M. C. Verçosa
- Center for Perfecting Sight See Hope Reviver (CAVIVER), Fortaleza 60110-370, Brazil;
| | - Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marília 17525-900, Brazil; (N.C.d.S.); (C.M.G.); (M.C.H.d.C.); (S.S.d.J.)
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Sadikova E, Soland J, Menezes M, Mazurek M. Impact of adverse childhood experiences and family resilience on sleep duration in autistic children. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024:13623613241235880. [PMID: 38807297 DOI: 10.1177/13623613241235880] [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: 05/30/2024]
Abstract
LAY ABSTRACT Autistic children are more likely to have sleep difficulties and to experience adverse childhood experiences. Adverse childhood experiences can include parental divorce, bullying, or witnessing violence. We also know that children in families who are resilient (e.g. families who are connected, work together, and help each other) are less impacted by adverse childhood experiences. Our study examined whether there was a relationship between adverse childhood experiences and sleep duration in autistic children. We also wanted to find out whether family resilience protects from the negative impact of adverse childhood experiences on sleep duration. We used data from 3247 parent surveys about their children that we got from the National Survey of Children's Health. We found that children with adverse childhood experiences are more likely to get less sleep. We also found that children with resilient families were more likely to get more sleep. Our results show that family resilience helps weaken the relationship between adverse childhood experiences and sleep, so it is important to help families build resilience.
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Leader G, Killeen C, Whelan S, Coyne R, Tones M, Mannion A. Factors associated with sleep disturbances in children and adolescents with Angelman Syndrome. Sleep Med 2024; 117:9-17. [PMID: 38479041 DOI: 10.1016/j.sleep.2024.02.038] [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: 01/08/2024] [Revised: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND Angelman Syndrome (AS) is a rare genetic disorder characterised by hyperactivity, overexcitability, developmental delays, and lack of speech. METHODS This study used secondary data analysis to investigate sleep disturbances in children and adolescents (n = 212) who are enrolled in the Global Angelman Syndrome Registry. Participants were divided into two groups based on the presence or absence of sleep disturbance. The cut-off score of 40 on the Sleep Disturbance Scale for Children was used to indicate the presence or absence of sleep disturbances. Sleep disturbances and their association with co-occurring conditions were examined regarding challenging behaviour, language and communication, infancy history, gastrointestinal symptoms, and epilepsy. Multiple regression was then conducted to investigate possible predictors for sleep disturbances. RESULTS Children and adolescents with AS, with and without sleep disturbances, differed considerably regarding anxiety. Sleep disturbances were significantly associated with an ability to use spoken words and computerised communication devices, and anxiety was a predictor of sleep disturbances. CONCLUSION Future research is necessary to replicate this novel research, and to advance the clinical treatment of sleep disturbances in children and adolescents with AS.
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Affiliation(s)
- Geraldine Leader
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Chloe Killeen
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sally Whelan
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland.
| | - Rory Coyne
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
| | - Megan Tones
- Research Office, Queensland University of Technology, Brisbane, Australia
| | - Arlene Mannion
- Irish Centre for Autism and Neurodevelopmental Research, School of Psychology, National University of Ireland, Galway, Ireland
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Johnson KP, Zarrinnegar P. Autism Spectrum Disorder and Sleep. Psychiatr Clin North Am 2024; 47:199-212. [PMID: 38302207 DOI: 10.1016/j.psc.2023.06.013] [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] [Indexed: 02/03/2024]
Abstract
Children and adolescents with autism spectrum disorder (ASD) experience sleep disturbances, particularly insomnia, at rates much higher than the general population. Daytime behavioral problems and parental stress are associated with the resultant sleep deprivation. Behavioral interventions, parental education, and melatonin are effective treatments. The epidemiology of sleep disturbances in youth with ASD is reviewed in this article as well as the latest in treatments.
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Affiliation(s)
- Kyle P Johnson
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Paria Zarrinnegar
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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5
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Tse ACY, Lee PH, Sit CHP, Poon ETC, Sun F, Pang CL, Cheng JCH. Comparing the Effectiveness of Physical Exercise Intervention and Melatonin Supplement in Improving Sleep Quality in Children with ASD. J Autism Dev Disord 2023:10.1007/s10803-023-06172-7. [PMID: 37950776 DOI: 10.1007/s10803-023-06172-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2023] [Indexed: 11/13/2023]
Abstract
PURPOSE Previous studies have demonstrated that physical exercise can modulate the endogenous melatonin level in children with autism spectrum disorder (ASD) and improve their sleep quality. However, it remains unclear whether physical exercise or melatonin supplement, or a combination of both, is more effective in improving sleep quality in this population. The purpose of this study is to answer this research question by comparing the effectiveness of three types of interventions (physical exercise vs. melatonin supplement or a combination of both) in improving sleep quality in children with ASD. METHODS Sixty-two (62) children diagnosed with ASD were randomly assigned to one of four groups: cycling (n = 18), melatonin supplement (n = 14), a combination of both (n = 12), and placebo control group (n = 18). Four (4) sleep parameters (sleep efficiency, sleep onset latency, sleep duration, and wake after sleep onset) were assessed. RESULTS The results revealed a significant improvement in sleep efficiency, sleep onset latency, and sleep duration in all of the interventions, but not in the placebo control group. However, no significant group differences were found among the interventions (ps > .05). CONCLUSION Our findings suggest similar effectiveness of physical exercise and melatonin supplementation in improving sleep quality in children with ASD.
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Affiliation(s)
- Andy C Y Tse
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China.
| | - Paul H Lee
- Clinical Trial Unit, University of Southampton, Southampton, UK
| | - Cindy H P Sit
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - Eric Tsz-Chun Poon
- Department of Sports Science and Physical Education, Chinese University of Hong Kong, Hong Kong, China
| | - F Sun
- Department of Health and Physical Education, The Education University of Hong Kong, Rm D4-2/F-02, Block D4, 10 Lo Ping Road, Tai Po, N.T, Hong Kong, China
| | - Chi-Ling Pang
- School of Education, John Hopkins University, Baltimore, USA
| | - James C H Cheng
- Department of Paediatrics and Adolescent Health, United Christian Hospital, Hong Kong, China
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López-Zamora M, Cano-Villagrasa A, Cortés-Ramos A, Porcar-Gozalbo N. The Influence of Sleep Disorders on Neurobiological Structures and Cognitive Processes in Pediatric Population with ASD and Epilepsy: A Systematic Review. Eur J Investig Health Psychol Educ 2023; 13:2358-2372. [PMID: 37998056 PMCID: PMC10670909 DOI: 10.3390/ejihpe13110166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Revised: 10/18/2023] [Accepted: 10/23/2023] [Indexed: 11/25/2023] Open
Abstract
Autism Spectrum Disorder (ASD) and epilepsy are increasingly prevalent comorbidities in our society. These two disorders are often accompanied by other comorbidities, such as sleep disorders, significantly impacting the quality of life of individuals with ASD and epilepsy. To date, clinical approaches have primarily been descriptive in nature. Therefore, this study aimed to analyze the relationship between ASD, epilepsy, and sleep disorders, exploring neurobiological dysfunctions and cognitive alterations. A total of 22 scientific articles were selected using a systematic literature review following the criteria established using the PRISMA model. The selected articles were gathered from major databases: Medline, PubMed, PsycINFO, Google Scholar, and Web of Science. Inclusion criteria specified that study participants had an official diagnosis of ASD, the article precisely described the evaluation parameters used in the study participants, and individual characteristics of the sleep disorders of the study participants were specified. The results indicate, firstly, that the primary cause of sleep disorders in this population is directly linked to abnormal serotonin behaviors. Secondly, significant alterations in memory, attention, and hyperactivity were observed. In conclusion, sleep disorders negatively impact the quality of life and neurocognitive development of the pediatric population with ASD and epilepsy.
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Affiliation(s)
- Miguel López-Zamora
- Department of Developmental and Educational Psychology, University of Malaga, 29010 Malaga, Spain;
| | - Alejandro Cano-Villagrasa
- Faculty of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain;
- Health Sciences PhD Program, Universidad Católica de Murcia UCAM, Campus de los Jerónimos n°135, Guadalupe, 30107 Murcia, Spain
| | - Antonio Cortés-Ramos
- Department of Developmental and Educational Psychology, Faculty of Educational and Sports Sciences of Melilla, University of Granada, 18071 Granada, Spain;
| | - Nadia Porcar-Gozalbo
- Faculty of Health Sciences, Universidad Internacional de Valencia, 46002 Valencia, Spain;
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7
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Henderson LM, St Clair M, Knowland V, van Rijn E, Walker S, Gaskell MG. Stronger Associations Between Sleep and Mental Health in Adults with Autism: A UK Biobank Study. J Autism Dev Disord 2023; 53:1543-1559. [PMID: 34860312 PMCID: PMC10066094 DOI: 10.1007/s10803-021-05382-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 12/26/2022]
Abstract
This study examined sleep and its cognitive and affective correlates in adults with and without autism spectrum disorder (ASD), utilizing UK Biobank data. There were no group differences in subjective sleep duration [n = 220 ASD; n = 2200 general population (GP)]. Accelerometer measures of sleep duration or nighttime activity did not differ by group, but sleep efficiency was marginally lower in ASD (n = 83 ASD; n = 824 GP). Sleep efficiency was associated with wellbeing and mental health, and pathways between accelerometer sleep measures and wellbeing and mental health were significantly stronger for adults with ASD (who also reported substantially poorer wellbeing and > 5 × likelihood of experiencing mental distress). These findings highlight the need to monitor sleep to maintain good mental health in adult ASD.
