Sleep Problems In Individuals Research Articles

The sleep problems in individuals with Rett syndrome and their caregivers

Sleep problems are prevalent among individuals with Rett syndrome. We aimed to investigate sleep problems in individuals with Rett syndrome and their caregivers. A total of 29 participants diagnosed with Rett syndrome and their respective 29 caregivers were included. The Children Sleep Habits Questionnaire (CSHQ), the Pittsburgh Sleep Quality Index (PSQI), the Center for Epidemiologic Studies Depression Scale (CES-D), and the actigraphy data collected from Actiwatch 2 were used to investigate the change of sleep pattern. Based on the CSHQ questionnaire, 75.9% (22/29) of the patients reported sleep disturbances. The younger patients exhibited higher CSHQ scores. Actigraphy data revealed that both young and older patients had short total sleep duration, low sleep efficiency, long sleep-onset latency, long awaking duration, and fragmented sleep. The caregivers reported significantly higher PSQI scores, mildly declined sleep efficiency, and shorter total sleep duration in the actigraphy study. Associations were identified between smaller head circumference and shorter total sleep duration, more severe motor dysfunction and longer wake after sleep onset, worsen scoliosis and more awakenings per night. Sleep efficiency was inversely associated with epilepsy and positively associated with somatic growth. Sleep disturbances are common and should be investigated in individuals with Rett syndrome and their caregivers. Lay abstract Sleep problems are common and impactful among individuals with Rett syndrome (RTT) and their caregivers. We examined the sleep patterns of 29 RTT patients and their primary caregivers using various assessment tools. The study found that a majority of the patients experienced sleep disturbances, with younger patients showing more sleep difficulties. Caregivers also reported poor sleep quality. The findings emphasize the need to address sleep problems in RTT management, as improving sleep quality can positively impact the well-being of individuals with RTT and their caregivers.

The Relationship between Stress Levels and Excessive Daytime Sleepiness in Final Year Students of the Faculty of Nursing, University of Riau

Final year students are prone to experiencing stress as a result of the pressure or burden they experience. Stressful conditions can cause sleep problems in individuals, one of which is Excessive Daytime Sleepiness. EDS is a feeling of excessive sleepiness during the day. The purpose of this study was to determine the relationship between stress levels and the incidence of Excessive Daytime Sleepiness in final year students of the Faculty of Nursing, University of Riau. This study uses a type of quantitative research with a correlation research design and a cross sectional approach. The study was conducted on 105 respondents, namely final year students at the Faculty of Nursing, University of Riau with a sampling technique using proportional random sampling. The research instrument used a questionnaire sheet. The analysis used was univariate and bivariate analysis using the Pearson Chi Square test. The results of the bivariate statistical test showed that there was a relationship between stress levels and the incidence of Excessive Daytime Sleepiness in final year students of the Faculty of Nursing, University of Riau with a p value of 0.000 α (0.05). There is a relationship between stress levels and the incidence of Excessive Daytime Sleepiness in students of the Faculty of Nursing, University of Riau. It is expected that students can control stressful events to avoid Excessive Daytime Sleepiness.

Prevalence of sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD across the lifespan: a Swedish nationwide register-based study

BackgroundConsistent evidence suggests a strong association between attention-deficit/hyperactivity disorder (ADHD) and subjectively reported sleep problems. However, the prevalence of clinically ascertained sleep disorder diagnoses and sleep medication prescriptions in individuals...

Evaluation of Depression, Anxiety and Sleep Quality Scores in Patients with Cervical Disc Herniation: A Study Conducted in Turkey

Aim: Neck pain is one of the most prevalent medical complaints. Chronic pain conditions can lead to
 depression, anxiety and sleep problems in individuals. Thus, both the pain itself and the psychiatric
 problems it causes impair the quality of life of the patient. Depression and anxiety can also cause changes
 in the perception of pain. In this study, we aimed to investigate the effects of cervical disc herniation (CDH),
 which causes chronic neck pain, on the level of neck disability, sleep quality, anxiety and depression.
 Material and Methods: Patients’ pain intensity, neck disability indexes, depression and anxiety status,
 and sleep quality were evaluated using a visual analog scale (VAS), the neck disability index (NDI),
 Beck Depression Inventory (BDI), beck anxiety inventory (BAI) and the Pittsburgh Sleep Quality Index
 (PSQI), respectively.
 Results: We found a statistically significant relationship between CDH and anxiety, depression and sleep
 quality. In addition, we found higher levels of pain, anxiety and depression in the group with poor sleep
 quality.
 Conclusion: For optimal treatment approaches of patients with chronic neck pain, accompanying sleep
 disorder, depression and anxiety should also be evaluated.

