Sleep Architecture and NREM Alterations in Children and Adolescents with Asperger Syndrome

Bruni, Oliviero; Ferri, Raffaele; Vittori, Elena; Novelli, Luana; Vignati, Manuela; Porfirio, Maria Cristina; Aricò, Debora; Bernabei, Paola; Curatolo, Paolo

doi:10.1093/sleep/30.11.1577

Cited by 94 publications

(49 citation statements)

References 36 publications

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“…Although we could not show any difference between children with ASD with and without learning difficulties, disturbed sleep patterns in ASD do appear to be different from those seen in children with intellectual disabilities 28 29. We speculate that such widespread and early effects on sleep duration reflect an underlying shared neuropathological basis between autism and disturbances of the biological clock 29 30.…”

Section: Discussioncontrasting

confidence: 67%

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study

Humphreys

Gringras

Blair

et al. 2013

Archives of Disease in Childhood

155

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ObjectiveTo investigate longitudinal sleep patterns in children with autistic spectrum disorders (ASDs).Study designProspective longitudinal study using Avon Longitudinal Study of Parents and Children, an English cohort born in 1991–1992. Parental reports of sleep duration were collected by questionnaires at 8 time points from 6 months to 11 years. Children with an ASD diagnosis at age 11 years (n=73) were identified from health and education records.ResultsFrom aged 30 months to 11 years old, children with ASD slept for 17–43 min less each day than contemporary controls. No significant difference in total sleep duration was found in infancy, but from 30 months of age children with ASD slept less than their peers, a difference that remained significant after adjusting for sex, ethnicity, high parity and epilepsy. The reduction in total sleep was wholly due to changes in night rather than daytime sleep duration. Night-time sleep duration was shortened by later bedtimes and earlier waking times. Frequent waking (3 or more times a night) was also evident among the children with ASD from 30 months of age. Age-specific decreases of >1SD within individuals in sleep duration across adjacent time points was a predictor of ASD between 18 months and 30 months of age (p=0.04) and from 30 months to 42 months (p=0.02).ConclusionsSleep duration in children with ASD is reduced from 30 months of age and persists until adolescence.

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Section: Discussioncontrasting

confidence: 67%

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study

Humphreys

Gringras

Blair

et al. 2013

Archives of Disease in Childhood

155

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“…Evidence has suggested that inadequate sleep in children with ASD tends to be associated with emotional/behavioral dysregulation (e.g., hyperactivity) rather than with daytime sleepiness [12]. However, not all previous studies supported this finding [4,5,15,49]. Further studies might want to examine differences in daytime sleepiness between children with ASD and typically developing children.…”

Section: Discussionmentioning

confidence: 93%

“…Sleep disturbances are the most frequent comorbid conditions for children with ASD [2]. Sleep disturbances are linked to a wide range of negative outcomes, including worsened autistic symptoms, impairments in cognitive and daily functioning in children with ASD [3][4][5][6], and elevated mental problems in their parents [7][8][9]. Furthermore, both cross-sectional [10] and longitudinal [11] evidence suggest that sleep disturbances in children with ASD can persist throughout childhood into later life.…”

Section: Introductionmentioning

confidence: 99%

Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study

Wang

Liu

et al. 2015

Child Psychiatry Hum Dev

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Sleep disturbances in children with autism spectrum disorder (ASD) exist worldwide, but little is known about this issue in non-Western cultures. This study aimed to characterize sleep disturbances in Chinese children with ASD and to examine associated sociodemographic factors and emotional/behavioral problems. Parents of 60 Chinese children with ASD (aged 6-17 years) from Shenzhen, China completed the Children's Sleep Habits Questionnaire (CSHQ), and the Strengths and Difficulties Questionnaire (SDQ). Sleep disturbances were severe and common, with rates of 70.0% for overall disturbances and 15.0% (daytime sleepiness) to 40.0% (sleep duration) for specific domains. The severity and rate of sleep disturbances were higher compared to previous studies in typically developing children from the same region of China and American children with ASD, respectively. Further, there were significant correlations between most CSHQ and SDQ domains. Female gender, older parental age, higher hyperactivity, and poorer prosocial behavior were associated with increased overall sleep disturbances.