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Affiliation(s)
- Lisa M Henderson
- Department of Psychology, University of York, York, YO10 5DD, UK.
| | - M St Clair
- Department of Psychology, University of Bath, Bath, UK
| | - V Knowland
- Department of Speech and Language Sciences, University of Newcastle, Newcastle, Australia
| | - E van Rijn
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - S Walker
- Department of Psychology, University of York, York, YO10 5DD, UK
| | - M G Gaskell
- Department of Psychology, University of York, York, YO10 5DD, UK
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Deng W, Wang S, Li F, Wang F, Xing YP, Li Y, Lv Y, Ke H, Li Z, Lv PJ, Hao H, Chen Y, Xiao X. Gastrointestinal symptoms have a minor impact on autism spectrum disorder and associations with gut microbiota and short-chain fatty acids. Front Microbiol 2022; 13:1000419. [PMID: 36274684 PMCID: PMC9585932 DOI: 10.3389/fmicb.2022.1000419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
Children with autism spectrum disorder (ASD) experience gastrointestinal (GI) issues more frequently and severely than children who are typically developing (TD). The connections between gastrointestinal problems, microbiota, and short-chain fatty acids (SCFAs) in ASD are still being debated. We enrolled 90 children, 45 of whom were diagnosed with ASD, and examined the impact of GI disorders on ASD. The six-item GI Severity Index questionnaire was used to evaluate gastrointestinal symptoms, while the Social Responsiveness Scale was used to evaluate autism symptoms. Further, the Children’s Sleep Habits Questionnaire and the Children’s Eating Behavior Questionnaire are used to assess sleep and eating disorders in children. We assessed fecal microbiota by 16S rRNA gene sequencing, and SCFA concentrations by gas chromatography/mass spectrometry. The results revealed that children with ASD exhibited a high rate of gastrointestinal issues (78%), as well as higher rates of social impairment and poor sleeping habits, compared to TD children. However, GI disturbances have a minor impact on autism. In addition, the levels of propionic acid, butyric acid, and valeric acid were significantly higher in the ASD group. Besides, the ASD, TD, and GI subgroups possessed distinct microbiome profiles. These findings suggest that gastrointestinal disturbances have no discernible effect on the core symptoms of autism. Although autism may not cause an increase in GI symptoms directly, alterations in metabolites, such as SCFAs, may cause GI symptoms.
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Affiliation(s)
- Wenlin Deng
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
- *Correspondence: Wenlin Deng,
| | - Siqi Wang
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Fang Li
- Department of Gastroenterology, Gastroenterology Endoscopy Center, Hainan General Hospital, Hainan Affiliated Hospital of Hainan Medical University, Haikou, China
| | - Fang Wang
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yi Pei Xing
- Third Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yongchun Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Ying Lv
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Haoran Ke
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Zitong Li
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Pin Jing Lv
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Hu Hao
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Ye Chen
- Nanfang Hospital, Southern Medical University, Guangzhou, China
- Shenzhen Hospital, Southern Medical University, Shenzhen, China
| | - Xin Xiao
- Department of Pediatrics, The Sixth Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
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Lou M, Cao A, Jin C, Mi K, Xiong X, Zeng Z, Pan X, Qie J, Qiu S, Niu Y, Liang H, Liu Y, Chen L, Liu Z, Zhao Q, Qiu X, Jin Y, Sheng X, Hu Z, Jin G, Liu J, Liu X, Wang Y. Deviated and early unsustainable stunted development of gut microbiota in children with autism spectrum disorder. Gut 2022; 71:1588-1599. [PMID: 34930815 PMCID: PMC9279844 DOI: 10.1136/gutjnl-2021-325115] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Accepted: 12/07/2021] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Recent studies have provided insights into the gut microbiota in autism spectrum disorder (ASD); however, these studies were restricted owing to limited sampling at the unitary stage of childhood. Herein, we aimed to reveal developmental characteristics of gut microbiota in a large cohort of subjects with ASD combined with interindividual factors impacting gut microbiota. DESIGN A large cohort of 773 subjects with ASD (aged 16 months to 19 years), 429 neurotypical (NT) development subjects (aged 11 months to 15 years) were emolyed to determine the dynamics change of gut microbiota across different ages using 16S rRNA sequencing. RESULT In subjects with ASD, we observed a distinct but progressive deviation in the development of gut microbiota characterised by persistently decreased alpha diversity, early unsustainable immature microbiota, altered aboudance of 20 operational taxonomic units (OTUs), decreased taxon detection rate and 325 deregulated microbial metabolic functions with age-dependent patterns. We further revealed microbial relationships that have changed extensively in ASD before 3 years of age, which were associated with the severity of behaviour, sleep and GI symptoms in the ASD group. This analysis demonstrated that a signature of the combination of 2 OTUs, Veillonella and Enterobacteriaceae, and 17 microbial metabolic functions efficiently discriminated ASD from NT subjects in both the discovery (area under the curve (AUC)=0.86), and validation 1 (AUC=0.78), 2 (AUC=0.82) and 3 (AUC=0.67) sets. CONCLUSION Our large cohort combined with clinical symptom analysis highlights the key regulator of gut microbiota in the pathogenesis of ASD and emphasises the importance of monitoring and targeting the gut microbiome in future clinical applications of ASD.
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Affiliation(s)
- Mingxing Lou
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Aihua Cao
- Department of Pediatrics, Shandong University Qilu Hospital, Jinan, Shandong, China
| | - Cuiyuan Jin
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Kai Mi
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Pathogen of Jiangsu Province, Key Laboratory of Human Functional Genomics of Jiangsu Province Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiyue Xiong
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Zhaoyang Zeng
- Institute of Translational Medicine, Zhejiang Shuren University, Hangzhou, Zhejiang, China
| | - Xu Pan
- College of Bioinformatics Science and Technology, Harbin Medical University, Harbin, Heilongjiang, China
| | - Jinlong Qie
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Pathogen of Jiangsu Province, Key Laboratory of Human Functional Genomics of Jiangsu Province Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Shangfeng Qiu
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yaofang Niu
- Guhe Information Technology Co Ltd, Hangzhou, China
| | - Hao Liang
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yanping Liu
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Lin Chen
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Zhi Liu
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Pathogen of Jiangsu Province, Key Laboratory of Human Functional Genomics of Jiangsu Province Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Qing Zhao
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Pathogen of Jiangsu Province, Key Laboratory of Human Functional Genomics of Jiangsu Province Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Xiyan Qiu
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Yuanxiang Jin
- College of Biotechnology and Bioengineering, Zhejiang University of Technology, Hangzhou, Zhejiang, China
| | - Xiaoqi Sheng
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Zhibin Hu
- State Key Laboratory of Reproductive Medicine, Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Gulei Jin
- Guhe Information Technology Co Ltd, Hangzhou, China
| | - Jingshi Liu
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
| | - Xingyin Liu
- State Key Laboratory of Reproductive Medicine, Key Laboratory of Pathogen of Jiangsu Province, Key Laboratory of Human Functional Genomics of Jiangsu Province Center of Global Health, Nanjing Medical University, Nanjing, Jiangsu, China
| | - Yichao Wang
- National Health Commission (NHC) Key Laboratory of Birth Defect for Research and Prevention, Hunan Provincial Maternal and Child Health Care Hospital, Changsha, Hunan, China
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Sadikova E, Dovgan K, Mazurek MO. Longitudinal Examination of Sleep Problems and Symptom Severity in Children with Autism Spectrum Disorder. J Autism Dev Disord 2022; 53:1673-1681. [PMID: 35384626 DOI: 10.1007/s10803-021-05401-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2021] [Indexed: 10/18/2022]
Abstract
Up to 80% of children with autism spectrum disorder (ASD) experience sleep problems, which have been associated with more severe presentations of ASD symptoms. We examined the bidirectional link between sleep problems and specific ASD symptoms at two time points within 5 years in a well-characterized sample (659 children with ASD). Using cross-lagged panel analyses, we found evidence for a unidirectional link between baseline ASD symptoms (specifically repetitive behaviors, atypical behaviors, communication, and peer interactions) and future sleep problems, but did not find evidence of a bidirectional relationship. We did not find any longitudinal association between social reciprocity and sleep problems. It is important for providers and caregivers to understand and monitor the link between ASD symptoms and sleep problems.