Risk Perception, Perceived Government Coping Validity, and Individual Sleep Problems in the Early Stage of the COVID-19 Pandemic in China: Mediation Analysis Based on Negative Emotions

This study aimed to investigate the relationship among risk perception, negative emotions, perceived government coping validity, and the sleep problem of the public, through regression analysis and mediation analysis of data from the early stages of the COVID-19 outbreak in China (three months after the outbreak). It found that people's perception of the risk of the pandemic, negative emotions, and perceived government coping validity significantly affected people's sleep quality and nightmares. Further analysis found that individuals' perception of risk not only affected their sleep but also intensified their negative emotions, ultimately impairing the quality of their sleep and leading to nightmares. However, having a high level of coping validity can mitigate negative emotions and consequently decrease the occurrence of nightmares, thereby enhancing the quality of sleep. Specifically, perceived government coping validity could not only directly reduce nightmares, but also indirectly reduce nightmares by lowering negative emotions. However, it could only indirectly improve sleep by reducing negative emotions. It implicated that improving and resolving sleep problems required not only medical intervention but also psychological intervention. Simultaneously, improving the government's response effectiveness could strengthen people's trust in the government, stabilize their mental states, and significantly improve their quality of life by reducing negative emotions and improving sleep.

0642 Characterizing Actigraphy-Measured Sleep Disturbance in Veterans and Service Members with Post-traumatic Headache following Mild Traumatic Brain Injury

Abstract Introduction Post-traumatic headache (PTH) frequently occur following traumatic brain injury (TBI) is particularly prevalent in Veterans with deployment-related TBI. PTH is associated with a range of physical and mental health symptoms, including post-traumatic stress disorder (PTSD), depression, anxiety, post-concussive symptoms, and subjective sleep complaints. Subjective sleep disturbance is associated with greater pain severity, and headaches (HA) are associated with poorer sleep. Poor sleep may be a mechanism by which PTH exerts both direct and indirect effects on health outcomes Despite the high prevalence of sleep problems in individuals with PTH, we know little about sleep disturbance in Veterans and military personnel with PTH. This study sought to characterize the relationship between objective sleep disturbance and HA in Veterans and military personnel with chronic PTH following mild TBI. Methods Veterans and active-duty service members (N=39, Mage= 49.4, 89.7% male) were included from a larger study evaluating prazosin as prophylactic treatment for persistent PTH. Participants completed baseline measures of PTSD symptoms, insomnia, sleep quality, HA frequency and impairment, as well as 7-day actigraphy, sleep diary, and HA logs. Actigraphy-derived sleep parameters include sleep onset latency (SOL), total sleep time (TST), sleep efficiency (SE), and wake after sleep onset (WASO). Daily HA logs were used to assess HA severity and duration. Analyses were conducted in SPSS 26.0 using multilevel modeling, controlling for the effects of time. Results Preliminary results suggest number of HA days at baseline was significantly associated with self-reported sleep quality (r=-.398, p= .016), but not with subjective SOL, TST, or WASO. Number of HA days was significantly correlated with actigraphy-measured WASO (r=.178, p=.003). Actigraphy-measured SOL, SE, WASO, and TST were not significantly associated with same-day HA severity and duration. Conclusion This preliminary data suggest examination of sleep fragmentation may be important in enhancing our understanding of PTH and related impairment. Findings support the importance of using both subjective and objective measures in the assessment of sleep in Veterans and service members with PTH. Support (If Any) This project was supported by a VA Career Development Award 5IK2RX001136 from the United States Department of Veterans Affairs Rehabilitation Research and Development Service. The contents of this work do not represent the views of the Department of Veterans Affairs or the United States government.

