Abstract
BackgroundSleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress.MethodsHundred children with a diagnosis of ASD (mean age: 66.7 months, SD: 27.4, range: 24.7–152.1 months, n = 79 males) were included in the study. We collected data on sociodemographic, clinical, genetic and instrumental variables as well as comorbid conditions. Parents filled out the Questionnaire on sleep behavior in the first years of life, the BEARS questionnaire, and the Parenting Stress Index Short Form. From the analysis on sleep characteristics, we excluded 25 children treated with melatonin.ResultsFifty-seven (57%) out of 100 children met the criteria for insomnia. Sleep disorders were associated with developmental or cognitive delay, emotional and behavioral problems (such as anxiety problems and aggressive behaviors) and absence of strategies for inducing sleep after nocturnal awakenings. From parents' reports, sleep disorders had diurnal repercussions on their offspring; however, we found no statistical correlation between disturbances and family stress. Also, no significant correlation was found between sleep disturbances and epilepsy. Finally, a statistical correlation was found between the regular intake of melatonin and the resolution of insomnia.ConclusionsMultifactorial variables may be associated to insomnia that could have an impact on the children' behavior. Clinicians need to be aware of the value of screening for sleep disturbance in children with ASD to integrate sleep interventions in the treatment plan.
Highlights
Autism spectrum disorder (ASD) is a life-long neurodevelopmental condition affecting communication and social interaction across multiple contexts and it includes the presence of atypical and heterogeneous behaviors such as restricted and repetitive patterns of interests or activities manifesting with different degrees of severity; intellectual disability or global developmental delay does not explain it any better [1]
Sleep problems may be explained as the consequence of neurobiological and genetic alteration that result in sleep architecture disruption; for instance, abnormal expressions of several neurotransmitters implicated in sleep regulation [such as serotonin, melatonin [10–15], and gammaaminobutyric acid] [16, 17], and mutations in circadian-relevant genes as NR1D1, CLOCK, ARNTL2 [10], PER1-2-3 [18] have been reported in subjects with ASD
We got a written informed consent from parents and we conducted the study according to the Declaration of Helsinki which was approved by the Institutional Review Board of ASST Spedali Civili of Brescia (Comitato Etico di Brescia, ID number 4085 SLEEPASD)
Summary
Autism spectrum disorder (ASD) is a life-long neurodevelopmental condition affecting communication and social interaction across multiple contexts and it includes the presence of atypical and heterogeneous behaviors such as restricted and repetitive patterns of interests or activities manifesting with different degrees of severity; intellectual disability or global developmental delay does not explain it any better [1]. The most described insomnia [6] is onset insomnia or difficulty initiating sleep and sleep maintenance Besides insomnia, parasomnia such as sleepwalking, nightmare, pavor nocturnus and sleep apnea, enuresis, difficult awakening and daytime sleepiness are reported [7, 8]. Children with ASD seem to have a greater vulnerability to sleep problems, the pathophysiology of these difficulties remains unclear. Sleep problems may themselves be a core aspect of ASD related to the specific characteristics of the autism. Sleep disturbances are common in children affected by Autism Spectrum Disorder (ASD). The aim of our study was to describe sleep characteristics and disturbances in children with ASD, to evaluate possible related factors, and to assess parental stress
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