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Affiliation(s)
- Eleonora Sadikova
- University of Virginia, 417 Emmet Street South, Charlottesville, VA, 22904, USA.
| | - Kristen Dovgan
- Marist College, 3399 North Rd, Poughkeepsie, NY, 12601, USA
| | - Micah O Mazurek
- University of Virginia, 417 Emmet Street South, Charlottesville, VA, 22904, USA
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Whelan S, Mannion A, Madden A, Berger F, Costello R, Ghadiri S, Leader G. Examining the Relationship Between Sleep Quality, Social Functioning, and Behavior Problems in Children with Autism Spectrum Disorder: A Systematic Review. Nat Sci Sleep 2022; 14:675-695. [PMID: 35444482 PMCID: PMC9015051 DOI: 10.2147/nss.s239622] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 04/06/2022] [Indexed: 11/23/2022] Open
Abstract
Over forty percent of autistic children experience poor sleep quality, and social interaction difficulties are a core characteristic of autism. However, the relationship between sleep quality and social functioning and behavior remains poorly understood. This systematic review examined the evidence concerning the impact of sleep quality on the social functioning and behavior problems in autistic children and adolescents. It also identified key related factors and evaluated how this issue has been researched to date. Seven key journals were hand-searched and five databases were systematically searched, using keywords. Titles and abstracts of 4123 items were screened against eligibility criteria by two researchers. Relevant studies were retained if they were peer-reviewed empirical papers, published in English between 2000 and 2021. Then, the full text of 97 papers was screened and if they met the eligibility criteria, their reference lists were hand-searched. Forty-six studies were included in the final review. Data were systematically extracted and two authors critically appraised the strengths and weaknesses of studies using Critical Appraisal Skills Programme tools. Key themes were identified, because a meta-analysis was not possible due to the studies' heterogeneity. The review identified that sleep quality and social functioning are associated with one another and there is a small amount of evidence that a bi-directional causal relationship may exist. Evidence suggests that several nights of suboptimal sleep duration and a lack of deep continuous sleep negatively impact externalizing and internalizing behavior. Sleep quality is also reduced by anxiety and sensory sensitivity. However, longitudinal studies with larger samples are needed to establish causality. Future research needs to examine confounding factors and to develop consensus regarding best-practice processes for the objective measurement of sleep with autistic children. Additional research also needs to further examine the consequences of poor sleep quality on internalizing behavior, and the impact of socio-cultural practices.
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Affiliation(s)
- Sally Whelan
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Arlene Mannion
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Azeem Madden
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Fine Berger
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Rachel Costello
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Saeid Ghadiri
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
| | - Geraldine Leader
- Irish Center for Autism and Neurodevelopmental Research (ICAN), School of Psychology, National University of Ireland, Galway, Ireland
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12
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Shui AM, Richdale AL, Katz T. Evaluating sleep quality using the CSHQ-Autism. Sleep Med 2021; 87:69-76. [PMID: 34534745 DOI: 10.1016/j.sleep.2021.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 08/16/2021] [Accepted: 08/22/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Sleep problems are common in autistic children and adversely impact daytime functioning. The Children's Sleep Habits Questionnaire (CSHQ) [39] was developed from a community-based sample of children and has validated a cut-off score of 41. Katz et al. [50] developed an abbreviated 23-item four-factor version of the CSHQ, which may be useful when assessing sleep in autistic children. However, a cut-off value has not yet been developed. OBJECTIVE Our objective was to develop and validate a cut-off for the CSHQ-autism total score in order to identify sleep problems among autistic children. We hypothesized that the derived cut-off value for the CSHQ-autism would perform better than the original CSHQ cut at 41 on validation in a sample of autistic children. METHODS Age-specific cut-off values were developed and validated using receiver operating characteristic analysis. RESULTS The derived cut-off values for the CSHQ-autism total score were 34, 35, 33, and 35 for the 2-3, 4-10, 11-17, and 2-17 years age groups, respectively. On validation, all cut-off values performed with moderate to high sensitivity (76.6-82.4%) and moderate specificity (69.1-75.5%), while the original CSHQ cut at 41 had high sensitivity (89.9-93.0%) but low specificity (42.6-57.7%). Using McNemar's tests, the CSHQ-autism had significantly higher specificity but lower sensitivity than the original CSHQ cut at 41 in all age groups. CONCLUSIONS The CSHQ-autism cut-off values performed better overall than the original CSHQ cut at 41 in a sample of autistic children. The CSHQ-autism cut-off can help identify sleep problems among autistic children.
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Affiliation(s)
- Amy M Shui
- Biostatistics Center, Massachusetts General Hospital, 50 Staniford Street, Suite 560, Boston, MA, 02114, USA; Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th Street, 2(nd)Floor, San Francisco, CA, 94158, USA.
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Kingsbury Drive, Bundoora, VIC, 3086, Australia.
| | - Terry Katz
- Department of Pediatrics, University of Colorado School of Medicine, 13123 E, 16(th)Avenue, Aurora, CO, 80045, USA.
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13
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Lamônica DAC, Giacheti CM, Dias Hayssi Haduo M, Dias Dos Santos MJ, da Silva NC, Pinato L. Sleep quality, functional skills, and communication in preschool-aged children with autism spectrum disorder. RESEARCH IN DEVELOPMENTAL DISABILITIES 2021; 116:104024. [PMID: 34245976 DOI: 10.1016/j.ridd.2021.104024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 05/11/2021] [Accepted: 06/29/2021] [Indexed: 06/13/2023]
Abstract
AIM This study aimed to correlate sleep quality, the performance of functional skills (mobility, self-care, and social function), communication, independence, and severity of ASD in children with ASD. METHOD 58 children between 3 and 5 years and 11 months old were investigated. The Childhood Autism Rating Scale was applied to determine the severity of autism; the Sleep Disturbance Scale for Children was used to investigate sleep quality, and the Pediatric Evaluation of Disability Inventory to investigate functional abilities and independence of the children. RESULTS 68.9 % of the children showed indicative of sleep disorders. There was no correlation between the different sleep disorders and communication. Sleep disorders showed a negative correlation with functional performance and a positive correlation with ASD severity. INTERPRETATION The current study offers an exploration between sleep and functional skills in children with ASD. These findings provide important clinical implications in the diagnosis and intervention process of children with ASD and also stimulate reflections on the importance in minimize the impact of sleep disorders and functional abilities on the quality of life of these individuals and their families.
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Affiliation(s)
| | - Celia Maria Giacheti
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), Marilia, SP, Brazil
| | - Michele Dias Hayssi Haduo
- Department of Speech, Language and Hearing Sciences, University of São Paulo, (USP), Bauru, SP, Brazil
| | | | - Nathani Cristina da Silva
- 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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14
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McLay LL, France KG, Blampied NM, Hunter JE, van Deurs JR, Woodford EC, Gibbs R, Lang R. Collateral Child and Parent Effects of Function‑Based Behavioral Interventions for Sleep Problems in Children and Adolescents with Autism. J Autism Dev Disord 2021; 52:2258-2273. [PMID: 34110556 DOI: 10.1007/s10803-021-05116-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
This study follows McLay et al., Journal of Autism and Developmental Disorders, (2020) to investigate whether the function-based behavioral sleep interventions received by 41 children and adolescents with autism spectrum disorder (ASD) produced collateral improvements in ASD severity, internalizing and externalizing symptoms and parent relationship quality, ratings of depression, anxiety and stress, and personal sleep quality. Concomitant with reduced sleep problem severity, improvements were found in children's internalizing and externalizing behavior and ASD symptom severity. Small improvements were also found in maternal sleep quality and parental stress. There was little change in parental relationship quality post-treatment, possibly reflecting high baseline scores. Overall, collateral benefits were generally small but positive, consistent with the limited extant research, and underscore the importance of investigating collateral effects across a range of variables.
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Affiliation(s)
- Laurie L McLay
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand.
| | - Karyn G France
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Neville M Blampied
- Psychology Department, School of Psychology, Speech, and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Jolene E Hunter
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Jenna R van Deurs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Emma C Woodford
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Rosina Gibbs
- School of Health Sciences, University of Canterbury, Private bag 4800, Christchurch, New Zealand
| | - Russell Lang
- Department of Special Education, Center for Autism Research, Evaluation, and Support, Texas State University, San Marcos, TX, USA
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15
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The association of sleep quality and aggression: A systematic review and meta-analysis of observational studies. Sleep Med Rev 2021; 59:101500. [PMID: 34058519 DOI: 10.1016/j.smrv.2021.101500] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/22/2021] [Accepted: 04/26/2021] [Indexed: 11/23/2022]
Abstract
Poor sleep quality is closely related to aggression, but despite the promise of new therapeutic possibilities, a systematic synthesis of observational research on the association between sleep quality and aggression is lacking. This systematic review and meta-analysis examined the association between sleep quality and aggression, using the academic databases PubMed and PsycINFO. Subjective and objective measures of sleep quality were included, as well as multiple measures of aggression, assessing aggressive and externalizing behavior, anger, hostility and irritability. Ninety-two observational articles, containing 96 studies, encompassing a total of 58.154 children, adolescents and adults were sourced out of 7161 references identified. Methodological quality was moderate or strong in 76% of studies. Data for meta-analysis was available from 74 studies. Poorer sleep quality was associated with higher aggression in 80.8% of studies. Pooled results showed a correlation of 0.28 (95%CI 0.25-0.31; I2 = 90.1%) and odds ratio of 3.61 (95%CI 1.13-11.51; I2 = 88.3%). Effect estimates and heterogeneity varied according to population type and measurement instruments, but not according to article quality or age group. Our findings confirm that poor sleep quality is consistently associated with higher aggression. As most evidence is cross-sectional, more prospective and high-quality experimental evidence is required to elucidate cause-effect and optimize prevention and treatment of aggression.
