Atypical sleep architecture and the autism phenotype

Abstract

A growing body of evidence indicates that people with autism frequently experience sleep disorders and exhibit atypical sleep architecture. In order to establish whether sleep disorders truly belong to the autism spectrum disorder (ASD) phenotype, we conducted a subjective and objective study of sleep in a group of high-functioning adults with ASD but without sleep complaints, psychiatric disorders or neurological comorbidity. We compared the subjective data of 27 ASD participants with those of 78 healthy controls matched for chronological age and gender. Subjective measures of sleep in the clinical group were compatible with insomnia and/or a tolerable phase advance of the sleep-wake cycle. Subjective data were confirmed by objective laboratory sleep recordings in a subset of 16 patients and 16 controls. Persons with autism presented with a longer sleep latency (P < 0.04), more frequent nocturnal awakenings (P < 0.03), lower sleep efficiency (P < 0.03), increased duration of stage 1 sleep (P < 0.02), decreased non-REM sleep (stages 2 + 3 + 4, P < 0.04) and slow-wave sleep (stages 3 + 4, P < 0.05), fewer stage 2 EEG sleep spindles (P < 0.004), and a lower number of rapid eye movements during REM sleep (P < 0.006) than did control participants. On clinical scales, the scores of persons with ASD on the Beck Depression Inventory were similar to those of persons without, but their trait anxiety scores on the Spielberger Anxiety Scale were higher (P < 0.02). The state anxiety scores of the Spielberger scale and cortisol levels were the same in the two groups. Objective total sleep time correlated negatively with the Social (-0.52, P < 0.05) and Communication (-0.54, P < 0.02) scales of the Autism Diagnostic Interview-Revised. The sleep of clinical subgroups (10 with high-functioning autism, six with Asperger syndrome) did not differ, except for the presence of fewer EEG sleep spindles in the Asperger syndrome subgroup (P < 0.05). In conclusion, these findings indicate that atypicalities of sleep constitute a salient feature of the adult ASD phenotype and this should be further investigated in younger patients. Moreover, the results are consistent with an atypical organization of neural networks subserving the macro- and microstructure of sleep in ASD. We are furthering this research with quantified analysis of sleep EEG.

Complementary and Alternative Medicine in Autism: An Evidence-Based Approach to Negotiating Safe and Efficacious Interventions with Families

“…53 Children with ASD experience sleep disorders and atypical sleep architecture. 54 Low melatonin levels and abnormal melatonin synthesis in ASD have been reported, although the significance of this is currently unknown. 55 Melatonin has been found to be safe and effective in reducing sleep onset latency (SOL) in children with some primary and secondary sleep disorders.…”

Association of Per1 and Npas2 with autistic disorder: support for the clock genes/social timing hypothesis

“…[45][46][47][48] They also extend to the reciprocity/temporal synchrony skills required for conversation. [49][50][51][52] Objectively recorded atypical sleep architecture in young adults with high-functioning autism and Asperger syndrome 53 and in children with autistic disorder 54 shows association between sleep profiles and autistic symptomatology. 53,54 Circadian hormone (melatonin) anomalies are found in autistic disorder [55][56][57] as well as altered serotonin levels in autism.…”

“…[49][50][51][52] Objectively recorded atypical sleep architecture in young adults with high-functioning autism and Asperger syndrome 53 and in children with autistic disorder 54 shows association between sleep profiles and autistic symptomatology. 53,54 Circadian hormone (melatonin) anomalies are found in autistic disorder [55][56][57] as well as altered serotonin levels in autism. 58,59 An altered circadian clock mechanism affecting normal sleep wake cycles could have an effect on the levels of these hormones that is additional to any other specific transport and reuptake effects.…”

“…all are relevant to aspects of autism: sleep, 53,54 memory [32][33][34][35]73,74 and communicative timing 50,52 ).…”

Transition to Adulthood for High-Functioning Individuals with Autism Spectrum Disorders

“…Instead, daily living skills -perhaps more so than other types of adaptive behaviors -play a significant role in having friendships, employment or education typical of one's cognitive abilities, and general independence (Farley et al, 2009). Many adolescents and adults with ASD have difficulties with life skills such as cleaning, cooking, and hygiene (Balfe & Tantam, 2010) or other aspects of daily living such as sleeping (Limoges et al, 2005;Oyane & Bjorvatn, 2005), healthy or flexible eating, managing money, shopping, and driving or taking public transportation (Geller & Greenberg, 2010) . Poor physical quality of life appears common and may contribute to this phenomenon beyond social naïveté or lack of motivation, as many report dependence on medical treatment or pain and discomfort that can limit energy, work capacity, and other activities of daily living (Jennes-Coussens et al, 2006).…”