Relationship Between Sleep and Behavior in Autism Spectrum Disorder: Exploring the Impact of Sleep Variability.

Abigail Bangerter,Robert Hendren,Matthew S Goodwin,Geraldine Dawson,Anna Esbensen,Seth Ness,David Lewin,Meenakshi Chatterjee,Matthew Boice,Frederick Shic,Gahan Pandina,Bennett Leventhal,Nikolay V Manyakov,Andrew Skalkin

doi:10.3389/fnins.2020.00211

Abstract

ObjectiveThe relationship between sleep (caregiver-reported and actigraphy-measured) and other caregiver-reported behaviors in children and adults with autism spectrum disorder (ASD) was examined, including the use of machine learning to identify sleep variables important in predicting anxiety in ASD.MethodsCaregivers of ASD (n = 144) and typically developing (TD) (n = 41) participants reported on sleep and other behaviors. ASD participants wore an actigraphy device at nighttime during an 8 or 10-week non-interventional study. Mean and variability of actigraphy measures for ASD participants in the week preceding midpoint and endpoint were calculated and compared with caregiver-reported and clinician-reported symptoms using a mixed effects model. An elastic-net model was developed to examine which sleep measures may drive prediction of anxiety.ResultsPrevalence of caregiver-reported sleep difficulties in ASD was approximately 70% and correlated significantly (p < 0.05) with sleep efficiency measured by actigraphy. Mean and variability of actigraphy measures like sleep efficiency and number of awakenings were related significantly (p < 0.05) to ASD symptom severity, hyperactivity and anxiety. In the elastic net model, caregiver-reported sleep, and variability of sleep efficiency and awakenings were amongst the important predictors of anxiety.ConclusionCaregivers report problems with sleep in the majority of children and adults with ASD. Reported problems and actigraphy measures of sleep, particularly variability, are related to parent reported behaviors. Measuring variability in sleep may prove useful in understanding the relationship between sleep problems and behavior in individuals with ASD. These findings may have implications for both intervention and monitoring outcomes in ASD.

Highlights

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and presence of restrictive and repetitive behaviors and interests (American Psychiatric Association [APA], 2013)
Prevalence of caregiver-reported sleep difficulties in ASD was approximately 70% and correlated significantly (p < 0.05) with sleep efficiency measured by actigraphy
In the elastic net model, caregiver-reported sleep, and variability of sleep efficiency and awakenings were amongst the important predictors of anxiety

Summary

Introduction

Autism spectrum disorder (ASD) is a neurodevelopmental disorder characterized by impairments in social communication and presence of restrictive and repetitive behaviors and interests (American Psychiatric Association [APA], 2013). Many individuals with ASD have co-occurring mental health problems, such as obsessive/compulsive behaviors, aggression, self-injury, mood swings, hyperactivity and concentration issues, anxiety, and sleep disorders (Anagnostou et al, 2015). These difficulties coexist with core diagnostic symptoms and impact overall functioning, quality of life, and treatment outcomes for individuals with ASD. The prevalence of sleep problems in ASD is reported to be between 50 and 80% (Malow et al, 2006; Richdale and Schreck, 2009; Hollway et al, 2013). A recent meta-analysis of studies in adults with ASD showed increased prevalence of reported sleep problems compared to TD groups in both subjective and objective measures (Morgan et al, 2019)

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Discussion

Conclusion