He effects of neurofeedback on attention and sleep in individuals with and without ADHD or insomnia: a literature review

Electroencephalography-Neurofeedbacktraining (E-NFT) is a method to support subjects in learning to self-regulate their own brain activity. Besides that E-NFT may improve cognitive functions in healthy people, it may improve symptoms in different disorders, such as Attention Deficit and Hyperactivity Disorder (ADHD) and insomnia. The evidence of E-NFT for the treatment of attention problems in ADHD is still under debate just as the suggested efficacy of E-NFT for reducing sleep problems in individuals suffering from insomnia and for improving attention and sleep in the general population. Therefore, this review examines the efficacy of E-NFT on attention and sleep in patients and healthy individuals. The reviewed literature provides evidence that standard E-NFT protocols may have a positive long-lasting effect on the inattention and hyperactivity/impulsivity symptoms in children with ADHD. In healthy children and young adults, E-NFT has been found to improve different aspects of attention and to reduce impulsivity. In addition, positive effects of E-NFT have been documented on sleep onset latency and on tiredness in healthy individuals. Sleep improvements have also been found in insomnia patients after standard E-NFT, although these subjective sleep improvements may likely depend on unspecific E-NFT training effects.

Evaluating Sleep Disturbances in Children With Rare Genetic Neurodevelopmental Syndromes

BackgroundAdequate sleep is important for proper neurodevelopment and positive health outcomes. Sleep disturbances are more prevalent in children with genetically determined neurodevelopmental syndromes compared with typically developing counterparts. We characterize sleep behavior in Rett (RTT), Angelman (AS), and Prader-Willi (PWS) syndromes to identify effective approaches for treating sleep problems in these populations. We compared sleep-related symptoms across individuals with these different syndromes with each other, and with typically developing controls. MethodsChildren were recruited from the Rare Diseases Clinical Research Network consortium registries; unaffected siblings were enrolled as related controls. For each participant, a parent completed multiple sleep questionnaires including Pediatric Sleep Questionnaire (Sleep-Disordered Breathing), Children's Sleep Habits Questionnaire (CSHQ), and Pediatric Daytime Sleepiness Scale. ResultsSleep data were analyzed from 714 participants, aged two to 18 years. Young children with AS had more reported sleep problems than children with RTT or PWS. Older children with RTT had more reported daytime sleepiness than those with AS or PWS. Finally, all individuals with RTT had more evidence of sleep-disordered breathing when compared with individuals with PWS. Notably, typically developing siblings were also reported to have sleep problems, except for sleep-related breathing disturbances, which were associated with each of the genetic syndromes. ConclusionsIndividuals with RTT, AS, and PWS frequently experience sleep problems, including sleep-disordered breathing. Screening for sleep problems in individuals with these and other neurogenetic disorders should be included in clinical assessment and managements. These data may also be useful in developing treatment strategies and in clinical trials.

Attention-deficit/hyperactivity disorder symptoms and sleep problems in preschool children: the role of autistic traits

BackgroundSleep problems are elevated in children with attention-deficit/hyperactivity disorder (ADHD). However, until now there has been comparatively little research on the role of autistic traits in this association. The current study examined the association between ADHD symptoms and sleep problems in Japanese preschool children and whether autistic traits might also be important for this relationship. MethodsData were analyzed from 1053 children (average age 64.14 months, range 58–71; 50.3% male) that were drawn from the Tama Children's Survey (TCS). Parent-reported information was obtained on ADHD symptoms using the Strengths and Difficulties Questionnaire (SDQ) and autistic traits with the Social Responsiveness Scale Second Edition (SRS-2). Parents also provided information on three different categories of sleep problems experienced by their children – parasomnias, sleep disordered breathing and awakening/daytime problems. Ordinal logistic regression analysis was used to examine the associations. ResultsIn analyses adjusted for sociodemographic factors, the mother's mental health and child's emotional problems, compared to children with no ADHD symptoms or autistic traits, children with only ADHD symptoms had significantly increased odds for only one of 11 individual sleep problems – waking in a negative mood. In contrast, children with comorbid ADHD symptoms and autistic traits had elevated odds for five sleep problems with odds ratios ranging from 2.10 (takes time to become alert in the morning) to 3.46 (excessive body movement while sleeping). ConclusionsSleep problems may be especially elevated in children with comorbid ADHD symptoms and autistic traits.