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16
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Gisbert Gustemps L, Lugo Marín J, Setien Ramos I, Ibañez Jimenez P, Romero Santo-Tomás O, Jurado Luque MJ, Ballester Navarro P, Esteve Cruella A, Díez Villoria E, Canal Bedia R, Ramos Quiroga JA. Sleep disturbances in autism spectrum disorder without intellectual impairment: relationship with executive function and psychiatric symptoms. Sleep Med 2021; 83:106-114. [PMID: 33991890 DOI: 10.1016/j.sleep.2021.04.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 04/13/2021] [Accepted: 04/15/2021] [Indexed: 11/26/2022]
Abstract
The autism spectrum disorder (ASD) is a neurodevelopmental condition, frequently accompanied by medical and psychiatric pathology. One of the most commonly found problems associated with ASD is sleep disturbances, which are estimated to affect approximately 80% of the people with ASD, not only during childhood but also in the adolescence and adult stages. Nevertheless, the relationship of these sleep difficulties with autism severity, as well as other associated impairments such as executive functioning and psychiatric disorders (eg, depression), has not yet been widely studied. The main objective of the present study was to explore the relationship between sleep disturbances, subjective measures of executive function, and psychiatric pathology in the ASD population. To reach that goal, a group of 89 participants with ASD (44 children/adolescents and 45 adults) was recruited and evaluated with self-reported measures of executive function performance and psychiatric pathology tests. Multivariate analysis showed a significant association between sleep disturbances and psychiatric symptoms in both ASD groups, with greater sleep disturbances predicting more severe psychiatric pathology. No significant association was found with executive function in any group. Limitations included a small sample size and lack of objective measures. Sleep problems seem to be associated with the severity of psychiatric pathology throughout the lifespan, increasing the chance of developing psychiatric symptoms when they were present. Improving sleep quality in ASD at all ages may result in preventing and/or decreasing psychiatric pathology in this population.
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Affiliation(s)
- Laura Gisbert Gustemps
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Jorge Lugo Marín
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain
| | - Imanol Setien Ramos
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | - Pol Ibañez Jimenez
- Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain
| | | | | | - Pura Ballester Navarro
- Neuropharmacology on Pain and Functional Diversity (NED) Research Group, Alicante Institute of Sanitary and Biomedical Research (ISABIAL), Alicante, Spain; Department of Clinical Pharmacology, Organic Chemistry and Pediatrics, Miguel Hernández University of Elche, Elche, Spain
| | | | - Emiliano Díez Villoria
- Centro de Atención Integral al Autismo-InFoAutismo, INICO-Instituto Universitario de Integración en la Comunidad, University of Salamanca. Salamanca, Spain
| | - Ricardo Canal Bedia
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
| | - Josep Antoni Ramos Quiroga
- Department of Psychiatry, Hospital Universitari Vall d'Hebron, Barcelona, Catalonia, Spain; Group of Psychiatry, Mental Health and Addictions, Vall d'Hebron Research Institute (VHIR), Barcelona, Catalonia, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Biomedical Network Research Centre on Mental Health (CIBERSAM), Madrid, Spain
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17
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Ansari S, AdibSaber F, Elmieh A, Gholamrezaei S. The effect of water-based intervention on sleep habits and two sleep-related cytokines in children with autism. Sleep Med 2021; 82:78-83. [PMID: 33906043 DOI: 10.1016/j.sleep.2021.03.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Revised: 03/27/2021] [Accepted: 03/31/2021] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Previous studies have shown that children with autism have sleep disturbances and elevated levels of pro-inflammatory cytokines. This study aimed to evaluate the effect of aquatic exercise on sleep habits and two certain sleep-related cytokines of children with autism spectrum disorders (ASD). METHODS Forty boys with ASD (aged 6-14) were recruited and randomly assigned to an aquatic exercise (n = 20) or a control group (n = 20). Participants in aquatic exercise group performed water-based activities for 10 weeks/2 sessions per week/60 min, while control group didn't get any intervention. The serum levels of Interleukin-1 beta (IL-1β) and Tumor necrosis factor-α (TNF-α) and sleep quality were measured before and after the intervention. RESULTS Results revealed that aquatic exercise may improve sleep quality and reduce the serum levels of IL-1β and TNF-α in children with ASD compared to control group. CONCLUSIONS Overall, it is recommended that physicians and educators should provide a safe and effective exercise environment for ASD children to alleviate sleep issues and inflammatory biomarkers.
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Affiliation(s)
- Soleyman Ansari
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Fahimeh AdibSaber
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Alireza Elmieh
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
| | - Shahram Gholamrezaei
- Department of Physical Education, Rasht Branch, Islamic Azad University, Rasht, Iran.
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18
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Abstract
Children and adolescents with autism spectrum disorder (ASD) experience sleep disturbances, particularly insomnia, at rates much higher than the general population. Daytime behavioral problems and parental stress are associated with the resultant sleep deprivation. Behavioral interventions, parental education, and melatonin are effective treatments. The epidemiology of sleep disturbances in youth with ASD is reviewed in this article as well as the latest in treatments.
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Affiliation(s)
- Kyle P Johnson
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Paria Zarrinnegar
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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19
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Iwata M, Kaneko K. Non‐24‐hour sleep‐wake disorder successfully treated with the combination of ramelteon and suvorexant in a case of autism spectrum disorder. Neuropsychopharmacol Rep 2020; 40:383-387. [PMID: 32990413 PMCID: PMC7722683 DOI: 10.1002/npr2.12142] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 08/11/2020] [Accepted: 08/12/2020] [Indexed: 12/23/2022] Open
Abstract
Introduction Non‐24‐hour sleep‐wake disorder (N24SWD) is often observed in the visually impaired and those who isolate indoors. Melatonin receptor agonists may be used for treatment, but there is currently no evidence that they are effective in patients without visual impairment. Case We report a case of a 23‐year‐old woman who withdrew from her social life owing to autism spectrum disorder and experienced an unusual sleep rhythm. She presented with N24SWD. The N24SWD cycle averaged 25.6 days but was extended to 42 days using ramelteon. However, this was not enough. We prescribed the addition of suvorexant and the sleep cycle returned to normal. Conclusion N24SWD is a disease that seriously impairs social life and productivity. We propose a possible treatment strategy for N24SWD using ramelteon and suvorexant. We present a case in which the combination therapy of ramelteon and suvorexant was effective for a patient with autism spectrum disorder with non‐24‐hour sleep‐wake disorder (N24SWD) owing to social withdrawal. Here, we discussed the pharmacological mechanism of the combination of ramelteon and suvorexant as a possible therapeutic strategy for patients with N24SWD.![]()
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Affiliation(s)
- Masaaki Iwata
- Department of Neuropsychiatry Faculty of Medicine Tottori University Yonago Japan
| | - Koichi Kaneko
- Department of Neuropsychiatry Faculty of Medicine Tottori University Yonago Japan
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20
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Alivar A, Carlson C, Suliman A, Warren S, Prakash P, Thompson DE, Natarajan B. Smart bed based daytime behavior prediction in Children with autism spectrum disorder - A Pilot Study. Med Eng Phys 2020; 83:15-25. [PMID: 32807344 DOI: 10.1016/j.medengphy.2020.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 05/30/2020] [Accepted: 07/02/2020] [Indexed: 11/30/2022]
Abstract
Monitoring the sleep patterns of children with autism spectrum disorders (ASD) and understanding how sleep quality influences their daytime behavior is an important issue that has received very limited attention. Polysomnography (PSG) is commonly used as a gold standard for evaluating sleep quality in children and adults. However, the intrusive nature of sensors used as part of PSG can themselves affect sleep and is, therefore, not suitable for children with ASD. In this study, we evaluate an unobtrusive and inexpensive bed system for in-home, long-term sleep quality monitoring using ballistocardiogram (BCG) signals. Using the BCG signals from this smart bed system, we define "restlessness" as a surrogate sleep quality estimator. Using this sleep feature, we build predictive models for daytime behavior based on 1-8 previous nights of sleep. Specifically, we use two supervised machine learning algorithms namely support vector machine (SVM) and artificial neural network (ANN). For all daytime behaviors, we achieve more than 78% and 79% accuracy of correctly predicting behavioral issues with both SVM and ANN classifiers, respectively. Our findings indicate the usefulness of our designed bed system and how the restlessness feature can improve the prediction performance.
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Affiliation(s)
- Alaleh Alivar
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Charles Carlson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Ahmad Suliman
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Steve Warren
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Punit Prakash
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - David E Thompson
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
| | - Balasubramaniam Natarajan
- Department of Electrical and Computer Engineering, Kansas State University, Manhattan, KS 66506, United States.
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21
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Waddington H, McLay L, Woods L, Whitehouse AJO. Child and Family Characteristics Associated with Sleep Disturbance in Children with Autism Spectrum Disorder. J Autism Dev Disord 2020; 50:4121-4132. [DOI: 10.1007/s10803-020-04475-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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22
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Pinato L, Galina Spilla CS, Markus RP, da Silveira Cruz-Machado S. Dysregulation of Circadian Rhythms in Autism Spectrum Disorders. Curr Pharm Des 2020; 25:4379-4393. [DOI: 10.2174/1381612825666191102170450] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Accepted: 10/31/2019] [Indexed: 12/12/2022]
Abstract
Background:
The alterations in neurological and neuroendocrine functions observed in the autism
spectrum disorder (ASD) involves environmentally dependent dysregulation of neurodevelopment, in interaction
with multiple coding gene defects. Disturbed sleep-wake patterns, as well as abnormal melatonin and glucocorticoid
secretion, show the relevance of an underlying impairment of the circadian timing system to the behavioral
phenotype of ASD. Thus, understanding the mechanisms involved in the circadian dysregulation in ASD could
help to identify early biomarkers to improve the diagnosis and therapeutics as well as providing a significant
impact on the lifelong prognosis.