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“…[36,40] Microstructure alterations of REM sleep (immaturity in the organization of eye movements into discrete bursts, increased muscle twitches during REM sleep) are recurrent findings; conversely, NREM sleep microstructure alterations, disclosed by cyclic alternating pattern analysis, seem to be related to mental retardation and not to ASD itself. [36,41] The REM sleep microstructure alterations might reflect a serotoninergic and dopamine dysfunction of pontine tegmentum activity, causing a reduced ability to organize new information in a coherent system. [38,40,42,43] Moreover, the high percentage of undifferentiated sleep, the alterations in spindle activity (higher in children and lower in adults with autism), and the occurrence of epileptiform discharges during sleep are considered signs of immaturity of cortical activity and of cortical disinhibition.…”

Section: Sleep Polysomnographic Studiesmentioning

confidence: 99%

Epidemiology and Management of Insomnia in Children with Autistic Spectrum Disorders

Miano

Ferri

2010

Pediatric Drugs

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Insomnia is the predominant sleep concern in children with autistic spectrum disorder (ASD), and its nature is most likely multifactorial, with neurochemical (abnormalities in serotonergic transmission or melatonin levels), psychiatric (anxiety), and behavioral (poor sleep habits) etiological factors involved. Children with ASD experience sleep problems similar to those of typically developing children, although the prevalence is markedly higher, occurring in 44-83% of school-aged children with ASD. Caregivers usually report that insomnia is the most frequent sleep disorder, described as disorders of initiating and maintaining sleep, restless sleep, bedtime resistance, co-sleeping, alterations of sleep hygiene, and early awakenings in the morning. Many actigraphic studies have added information on sleep disorders, confirming the questionnaire findings in the majority of cases. There are relatively few polysomnographic data for ASD, compared with questionnaire studies, and most of these studies reported a reduction in total sleep time and more undifferentiated sleep in the youngest patients. These findings were associated with several sleep microstructure alterations during rapid eye movement (REM) sleep, and with non-REM (NREM) sleep microstructure changes that appeared to be related to cognitive impairment rather than to the autistic core. Moreover, few data about other less frequent sleep disorders, such as periodic limb movements disorder and obstructive sleep apnea syndrome, bruxism, and the influence of epilepsy and EEG abnormalities, are available. Both pharmacologic and behavioral interventions have been suggested for the treatment of sleep problems in autistic children. The most common types of behavioral interventions are complete extinction (removing reinforcement to reduce a behavior) and various forms of graduated extinction. Melatonin has shown promising results in the treatment of insomnia in children with ASD. Although controlled studies are limited, there are more data demonstrating the safety and effectiveness of melatonin in ASD than for other sedative/hypnotic drugs. Finally, a dual treatment for insomnia in ASDs with melatonin and behavioral techniques has been suggested. A recent study using a combination of genetic and functional experimental techniques reported evidence that low melatonin concentration caused by a primary deficit in acetylserotonin methyltransferase activity is a risk factor for ASD. Sleep problems usually start at the same age as developmental regression, suggesting a higher vulnerability at this period of life. Further studies, beginning at younger ages, are necessary to better investigate these aspects and the role of melatonin in insomnia in children with ASD.

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Sleep Architecture and NREM Alterations in Children and Adolescents with Asperger Syndrome

Abstract: This study shows peculiar CAP modifications in children with AS and represents an attempt to correlate the quantification of sleep EEG oscillations with the degree of mental ability/disability.

Cited by 94 publications

References 36 publications

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study

Sleep patterns in children with autistic spectrum disorders: a prospective cohort study

Sleep Disturbances and Associated Factors in Chinese Children with Autism Spectrum Disorder: A Retrospective and Cross-Sectional Study

Epidemiology and Management of Insomnia in Children with Autistic Spectrum Disorders

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