Sleep Problems in Children with ASD and Gene Disrupting Mutations

Sleep difficulties are pervasive in autism spectrum disorder (ASD), yet how sleep problems relate to underlying biological mechanisms such as genetic etiology is unclear, despite recent reports of profound sleep problems in children with ASD-associated de novo likely gene disrupting (dnLGD) mutations, CHD8, DYRK1A, and ADNP. We aimed to inform etiological contributions to ASD and sleep by characterizing sleep problems in individuals with dnLGD mutations. Participants (N = 2886) were families who completed dichotomous questions about sleep problems within a medical history interview for their child with ASD (age 3-28 years). Confirmatory factor analyses compared between those with ASD and a dnLGD mutation and those with idiopathic ASD (i.e., no known genetic event, NON) highlighted four domains (sleep onset, breathing issues, nighttime awakenings, and daytime tiredness) with sleep onset as a strong factor for both groups. Overall, participant predictors indicated that internalizing behavioral problems and lower cognitive scores were related to increased sleep problems. Internalizing problems were also related to increase nighttime awakenings in the dnLGD group. As an exploratory aim, patterns of sleep issues are described for genetic subgroups with unique patterns including more overall sleep issues in ADNP (n = 19), problems falling asleep in CHD8 (n = 22), and increased daytime naps in DYRK1A (n = 23). Implications for considering genetically defined subgroups when approaching sleep problems in children with ASD are discussed.

Sleep problems in children with autism spectrum disorder and typical development

Although higher sleep problems have been mostly reported in children with autism spectrum disorder (ASD) compared with typically developing (TD) children, particularly in Western countries, such evidence is relatively scarce in developing countries. We therefore investigated sleep difficulties in Thai children aged 3-16years with ASD compared with age- and gender-matched TD children by using the Children's Sleep Habits Questionnaire (CSHQ)-Thai version. Sixty-five children with ASD (mean age 97.7, SD 44.5months; boys 70.8%) and 65 TD individuals (mean age 98.5, SD 43.5months) were enrolled at a university-based hospital in Bangkok. Background characteristics, sleep duration variables, and the CSHQ were completed by the participants' parents. The CSHQ subscales and total score between children with ASD and TD controls were then compared. Children with ASD were more likely to have longer sleep latency than TD individuals for both weekdays and the weekend. Those with ASD had higher CSHQ subscales including bedtime resistance, sleep onset delay, sleep anxiety, and night waking in addition to the CSHQ total scores than TD controls. In the ASD group, those who took psychostimulants for treatment of ADHD had lower scores on the sleep duration subscale compared with unmedicated individuals. Sleep difficulties were more prevalent in children with ASD compared with TD individuals. Parents should be advised to be aware of sleep problems in individuals with ASD. As such, sleep disturbances will be identified early, resulting in appropriate management and improved quality of life, not only for those with ASD but also their families.

Acceptance and Commitment Therapy (ACT) Improves Sleep Quality, Experiential Avoidance, and Emotion Regulation in Individuals with Insomnia-Results from a Randomized Interventional Study.

Insomnia is a common problem in the general population. To treat insomnia, medication therapies and insomnia-related cognitive-behavioral interventions are often applied. The aim of the present study was to investigate the influence of acceptance and commitment therapy (ACT) on sleep quality, dysfunctional sleep beliefs and attitudes, experiential avoidance, and acceptance of sleep problems in individuals with insomnia, compared to a control condition. A total of 35 participants with diagnosed insomnia (mean age: 41.46 years old; 62.9% females) were randomly assigned to the ACT intervention (weekly group therapy for 60–70 min) or to the active control condition (weekly group meetings for 60–70 min without interventional and psychotherapeutic character). At baseline and after eight weeks (end of the study), and again 12 weeks later at follow-up, participants completed self-rating questionnaires on sleep quality, dysfunctional beliefs and attitudes about sleep, emotion regulation, and experiential avoidance. Furthermore, participants in the intervention condition kept a weekly sleep log for eight consecutive weeks (micro-analysis). Every morning, participants completed the daily sleep log, which consisted of items regarding subjective sleep duration, sleep quality, and the feeling of being restored. Sleep quality, dysfunctional beliefs and attitudes towards sleep, emotion regulation, and experiential avoidance improved over time, but only in the ACT condition compared to the control condition. Improvements remained stable until follow-up. Improvements in experiential avoidance were related to a favorable change in sleep and cognitive-emotional processing. Micro-analyses showed that improvements occurred within the first three weeks of treatment. The pattern of results suggests that ACT appeared to have improved experiential avoidance, which in turn improved both sleep quality and sleep-related cognitive-emotional processes at longer-term in adults with insomnia.