Objective:
In this review, we discuss the organization of the circadian timing system and explore the connection
between neuroanatomic, molecular, and neuroendocrine responses of ASD and its clinical manifestations. Here
we propose interconnections between circadian dysregulation, inflammatory baseline and behavioral changes in
ASD. Taking into account, the high relevancy of melatonin in orchestrating both circadian timing and the maintenance
of physiological immune quiescence, we raise the hypothesis that melatonin or analogs should be considered
as a pharmacological approach to suppress inflammation and circadian misalignment in ASD patients.
Strategy:
This review provides a comprehensive update on the state-of-art of studies related to inflammatory
states and ASD with a special focus on the relationship with melatonin and clock genes. The hypothesis raised
above was analyzed according to the published data.
Conclusion:
Current evidence supports the existence of associations between ASD to circadian dysregulation,
behavior problems, increased inflammatory levels of cytokines, sleep disorders, as well as reduced circadian
neuroendocrine responses. Indeed, major effects may be related to a low melatonin rhythm. We propose that
maintaining the proper rhythm of the circadian timing system may be helpful to improve the health and to cope
with several behavioral changes observed in ASD subjects.
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Affiliation(s)
- Luciana Pinato
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Caio Sergio Galina Spilla
- Department of Speech, Language and Hearing Sciences, São Paulo State University (UNESP), 17525-900, Marilia, SP, Brazil
| | - Regina Pekelmann Markus
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
| | - Sanseray da Silveira Cruz-Machado
- Laboratory of Chronopharmacology, Department of Physiology, Institute of Biosciences, University of São Paulo (USP), 05508-090, São Paulo, SP, Brazil
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23
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Koo HW, Ismail J, Yang WW, Syed Zakaria SZ. Sleep Disturbances in Children With Autism Spectrum Disorder at a Malaysian Tertiary Hospital. Front Pediatr 2020; 8:608242. [PMID: 33537265 PMCID: PMC7849202 DOI: 10.3389/fped.2020.608242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/14/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction: Children with autism spectrum disorder (ASD) have a variety of co-morbid medical problems, including sleep disturbances. Prevalence of sleep disorders has been reported to be higher in this group as compared to the general population. Identifying sleep problems in children with ASD may help increase awareness and improve the overall quality of care for them. The aim of this study was to determine the prevalence of sleep problems and associated factors in a group of Malaysian children aged 6-16 years, with ASD. Method: This is a cross-sectional study at the Child Development Centre of UKM Medical Centre (UKM MC) on ASD children aged 6-16 years. Demographic data was obtained and the Sleep Disturbances Scale for Children (SDSC) questionnaire was completed by the main caregiver. Logistic regression analysis was used to determine factors related to higher total SDSC scores. Results: A total of 128 patients were recruited (111 boys) with a median age of 8 years 3 months (IQR: 2 years 10 months). Forty-seven (36.7%) of them obtained total SDSC scores in the pathological range with 19 (14.8%) scoring high for overall disturbances and 28 (21.9%) for at least one subtype of sleep disorders: 25 (19.5%) DIMS, 18 (14.1%) SBD, 10 (7.8%) DOES, 5 (3.9%) DOA, 6 (4.7%) SWTD, and 3 (2.3%) SHY. More than half of the children (57.8%) were reported to have sufficient sleep duration of 8-11 h, but longer sleep latency of at least 15 min (82.8%). Half of the ASD children also had co-morbidities in which one-third (34.4%) had attention-deficit hyperactivity disorder (ADHD). Using logistic regression analysis, four factors were significantly associated with higher total SDSC scores; female gender (p = 0.016), older age group (11-16 years old) (p = 0.039), shorter sleep length (p = 0.043), and longer sleep latency (p < 0.001). Conclusion: The prevalence of sleep disturbances is high among Malaysian children with ASD, especially DIMS. Female gender, older age group, shorter sleep length, and longer sleep latency were found to be associated with the sleep disturbances. Evaluation of sleep problems should form part of the comprehensive care of children with ASD.
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Affiliation(s)
- Ho Wai Koo
- Department of Paediatrics, Hospital Tunku Azizah, Kuala Lumpur, Malaysia
| | - Juriza Ismail
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
| | - Wai Wai Yang
- Department of Paediatrics, Faculty of Medicine, National University of Malaysia, Kuala Lumpur, Malaysia
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24
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Hyman SL, Levy SE, Myers SM. Identification, Evaluation, and Management of Children With Autism Spectrum Disorder. Pediatrics 2020; 145:peds.2019-3447. [PMID: 31843864 DOI: 10.1542/peds.2019-3447] [Citation(s) in RCA: 475] [Impact Index Per Article: 118.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Autism spectrum disorder (ASD) is a common neurodevelopmental disorder with reported prevalence in the United States of 1 in 59 children (approximately 1.7%). Core deficits are identified in 2 domains: social communication/interaction and restrictive, repetitive patterns of behavior. Children and youth with ASD have service needs in behavioral, educational, health, leisure, family support, and other areas. Standardized screening for ASD at 18 and 24 months of age with ongoing developmental surveillance continues to be recommended in primary care (although it may be performed in other settings), because ASD is common, can be diagnosed as young as 18 months of age, and has evidenced-based interventions that may improve function. More accurate and culturally sensitive screening approaches are needed. Primary care providers should be familiar with the diagnostic criteria for ASD, appropriate etiologic evaluation, and co-occurring medical and behavioral conditions (such as disorders of sleep and feeding, gastrointestinal tract symptoms, obesity, seizures, attention-deficit/hyperactivity disorder, anxiety, and wandering) that affect the child's function and quality of life. There is an increasing evidence base to support behavioral and other interventions to address specific skills and symptoms. Shared decision making calls for collaboration with families in evaluation and choice of interventions. This single clinical report updates the 2007 American Academy of Pediatrics clinical reports on the evaluation and treatment of ASD in one publication with an online table of contents and section view available through the American Academy of Pediatrics Gateway to help the reader identify topic areas within the report.
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Affiliation(s)
- Susan L Hyman
- Golisano Children's Hospital, University of Rochester, Rochester, New York;
| | - Susan E Levy
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and
| | - Scott M Myers
- Geisinger Autism & Developmental Medicine Institute, Danville, Pennsylvania
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25
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Samanta P, Mishra DP, Panigrahi A, Mishra J, Senapati LK, Ravan JR. Sleep disturbances and associated factors among 2-6-year-old male children with autism in Bhubaneswar, India. Sleep Med 2019; 67:77-82. [PMID: 31918121 DOI: 10.1016/j.sleep.2019.11.1244] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Revised: 11/09/2019] [Accepted: 11/11/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Sleep disturbances are considered one of the significant comorbidities of autism; they negatively impact the quality of life of children with autism as well as their parents or caregivers. This study aimed to determine the prevalence of sleep disturbances in Indian male children diagnosed with autism and examine the association of lifestyle behaviors and socio-demographic characteristics with sleep problems. METHODS The present cross-sectional study was conducted in Bhubaneswar city in the year 2018, involving mothers of 100 male children with autism aged 2-6 years. We used a children's sleep habits questionnaire (CSHQ) to evaluate the sleep problems in children with autism and a semi-structured schedule for gathering information regarding lifestyle behaviors and socio-demographic characteristics. RESULTS The overall prevalence of parent-reported sleep problems was 93%; the most prevalent CSHQ subscales were: bedtime resistance (95%), sleep anxiety (85%), and sleep duration (81%). The mean ISAA score of the study sample was 133.89 ± 19.59, where 12%, 71%, and 17% of the children had mild, moderate, and severe autism, respectively. Multiple linear regression analysis revealed that variables such as autism severity, screen time, caffeine intake, physical activity, maternal age, child's age, and birth weight were significantly associated with the CSHQ subscales. CONCLUSION The prevalence of parent-reported sleep problems is very high among the male children with autism in Bhubaneswar, India, and there is an urgent need for interventional measures for appropriate management of this problem among these children.
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Affiliation(s)
- Priyadarsini Samanta
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India.
| | | | - Ansuman Panigrahi
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India.
| | - Jayanti Mishra
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India.
| | - Laxman Kumar Senapati
- Kalinga Institute of Medical Sciences, KIIT University, Bhubaneswar, 751024, Odisha, India.
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Papadopoulos N, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Engel L, Fuller-Tyszkiewicz M, Bellows ST, Marks D, Howlin P, Rinehart N. Sleeping sound with autism spectrum disorder (ASD): study protocol for an efficacy randomised controlled trial of a tailored brief behavioural sleep intervention for ASD. BMJ Open 2019; 9:e029767. [PMID: 31748288 PMCID: PMC6887021 DOI: 10.1136/bmjopen-2019-029767] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Revised: 07/25/2019] [Accepted: 09/09/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Sleep problems are a characteristic feature of children with autism spectrum disorder (ASD) with 40% to 80% of children experiencing sleep difficulties. Sleep problems have been found to have a pervasive impact on a child's socio-emotional functioning, as well as on parents' psychological functioning. The Sleeping Sound ASD project aims to evaluate the efficacy of a brief behavioural sleep intervention in reducing ASD children's sleep problems in a fully powered randomised controlled trial (RCT). Intervention impact on child and family functioning is also assessed. METHODS AND ANALYSIS The RCT aims to recruit 234 children with a diagnosis of ASD, aged 5-13 years, who experience moderate to severe sleep problems. Participants are recruited from paediatrician clinics in Victoria, Australia, and via social media. Families interested in the study are screened for eligibility via phone, and then asked to complete a baseline survey online, assessing child sleep problems, and child and family functioning. Participants are then randomised to the intervention group or treatment as usual comparator group. Families in the intervention group attend two face-to-face sessions and a follow-up phone call with a trained clinician, where families are provided with individually tailored behavioural sleep strategies to help manage the child's sleep problems. Teacher reports of sleep, behavioural and social functioning are collected, and cognitive ability assessed to provide measures blind to treatment group. The primary outcome is children's sleep problems as measured by the Children's Sleep Habits Questionnaire at 3 months post-randomisation. Secondary outcomes include parent and child quality of life; child social, emotional, behavioural and cognitive functioning; and parenting stress and parent mental health. Cost-effectiveness of the intervention is also evaluated. ETHICS AND DISSEMINATION Findings from this study will be published in peer-reviewed journals and disseminated at national and international conferences, local networks and online. TRIAL REGISTRATION NUMBER ISRCTN14077107 (ISRCTN registry dated on 3 March 2017).
