The Sensory Abnormality Mediated Partially the Efficacy of Repetitive Transcranial Magnetic Stimulation on Treating Comorbid Sleep Disorder in Autism Spectrum Disorder Children

Abstract

Sleep disorder emerges as a common comorbidity in children with autism spectrum disorder (ASD), and the interaction between the core symptoms of ASD and its sleep disorder remains unclear. Repetitive transcranial magnetic stimulation (rTMS) was used on the bilateral dorsolateral prefrontal cortex (DLPFC) to investigate the efficacy of rTMS on the core symptoms of ASD and comorbid sleep problems as well as the mediation role of the ASD symptoms between rTMS intervention and sleep improvement. A total of 41 Chinese children with ASD and who met the criteria in the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders were recruited, and 39 of them (mean age: 9.0 ± 4.4 years old; the male–female ratio was 3.9: 1) completed the study with the stimulating protocol of high frequency on the left DLPFC and low frequency on the right DLPFC. They were all assessed three times (before, at 4 weeks after, and at 8 weeks after the stimulation) by the Children's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), Childhood Autism Rating Scale, Repetitive Behavior Questionnaire-2, and Short Sensory Profile (SSP). The repeated-measures ANOVA showed that the main effect of “intervention time” of CSHQ (F = 25.103, P < 0.001), SSP (F = 6.345, P = 0.003), and SDQ (F = 9.975, P < 0.001) was statistically significant. By Bayesian mediation analysis, we only found that the total score of SSP mediated the treating efficacy of rTMS on CSHQ (αβ = 5.11 ± 1.51, 95% CI: 2.50–8.41). The percentage of mediation effect in total effect was 37.94%. Our results indicated the treating efficacy of rTMS modulation on bilateral DLPFC for both autistic symptoms and sleep disturbances. The sensory abnormality of ASD mediated the improvement of rTMS on sleep problems of ASD.

Exploring the Effects of Repetitive Transcranial Magnetic Stimulation on CoMorbid Sleep Disorders in Preschool Children with Attention-Deficit Hyperactivity Disorder

“… 19 , 27 In summary, low-frequency rTMS stimulation of the right DLPFC has been shown to have an intervention effect by modulating the anterior cingulated cortex connectivity in the meso-cortical-limbic circuit and the GABAergic and glutamatergic circuitries. 28 , 29 , 30 rTMS has not been used for a long time in the treatment of ADHD and its comorbidities, but reports of adverse side effects of rTMS are uncommon. Occasionally, pressure and allergies due to the device being worn on the head have been reported.…”

“… 9 , 17 , 19 Repetitive transcranial magnetic stimulation has been shown to be effective for SD in adult patients with ADHD and comorbid SD in children with autism spectrum disorders. 19 , 20 , 21 , 32 Therefore, it is a promising approach to SD intervention for children, especially preschool (4-6 years) children with ADHD. 22 …”

Efficacy of auricular plaster therapy for sleep disorders in preschool children with autism spectrum disorders: Study protocol for a randomized controlled trial

“…The consequences of abnormal behavior during the day can negatively impact the quality of sleep, resulting in a vicious cycle. Additionally, sleep disorders have a greater impact on obesity, injuries, and attention deficit in children with ASD than in other children ( 11 , 65 , 66 ).…”

Repetitive transcranial magnetic stimulation for insomnia in patients with autism spectrum disorder: Study protocol for a randomized, double-blind, and sham-controlled clinical trial

“…The right DLPFC is known as one part of the socially related brain areas, plays a crucial role in the integration of goals and the reward system, has been found the weak responses in ASDs and selected for treating primary insomnia with good effects ( 23 , 24 ). In addition, another study using 25% MT for the treatment of ASD found that it could alleviate sleep disturbances with little adverse effects ( 29 ). In this ongoing clinical trial, 1 Hz rTMS at 50% RMT (50 trains of 30 pulses, with a 3-s interval between each, leading to a sum of 1,500 pulses) will be applied over the right DLPFC.…”

“…However, the implications of rTMS for insomnia in ASD patients have not been fully established. Only one study indicated that rTMS can alleviate sleep disturbances in ASD, which were assessed by the Children's Sleep Habits Questionnaire (CSHQ) ( 29 ). No randomized, double-blind, controlled studies were conducted to evaluate the efficacy of rTMS for insomnia through objective assessments such as PSG or actigraphy.…”