Individual and additive-effect relationships of sleep problems and severe menopausal symptoms among women in menopausal transition.

Sleep problems and menopausal symptoms are both common complaints among midlife women. However, the associations of the quality and quantity of sleep problems with the severity of menopausal symptoms have not been well studied. Thus, this study aims to examine the relationships between individual sleep problems and the additive number of sleep problems with severe menopausal symptoms among women during the menopausal transition. Using the convenience sampling, a total of 848 middle-aged women in China were investigated from December 2017 to August 2018. All participants completed a questionnaire on sleep problems, Menopause Rating Scale, and the general information questionnaire. Based on the cutoff of the Menopause Rating Scale, participants were divided into the nonsevere menopausal symptom group and severe menopausal symptoms group. Propensity score matching was used to balance covariates between the two groups. Stepwise binary logistic regression and restricted cubic spline were applied to analyze the associations of individual and additive sleep problems with severe menopausal symptoms. After propensity score matching, no significant difference was observed between the nonsevere menopausal symptoms group and severe menopausal symptoms group (Ps > 0.05). Logistic regression analysis showed that five sleep problems ("feeling too hot," "having pain," "restless legs syndrome," "taking medicine to help sleep," and "having trouble staying awake") were closely associated with severe menopausal symptoms. The restricted cubic spline curve showed an upward trend in odds ratios between the number of these five sleep problems and severe menopausal symptoms, and women were more than twice as likely to suffer severe menopausal symptoms when they experienced more than three of these individual sleep problems. Both the individual and additive number of sleep problems exerted significant effects on severe menopausal symptoms. It might be useful for healthcare providers to set guidelines to support a healthy menopausal transition for midlife women.

Sleep Problems in Children and Adolescents with Autism: Type, Severity and Impact

Sleep problems of varying kind and severity, including both insomnias and parasomnias, are a commonly reported clinical problem among children and adolescents with autism spectrum disorder (ASD) and, it is estimated that approximately 50–80% of children with ASD and their families are affected by such problems. Without effective treatment, these sleep problems are likely to persist and can result in adverse long-term effects for the child and other family members. Despite the higher prevalence of sleep problems in individuals with ASD, little is known about the interaction between the type of sleep problems and the impact they have on the individual and their families. The purpose of this study was to examine the types of sleep problems reported by parents of children with ASD and their secondary impact. Specifically, using data from a survey of families with a child with ASD we classified the types of sleep problems reported and examined correlations between these sleep problems and reported effects on the individual and their family. Data from 244 children with ASD were reported to experience various types of sleep problems, particularly insomnia and bedtime resistance. Further, the findings confirm the far reaching adverse effects of sleep problems on child and family wellbeing. The implications of these findings and future research directions are discussed.

EEP QUALITY OF MEDICAL STUDENTS IN TURKEY DURING THE COVID-19 PANDEMIC

The COVID-19 pandemic had physical, social, and psychological effects on individuals. In this process, the psychological effects of the pandemic led to the need to examine the pandemic spiritually. Many studies have reported sleep problems in individuals. Sleep is important for cognitive, psychomotor, and emotional functions as well as physical health. Sleep quality is an important subject that should not be neglected in medical school students. This study aims to evaluate the sleep quality of medical students in Turkey during the pandemic.  424 students studying at Dicle University Medicine Faculty participated in the study between September-December 2020. Sociodemographic data form prepared by us, Pittsburg Sleep Quality Index (PSQI), State-Trait Anxiety Inventory (STAI), Coronavirus Anxiety Scale (CAS) were administered. PSQI scores of the students were 6.77±3.44, STAI-S scores were 40.69±4.84, STAI-T scores were 44.97±5.82, CAS scores were 2.80±4.17. The PSQI score of 72.4% of the students was five and above. 40.8% of the students reported worsening in their sleep. Female gender, having the COVID-19 test or relatives with COVID-19 infection, spending 1 hour or more in a day associated with COVID-19, smoking, using alcohol or sedative medication, and increasing caffeine habits found risk factors for poor sleep quality. PSQI scores were positively correlated with STAI-S and CAS scores. According to our study, medical students had poor sleep quality in the pandemic. We should give more importance to students during and outside the pandemic because they are a risky group for psychological stressors due to young age, student status. Sleep quality in medical students is an important issue that needs to be addressed. Students should be informed about sleep hygiene rules, be supported in giving smoking, alcohol, and other bad habits, and psychosocial support units should be established in universities.