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Affiliation(s)
| | - Emma Sciberras
- Deakin University, Geelong, Victoria, Australia
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | | | | | - Lidia Engel
- Deakin University, Geelong, Victoria, Australia
| | | | | | - Deborah Marks
- Deakin University, Geelong, Victoria, Australia
- The Royal Children's Hospital, Parkville, Victoria, Australia
| | - Patricia Howlin
- Brain and Mind Centre, University of Sydney, Camperdown, New South Wales, Australia
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
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27
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Ballester P, Martínez MJ, Inda MDM, Javaloyes A, Richdale AL, Muriel J, Belda C, Toral N, Morales D, Fernández E, Peiró AM. Evaluation of agomelatine for the treatment of sleep problems in adults with autism spectrum disorder and co-morbid intellectual disability. J Psychopharmacol 2019; 33:1395-1406. [PMID: 31423939 DOI: 10.1177/0269881119864968] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE Intellectual disability (ID) and autism spectrum disorder (ASD) are common, co-occurring developmental disorders and are frequently associated with sleep problems. This study aimed to assess the effectiveness and tolerability of agomelatine as a pharmacotherapy for sleep problems in ASD adults with ID. METHOD A randomised, crossover, triple-blind, placebo-controlled clinical trial, with two three-month periods of treatment starting with either agomelatine or placebo and a washout period of two weeks. Ambulatory circadian monitoring (24 hours/7 days) evaluated total sleep time (TST) as the primary outcome variable. RESULTS Participants (N=23; 35±12 years old; 83% male) had a median of three (interquartile range (IQR) 1-4) co-morbidities and were taking a median of five (IQR 2-7) prescribed drugs. Before agomelatine or placebo treatment, all subjects presented with insomnia symptoms, including sleep latency (100% abnormal, 55±23 minutes) or TST (55% abnormal, 449±177 minutes), and 66% had circadian rhythm sleep-wake abnormalities with rhythm phase advancements according to the M5 sleep phase marker values. During the three-month agomelatine treatment, night TST significantly increased by a mean of 83 minutes (16% abnormal, 532±121 minutes), together with a phase correction (M5 1:45±2:28 hours vs. 3:15±2:20 hours), improving sleep stability in wrist temperature rhythm (0.43±0.29 vs. 0.52±0.18 AU). Adverse events were mild and transient. CONCLUSIONS Agomelatine was effective and well tolerated for treating insomnia and circadian rhythm sleep problems present in adults with ASD and ID.
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Affiliation(s)
- Pura Ballester
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Department of Clinical Pharmacology, Organic Chemistry and Paediatrics, Miguel Hernández University of Elche, Elche, Spain
| | - María José Martínez
- Chronobiology Lab, Department of Physiology, College of Biology, University of Murcia, Mare Nostrum Campus, Murcia Spain.,Ciber Fragilidad y Envejecimiento Saludable (CIBERFES), Madrid, Spain
| | - María-Del-Mar Inda
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - Auxiliadora Javaloyes
- Education Centre for Children and Adolescents with Autism, Mental Health Problems and Behavioural Disorders (EDUCATEA), Alicante, Spain
| | - Amanda L Richdale
- Olga Tennison Autism Research Centre, School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia
| | - Javier Muriel
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain
| | - César Belda
- Infanta Leonor Autism Centre, Alicante, Spain
| | | | - Domingo Morales
- Operations Research Centre, Miguel Hernández University of Elche, Elche, Spain
| | - Eduardo Fernández
- Bioengineering Institute, Miguel Hernández University of Elche, Elche, Spain
| | - Ana M Peiró
- Neuropharmacology on Pain (NED), Alicante Institute for Health and Biomedical Research (ISABIAL-FISABIO Foundation), Alicante, Spain.,Clinical Pharmacology Department, Department of Health of Alicante, Alicante General Hospital, Alicante, Spain
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28
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Modification of the Children's Sleep Habits Questionnaire for Children with Autism Spectrum Disorder. J Autism Dev Disord 2019; 48:2629-2641. [PMID: 29500758 DOI: 10.1007/s10803-018-3520-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD) and adversely impact daytime functioning. Although no questionnaires have been developed to assess sleep in children with ASD, the 33-item Children's Sleep Habits Questionnaire (CSHQ) is widely used in this population. We examined the factor structure of the CSHQ in 2872 children (age 4-10 years) enrolled in the Autism Treatment Network. A four-factor solution (Sleep Initiation and Duration, Sleep Anxiety/Co-Sleeping, Night Waking/Parasomnias, and Daytime Alertness) with 5-6 items per factor explained 75% of the total variation. Ten items failed to load on any factor. This abbreviated 23-item four-factor version of this measure may be useful when assessing sleep in children with ASD.
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29
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Pinato L, Ribeiro EM, Leite RFP, Lopes TF, Pessoa ALS, Guissoni Campos LM, Piffer GE, Souza ALDM, Giacheti CM. Sleep findings in Brazilian children with congenital Zika syndrome. Sleep 2019; 41:4791871. [PMID: 29325155 DOI: 10.1093/sleep/zsy009] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Study Objectives Zika virus infection during pregnancy may result in congenital Zika syndrome (CZS), whose characteristics are being described. Methods The present study aimed to investigate the sleep characteristics of 136 infants/toddlers (88 with CZS and 48 with typical development (TD), age and gender matched, 60% girls and 40% boys in both groups) using the Brief Infant Sleep Questionnaire. The ages of children in both groups ranged from 5 to 24 months (CZS 15.9 ± 0.4 vs. TD 15.8 ± 1.0 months, P= 0.90). Results The results show that 34.1% of CZS and 2% of TD children were defined as poor sleepers, 15% of CZS and 2% of TD children remained awake at night for a period longer than 1 hour, and 24% of CZS and 2% of TD children slept less than 9 hours. The CZS group showed shorter total sleep time (CZS 11.24 ± 2.6 vs. TD 12.02 ± 1.9 hours, P= 0.03) and shorter nocturnal sleep duration than the TD group (CZS 8.2 ± 0.2 vs. TD 9.4 ± 0.2 hours, P= 0.0002). In contrast to the control group (P= 0.02, r= -0.34), in the CZS group, no correlation was found between age and nocturnal wakefulness. Future studies should explore these data in relation to the development and maturation of the central nervous system of these children. Conclusions Considering the well-known consequences of poor sleep quality on health in several populations, the presence of sleep disorders should be considered in CZS using multidisciplinary treatments.
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Affiliation(s)
- Luciana Pinato
- São Paulo State University - UNESP, Marilia, São Paulo, Brazil
| | - Erlane M Ribeiro
- Albert Sabin Children's Hospital, Fortaleza, Ceará, Brazil.,Christus University Center, Fortaleza, Ceará, Brazil
| | | | - Thayse F Lopes
- Albert Sabin Children's Hospital, Fortaleza, Ceará, Brazil
| | - André L S Pessoa
- Albert Sabin Children's Hospital, Fortaleza, Ceará, Brazil.,State University of Ceará (UECE), Fortaleza, Ceará, Brazil
| | | | | | - Ana L D M Souza
- São Paulo State University - UNESP, Marilia, São Paulo, Brazil
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Lindor E, Sivaratnam C, May T, Stefanac N, Howells K, Rinehart N. Problem Behavior in Autism Spectrum Disorder: Considering Core Symptom Severity and Accompanying Sleep Disturbance. Front Psychiatry 2019; 10:487. [PMID: 31354548 PMCID: PMC6639428 DOI: 10.3389/fpsyt.2019.00487] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2018] [Accepted: 06/20/2019] [Indexed: 11/25/2022] Open
Abstract
In addition to the core symptoms that define autism spectrum disorder (ASD), many individuals experience broader problem behavior at a level significant enough for families to seek further clinical assessment and intervention. We define "problem behavior" as any significant emotional or behavioral issue captured by the Child Behavior Checklist (CBCL) including anxiety, depression, withdrawal, somatic complaints, problems with socialization, thought or attention, rule-breaking, and aggression. While greater ASD symptom severity and accompanying sleep disturbance have each been linked with more severe problem behavior, there is little understanding about how these two key factors interact; that is, it is unclear whether the severity and type of sleep disturbance an individual experiences differentially influences the relationship between ASD symptom severity and problem behavior. The aim of the current study was, thus, to explore whether the link between greater ASD symptom severity and clinically elevated problem behavior is moderated by the presence/degree of accompanying sleep disturbance. Forty males with ASD, aged 5-12, participated in the study. The Social Responsiveness Scale, CBCL, and Children's Sleep Habits Questionnaire were administered to obtain information about ASD symptom severity, problem behavior, and sleep habits, respectively. Results indicated that the relationship between ASD symptom severity and problem behavior differed among individuals with ASD depending on the degree of sleep disturbance they experienced. Specifically, there was a significant positive relationship between ASD symptom severity and problem behavior for individuals with no sleep disturbance or milder sleep disturbance (i.e., in these cases, individuals with severe ASD symptoms experienced clinically elevated problem behavior, while those with milder ASD symptoms experienced milder problem behavior). In contrast, there was no significant relationship between ASD symptom severity and problem behavior for individuals with moderate-to-severe sleep disturbance; rather, clinically significant problem behavior was apparent across all individuals irrespective of ASD symptom severity. Follow-up analyses indicated that disturbances in sleep duration, disordered breathing, and daytime sleepiness were related to clinically elevated problem behavior even among those with milder ASD symptoms. These findings emphasize the importance of routinely assessing for accompanying sleep disturbance in this population regardless of whether individuals present with mild, moderate, or severe ASD.
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Affiliation(s)
- Ebony Lindor
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
| | - Carmel Sivaratnam
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
| | - Tamara May
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
| | - Nicole Stefanac
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
| | - Katherine Howells
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
| | - Nicole Rinehart
- Faculty of Health, School of Psychology, Deakin Child Study Centre, Deakin University, Geelong, VIC, Australia
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31
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Malhi P, Kaur A, Singhi P, Sankhyan N. Sleep Dysfunction and Behavioral Daytime Problems in Children with Autism Spectrum Disorders: A Comparative Study. Indian J Pediatr 2019; 86:12-17. [PMID: 29951780 DOI: 10.1007/s12098-018-2731-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 05/30/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare parent reported sleep behaviors of children with Autism Spectrum Disorders (ASD) and normal healthy controls and to examine the association of sleep disturbances with daytime behavioral difficulties in children with ASD. METHODS Sixty ASD children (85% boys) (Mean age=6.1 y, SD=2.4) were recruited from the Psychology unit of the Department of Pediatrics of a tertiary care hospital. An age and socio-economic status matched group of typically developing (TD) children (N=60) were also recruited. The Children's Sleep Habits Questionnaire (CSHQ) was used to measure sleep problems. The Childhood Psychopathology Measurement Schedule was used to measure day time behavioral difficulties. RESULTS Sleep problems were nearly two times more prevalent among children with ASD (88.3%) as compared to the TD group (46.7%) (χ2=23.74, P=0.0001). The total CSHQ and 6 out of the 8 subscales scores of the ASD group were also significantly higher than the TD group. Overall, children with ASD displayed significant more bedtime resistance than controls (t= 3.95, P=0.001). The sleep duration subscale showed that children with ASD, relative to the TD group, slept too little (χ2=23.08, P=0.0001), did not sleep the right amount of time (χ2= 11.86, P=0.003), and displayed significant variation in the duration of time slept (χ2=11.96, P=0.003). In addition, parent reported sleep dysfunction had a significant relationship with daytime reported behavior difficulties (r=0.53, P=0.01) in children with ASD. Stepwise multiple regression analysis revealed that 30% of the variance in number of daytime behavioral problems was explained by only two variables: total CSHQ scores and duration of night awake time (F=11.18, P=0.001). CONCLUSIONS Children with ASD are at a high risk for sleep problems and this is associated with daytime behavior disturbances. Pediatricians should routinely screen ASD children for sleep problems and initiate timely and appropriate interventions.
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Affiliation(s)
- Prahbhjot Malhi
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Amandeep Kaur
- Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Pratibha Singhi
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Naveen Sankhyan
- Department of Pediatrics, Post Graduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
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Sannar EM, Palka T, Beresford C, Peura C, Kaplan D, Verdi M, Siegel M, Kaplan S, Grados M. Sleep Problems and Their Relationship to Maladaptive Behavior Severity in Psychiatrically Hospitalized Children with Autism Spectrum Disorder (ASD). J Autism Dev Disord 2018; 48:3720-3726. [PMID: 29086209 DOI: 10.1007/s10803-017-3362-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
We examined the relationship between sleep duration and awakenings to Aberrant Behavior Checklist-Community (ABC-C) and Autism Diagnostic Observation Schedule (ADOS-2) scores in hospitalized youth with ASD and behavioral disturbance. Participants included 106 patients with a stay of at least 10 nights. Sleep in the hospital was recorded by staff observation. Higher scores on the ABC-C (irritability, stereotypy, and hyperactivity subscales) at admission were significantly associated with fewer minutes slept during the last five nights of hospitalization. There was no association between total awakenings and ABC-C scores or ADOS-2 comparison scores. Improved understanding of the relationship between sleep quality and maladaptive behavior in this challenging cohort of patients with ASD is vital to the definition and design of future effective interventions.
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Affiliation(s)
- Elise M Sannar
- Children's Hospital Colorado, 13123 E. 16th Ave., B-130, Aurora, CO, 80045, USA.
| | - Tamara Palka
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Carol Beresford
- Children's Hospital Colorado, 13123 E. 16th Ave., B-130, Aurora, CO, 80045, USA
| | - Christine Peura
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Desmond Kaplan
- Sheppard Pratt Health System, 6501 N. Charles St., Towson, MD, 21204, USA.,Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
| | - Mary Verdi
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA
| | - Matthew Siegel
- Spring Harbor Hospital, 123 Andover Road, Westbrook, ME, 04092, USA.,Tufts University School of Medicine, 136 Harrison Ave., Boston, MA, 02111, USA
| | - Shir Kaplan
- University of Maryland, College Park, MD, 20742, USA
| | - Marco Grados
- Johns Hopkins University School of Medicine, 733 N. Broadway, Baltimore, MD, 21205, USA
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Díaz-Román A, Zhang J, Delorme R, Beggiato A, Cortese S. Sleep in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies. EVIDENCE-BASED MENTAL HEALTH 2018; 21:146-154. [PMID: 30361331 PMCID: PMC10270396 DOI: 10.1136/ebmental-2018-300037] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 09/10/2018] [Accepted: 09/20/2018] [Indexed: 12/16/2022]
Abstract
BACKGROUND Sleep problems are common and impairing in individuals with autism spectrum disorders (ASD). Evidence synthesis including both subjective (ie, measured with questionnaires) and objective (ie, quantified with neurophysiological tools) sleep alterations in youth with ASD is currently lacking. OBJECTIVE We conducted a systematic review and meta-analysis of subjective and objective studies sleep studies in youth with ASD. METHODS We searched the following electronic databases with no language, date or type of document restriction up to 23 May 2018: PubMed, PsycInfo, Embase+Embase Classic, Ovid Medline and Web of Knowledge. Random-effects models were used. Heterogeneity was assessed with Cochran's Q and I2 statistics. Publication (small studies) bias was assessed with final plots and the Egger's test. Study quality was evaluated with the Newcastle Ottawa Scale. Analyses were conducted using Review Manager and Comprehensive Meta-Analysis. FINDINGS: From a pool of 3359 non-duplicate potentially relevant references, 47 datasets were included in the meta-analyses. Subjective and objective sleep outcome measures were extracted from 37 and 15 studies, respectively. Only five studies were based on comorbidity free, medication-naïve participants. Compared with typically developing controls, youth with ASD significantly differed in 10/14 subjective parameters and in 7/14 objective sleep parameters. The average quality score in the Newcastle-Ottawa Scale was 5.9/9. DISCUSSION AND CLINICAL IMPLICATIONS A number of subjective and, to a less extent, objective sleep alterations might characterise youth with ASD, but future studies should assess the impact of pharmacological treatment and psychiatric comorbidities.
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Affiliation(s)
- Amparo Díaz-Román
- Mind, Brain and Behavior Research Center, University of Granada, Granada, Spain
| | - Junhua Zhang
- School of Education, Jiangsu Key Laboratory for Big Data of Psychology and Cognitive Science, Yancheng Teachers University, Yancheng, China
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
| | - Richard Delorme
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Anita Beggiato
- Unité de Génétique Humaine et Fonctions Cognitives, Département de Neuroscience, Institut Pasteur, Paris, Île-de-France, France
- Département de Psychiatrie de l’Enfant et de l’Adolescent, Hôpital Robert Debré, L’Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Samuele Cortese
- Center for Innovation in Mental Health, Academic Unit of Psychology, University of Southampton, Southampton, UK
- Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
- Solent NHS Trust, Southampton, UK
- New York University Child Study Center, New York City, New York, USA
- Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK
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Tangsuwansri C, Saeliw T, Thongkorn S, Chonchaiya W, Suphapeetiporn K, Mutirangura A, Tencomnao T, Hu VW, Sarachana T. Investigation of epigenetic regulatory networks associated with autism spectrum disorder (ASD) by integrated global LINE-1 methylation and gene expression profiling analyses. PLoS One 2018; 13:e0201071. [PMID: 30036398 PMCID: PMC6056057 DOI: 10.1371/journal.pone.0201071] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/06/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND The exact cause and mechanisms underlying the pathobiology of autism spectrum disorder (ASD) remain unclear. Dysregulation of long interspersed element-1 (LINE-1) has been reported in the brains of ASD-like mutant mice and ASD brain tissues. However, the role and methylation of LINE-1 in individuals with ASD remain unclear. In this study, we aimed to investigate whether LINE-1 insertion is associated with differentially expressed genes (DEGs) and to assess LINE-1 methylation in ASD. METHODS To identify DEGs associated with LINE-1 in ASD, we reanalyzed previously published transcriptome profiles and overlapped them with the list of LINE-1-containing genes from the TranspoGene database. An Ingenuity Pathway Analysis (IPA) of DEGs associated with LINE-1 insertion was conducted. DNA methylation of LINE-1 was assessed via combined bisulfite restriction analysis (COBRA) of lymphoblastoid cell lines from ASD individuals and unaffected individuals, and the methylation levels were correlated with the expression levels of LINE-1 and two LINE-1-inserted DEGs, C1orf27 and ARMC8. RESULTS We found that LINE-1 insertion was significantly associated with DEGs in ASD. The IPA showed that LINE-1-inserted DEGs were associated with ASD-related mechanisms, including sex hormone receptor signaling and axon guidance signaling. Moreover, we observed that the LINE-1 methylation level was significantly reduced in lymphoblastoid cell lines from ASD individuals with severe language impairment and was inversely correlated with the transcript level. The methylation level of LINE-1 was also correlated with the expression of the LINE-1-inserted DEG C1orf27 but not ARMC8. CONCLUSIONS In ASD individuals with severe language impairment, LINE-1 methylation was reduced and correlated with the expression levels of LINE-1 and the LINE-1-inserted DEG C1orf27. Our findings highlight the association of LINE-1 with DEGs in ASD blood samples and warrant further investigation. The molecular mechanisms of LINE-1 and the effects of its methylation in ASD pathobiology deserve further study.