Cumulative incidence and relative risk of sleep problems among children and adolescents with newly diagnosed neurodevelopmental disorders: A nationwide register-based study.

We estimated the absolute and relative risk of sleep problems in children and adolescents with newly diagnosed neurodevelopmental disorders. This was a population-based cohort study of individuals born in Denmark in 1993-2014 and followed in nationwide registers in 2011-2016. We estimated the 5-year cumulative incidence of sleep problems in incident cases of attention-deficit/hyperactivity disorder (ADHD; n=12,844), autism spectrum disorder (ASD; n=8,073), oppositional defiant disorder/conduct disorder (ODD/CD; n=2,234) and epilepsy (n=3,709). Hazard ratios (HRs) for sleep problems were estimated by Cox regression. The 5-year risk of sleep problems was highest in ADHD (29.2%; 95% CI, 28.4-30.1), ASD (24.2%; 95% CI, 23.1-25.3) and ODD/CD (27.1% 95% CI, 25.0%-29.2%) and lowest in epilepsy (11.3%; 95% CI, 10.2%-12.6%). For ADHD and ASD, sleep problems were more common in females than in males. Furthermore, sleep problems were predicted by high parental socioeconomic status and varied with the geographical region of residence, suggesting that different clinical practices exist across Denmark and that sleep problems may be more likely to go undetected in families of lower socioeconomic position. Compared with individuals without these disorders, the likelihood of sleep problems was increased in individuals with ADHD (HR, 33.81; 95% CI, 32.78-34.87), ASD (HR, 16.77; 95% CI, 16.15-17.41), ODD/CD (HR, 14.73; 95% CI, 13.88-15.64) and epilepsy (HR, 6.01; 95% CI, 5.67-6.37). After mutual adjustment for comorbidity, HRs were attenuated, especially in ASD, ODD/CD and epilepsy when adjusted for ADHD, suggesting that the increased risk of sleep problems in individuals with ASD, ODD/CD and epilepsy is driven largely by comorbid ADHD.

Sleep Disorders in Children and Adolescents with Autism Spectrum Disorder: Diagnosis, Epidemiology, and Management.

Sleep problems are a common complaint in children/adolescents with autism spectrum disorder (ASD). Correctly diagnosing and treating sleep problems in individuals with ASD is key, as they can add to the psychosocial burden of the disorder and exacerbate associated symptoms, such as inattention or irritability. Here, we provide an overview of the epidemiology, diagnosis, and management of sleep problems/disorders in children and adolescents with ASD. This narrative review is mainly informed by a systematic search in PubMed and PsycInfo (last search: 10 October 2019) of available pertinent meta-analyses. We also searched for randomized controlled trials (RCTs) published after the search date of available meta-analyses. As for the epidemiology of sleep disorders in ASD, recent meta-analytic evidence shows a pooled prevalence of 13% (95% confidence interval [CI] 9-17) in the ASD population, compared with 3.7% in the general population. In terms of diagnosis of sleep disorders, it should be based on standardized criteria [e.g., the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) or third edition of the International Classification of Sleep Disorders (ICSD)]; clinicians should bear in mind that the communication difficulties presented by individuals with ASD may make the diagnostic process more challenging. Regarding the treatment, a meta-analysis of behavioral interventions, including only three RCTs, found significant effects in terms of increase in total sleep time (24.41min, 95% CI 5.71-43.11, P = 0.01), decrease in sleep-onset latency (- 18.31min, 95% CI - 30.84 to - 5.77, P = 0.004), and a significant effect on sleep efficiency (5.59, 95% CI 0.87-10.31, P = 0.02), albeit the risk of bias of the included studies was rated "high" in relation to issues with the blinding. The bulk of the evidence for the pharmacological treatment is for melatonin, with a meta-analysis of five double-blind RCTs showing a large effect size, favoring melatonin, in sleep duration (44min compared with placebo, Hedge's g 1.07 [95% CI 0.49-1.65]) and sleep-onset latency (39min compared with placebo, Hedge's g - 2.46 [95% CI - 1.96 to - 2.98]). We conclude that additional RCTs are desperately needed to support the management of sleep disorders in ASD with an evidence-based, precision medicine approach.