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Affiliation(s)
- Chayanin Tangsuwansri
- M.Sc. Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Thanit Saeliw
- M.Sc. Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Surangrat Thongkorn
- M.Sc. Program in Clinical Biochemistry and Molecular Medicine, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Weerasak Chonchaiya
- Division of Growth and Development and Maximizing Thai Children’s Developmental Potential Research Unit, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Kanya Suphapeetiporn
- Center of Excellence for Medical Genetics, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
- Excellence Center for Medical Genetics, King Chulalongkorn Memorial Hospital, the Thai Red Cross Society, Bangkok, Thailand
| | - Apiwat Mutirangura
- Center of Excellence in Molecular Genetics of Cancer and Human Diseases, Department of Anatomy, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Tewin Tencomnao
- Age-related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Valerie Wailin Hu
- Department of Biochemistry and Molecular Medicine, The George Washington University School of Medicine and Health Sciences, Washington, DC, United States of America
| | - Tewarit Sarachana
- Age-related Inflammation and Degeneration Research Unit, Department of Clinical Chemistry, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand
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35
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The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities. J Clin Med 2018; 7:jcm7050102. [PMID: 29751511 PMCID: PMC5977141 DOI: 10.3390/jcm7050102] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Revised: 04/25/2018] [Accepted: 04/30/2018] [Indexed: 12/20/2022] Open
Abstract
Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.
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36
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Zuculo GM, Gonçalves BSB, Brittes C, Menna-Barreto L, Pinato L. Melatonin and circadian rhythms in autism: Case report. Chronobiol Int 2018; 34:527-530. [PMID: 28426389 DOI: 10.1080/07420528.2017.1308375] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Among the most co-occurring conditions in autism spectrum disorders (ASD), there are sleep disorders which may exacerbate associated behavioral disorders and lead to intensification of existing autistic symptoms. Several studies investigating the use of melatonin in the treatment of sleep disorders in ASD have shown comparative efficiency in sleep with little or no side effects. Here we report a case of ASD with non-24-hour rhythm and the effect of melatonin in circadian parameters by actigraphy. Visual analysis of the first 10 days recorded and the periodogram suggest that this patient showed a non-24-hour rhythm. This ASD subject showed before melatonin administration an activity/rest rhythm lower than 24 hours. The results show that melatonin increased approximately 4.7 times the regularity of circadian activity rhythm and resting staying on average between 00:00 and 06:00 and showed positive effects in improving the quality of sleep and behavior. So, the actigraphy showed an ASD subject with a non-24-hour activity/rest rhythm which changed this rhythm to a 24-hour rhythm after melatonin administration. This result reinforces the prospect of therapy with melatonin for synchronization (increased regularity) of endogenous rhythms and improve sleep quality and hence behavior and indicates the actigraphy as a choice tool to characterize several parameters of the activity/rest rhythm of ASD individuals.
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Affiliation(s)
| | - Bruno S B Gonçalves
- b Escola de Artes , Ciências e Humanidades - Universidade de São Paulo , São Paulo , Brazil
| | - Clay Brittes
- c Laboratório de Dificuldades e Distúrbios da Aprendizagem e Transtornos da Atenção-UNICAMP , Campinas , Brazil
| | - Luiz Menna-Barreto
- b Escola de Artes , Ciências e Humanidades - Universidade de São Paulo , São Paulo , Brazil
| | - Luciana Pinato
- a Universidade Estadual Paulista (UNESP) , Marília , Brazil
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37
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Abstract
Children with autism spectrum disorder (ASD) are at high risk for sleep disturbance and behavioral dysregulation. However, the relationships between these difficulties are not fully understood. The current study examined the relationships between specific types of sleep and behavioral problems among 81 children with ASD. Sleep problems were significantly associated with physical aggression, irritability, inattention, and hyperactivity. In multivariate analyses, distinct sets of sleep problems accounted for between 22 and 32 % of the variance in behavior problems across models. These results indicate that sleep disturbance is associated with behavioral dysregulation among children with ASD. Of note, night awakenings had the most consistently strong association with daytime behavior problems, even after controlling for the effects of age and sex.
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38
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Abel E, Kim SY, Kellerman AM, Brodhead MT. Recommendations for Identifying Sleep Problems and Treatment Resources for Children with Autism Spectrum Disorder. Behav Anal Pract 2016; 10:261-269. [PMID: 29021937 DOI: 10.1007/s40617-016-0158-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
Many young children experience sleep problems that may influence their daytime functioning. These sleep problems are especially prevalent in young children with autism spectrum disorder (ASD). Therefore, general recommendations for identifying and treating sleep problems in children with ASD are needed for behavior analysts to identify potential sleep problems and make empirically informed decisions regarding treatment options. The current paper seeks to provide behavior analysts, who work with children with ASD, with informative research on pediatric sleep problems, sleep measures, and options for behavioral sleep treatment.
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Affiliation(s)
- Emily Abel
- Purdue University, West Lafayette, IN 47907 USA
| | - So Yeon Kim
- Purdue University, West Lafayette, IN 47907 USA
| | | | - Matthew T Brodhead
- Department of Counseling, Educational Psychology, and Special Education, Michigan State University, East Lansing, MI 48824 USA
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39
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Santoro SD, Giacheti CM, Rossi NF, Campos LMG, Pinato L. Correlations between behavior, memory, sleep-wake and melatonin in Williams-Beuren syndrome. Physiol Behav 2016; 159:14-9. [DOI: 10.1016/j.physbeh.2016.03.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 02/26/2016] [Accepted: 03/02/2016] [Indexed: 01/12/2023]
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40
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Souza-Teodoro LH, Dargenio-Garcia L, Petrilli-Lapa CL, Souza EDS, Fernandes PACM, Markus RP, Ferreira ZS. Adenosine triphosphate inhibits melatonin synthesis in the rat pineal gland. J Pineal Res 2016; 60:242-9. [PMID: 26732366 DOI: 10.1111/jpi.12309] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2015] [Accepted: 01/04/2016] [Indexed: 12/15/2022]
Abstract
Adenosine triphosphate (ATP) is released onto the pinealocyte, along with noradrenaline, from sympathetic neurons and triggers P2Y1 receptors that enhance β-adrenergic-induced N-acetylserotonin (NAS) synthesis. Nevertheless, the biotransformation of NAS into melatonin, which occurs due to the subsequent methylation by acetylserotonin O-methyltransferase (ASMT; EC 2.1.1.4), has not yet been evaluated in the presence of purinergic stimulation. We therefore evaluated the effects of purinergic signaling on melatonin synthesis induced by β-adrenergic stimulation. ATP increased NAS levels, but, surprisingly, inhibited melatonin synthesis in an inverse, concentration-dependent manner. Our results demonstrate that enhanced NAS levels, which depend on phospholipase C (PLC) activity (but not the induction of gene transcription), are a post-translational effect. By contrast, melatonin reduction is related to an ASMT inhibition of expression at both the gene transcription and protein levels. These results were independent of nuclear factor-kappa B (NF-kB) translocation. Neither the P2Y1 receptor activation nor the PLC-mediated pathway was involved in the decrease in melatonin, indicating that ATP regulates pineal metabolism through different mechanisms. Taken together, our data demonstrate that purinergic signaling differentially modulates NAS and melatonin synthesis and point to a regulatory role for ATP as a cotransmitter in the control of ASMT, the rate-limiting enzyme in melatonin synthesis. The endogenous production of melatonin regulates defense responses; therefore, understanding the mechanisms involving ASMT regulation might provide novel insights into the development and progression of neurological disorders since melatonin presents anti-inflammatory, neuroprotective, and neurogenic effects.
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Affiliation(s)
| | - Letícia Dargenio-Garcia
- Laboratory of Chronopharmacology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | | | - Ewerton da Silva Souza
- Laboratory of Chronopharmacology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Pedro A C M Fernandes
- Laboratory of Chronopharmacology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Regina P Markus
- Laboratory of Chronopharmacology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
| | - Zulma S Ferreira
- Laboratory of Chronopharmacology, Biosciences Institute, University of São Paulo, São Paulo, Brazil
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