Pharmacological Approach to Sleep Disturbances in Autism Spectrum Disorders with Psychiatric Comorbidities: A Literature Review.

Autism is a developmental disability that can cause significant emotional, social and behavioral dysfunction. Sleep disorders co-occur in approximately half of the patients with autism spectrum disorder (ASD). Sleep problems in individuals with ASD have also been associated with poor social interaction, increased stereotypy, problems in communication, and overall autistic behavior. Behavioral interventions are considered a primary modality of treatment. There is limited evidence for psychopharmacological treatments in autism; however, these are frequently prescribed. Melatonin, antipsychotics, antidepressants, and α agonists have generally been used with melatonin, having a relatively large body of evidence. Further research and information are needed to guide and individualize treatment for this population group.

The Relationship between Sleep Problems, Neurobiological Alterations, Core Symptoms of Autism Spectrum Disorder, and Psychiatric Comorbidities.

Children with Autism Spectrum Disorder (ASD) are at an increased risk for sleep disturbances, and studies indicate that between 50 and 80% of children with ASD experience sleep problems. These problems increase parental stress and adversely affect family quality of life. Studies have also suggested that sleep disturbances may increase behavioral problems in this clinical population. Although understanding the causes of sleep disorders in ASD is a clinical priority, the causal relationship between these two conditions remains unclear. Given the complex nature of ASD, the etiology of sleep problems in this clinical population is probably multi-factorial. In this overview, we discuss in detail three possible etiological explanations of sleep problems in ASD that can all contribute to the high rate of these symptoms in ASD. Specifically, we examine how neurobiological alterations, genetic mutations, and disrupted sleep architecture can cause sleep problems in individuals with ASD. We also discuss how sleep problems may be a direct result of core symptoms of ASD. Finally, a detailed examination of the relationship between sleep problems and associated clinical features and psychiatric comorbidities in individuals with ASD is described.

Sleep problems in Dravet syndrome: a modifiable comorbidity.

Many children with severe developmental and epileptic encephalopathies experience significant sleep disturbance, causing major disruption to the family's quality of life. We aimed to determine the frequency and nature of sleep problems in individuals with Dravet syndrome. The Sleep Disturbance Scale for Children and a seizure questionnaire were distributed to the parents/guardians of 96 patients with Dravet syndrome. Sixteen patients had two nights of home oximetry. Fifty-seven out of 96 questionnaires were completed. Forty-three out of 57 (75%) individuals had sleep problems. Twenty-five out of 57 (44%) individuals had an abnormal total sleep score, with difficulty initiating and maintaining sleep (22 out of 57, 39%), sleep-wake transition disorders (20 out of 57, 35%), and sleep breathing disorders (19 out of 57, 33%). Twenty-two out of 57 (39%) individuals took medication to assist sleep, predominantly melatonin (n=14). Thirty out of 57 (53%) recently had nocturnal seizures. Overnight oximetry showed 14 out of 16 (88%) had a higher oxygen desaturation index (>3%), and six out of 16 (38%) had higher mean pulse rates than normative values. Home oximetry was normal or inconclusive in all patients. Seventy-five per cent of individuals with Dravet syndrome had sleep problems, highlighting the importance of routinely assessing sleep and initiating appropriate behavioural and pharmacological interventions to improve the patient and family's quality of life. A high oxygen desaturation index and mean pulse rates on pulse oximetry may reflect unrecognized nocturnal seizures. More than 70% of patients with Dravet syndrome have sleep problems. Difficulty initiating and maintaining sleep was most common, particularly in those older than 20 years. Second most common were sleep-wake transition disorders, affecting more than 50% of those younger than 5 years. Sleep breathing disorders were a frequent problem across all age groups. Oximetry was not diagnostic of sleep-disordered breathing or obvious seizures.