Sleep concerns are common in children with autism spectrum disorders (ASD). We identified objective sleep measures that differentiated ASD children with and without parental sleep concerns, and related parental concerns and objective measures to aspects of daytime behavior. ASD poor sleepers differed from ASD good sleepers on actigraphic (sleep latency, sleep efficiency, fragmentation) and polysomnographic (sleep latency) measures, and were reported to have more inattention, hyperactivity, and restricted/repetitive behaviors. Fragmentation was correlated with more restricted/repetitive behaviors. This work provides the foundation for focused studies of pathophysiology and targeted interventions to improve sleep in this population. KeywordsActigraphy; Polysomnography; Insomnia; Children's Sleep Habits Questionnaire; Child Behavior Checklist; Repetitive Behavior Scale Autism spectrum disorders (ASD) are disorders of neurodevelopment characterized by impaired social interaction and communication (American Psychiatric Association, 2000). The prevalence of these disorders is estimated at approximately 1 in 150 children (CDC, 2007). Sleep disorders are common associated conditions , with a prevalence estimated to range from 44-83% (Richdale, 1999;Couturier et al., 2005;Krakowiak et al., 2008). Sleep-onset insomnia and nocturnal awakenings are the most frequent and consistent findings (Richdale, 1999;Honomichl et al., 2002;Wiggs and Stores, 2004;Williams et al., 2004). A recent consensus statement identified the treatment of insomnia in ASD to be a high priority area (Mindell et al., 2006). Treating disordered sleep in ASD also represents a potential avenue to improve daytime behavior and family functioning in this population (Malow and McGrew, 2008).An essential component in planning interventional trials to improve sleep in children with ASD is to define objective measures of sleep that can be measured to document improvement with the intervention, and related to parent concerns. Objective measures used to define sleep concerns include polysomnography (PSG) and actigraphy. In our prior work, PSG differentiated children with ASD who had significant parental sleep concerns from those who did not (Malow et al., 2006). However, some children with ASD may not be able to tolerate Correspondence to: Suzanne E. Goldman, PhD. NIH Public Access Author ManuscriptDev Neuropsychol. Author manuscript; available in PMC 2010 September 27. NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author ManuscriptPSG, given the anxiety of "sleeping with wires" in a non-home environment, intolerance due to a given child's tactile sensitivities, or both. Furthermore, PSG is a costly methodology and the limited amount of information provided by a pediatric PSG study may not justify its large expense. Actigraphy, a modality that measures sleep and wake patterns based on limb movement, is less-intrusive and costly than PSG, and can be performed in a child's home setting. It is recognized as a useful adjunct in the evaluation of pat...

Background Sleep concerns are common in children with Angelman syndrome, with 20–80% of individuals having a decreased sleep need and/or abnormal sleep–wake cycles. The impact of these sleep behaviours on parental sleep and stress is not known. Method Through the use of standardised questionnaires, wrist actigraphy and polysomnography, we defined the sleep behaviours of 15 children/adolescents with Angelman syndrome and the association of the child/adolescents sleep behaviours on parental sleep behaviours and parental stress. Results Both children/adolescents and their parents exhibited over 1 h of wake time after sleep onset and fragmented sleep. Prolonged sleep latency in the child was associated with parent insomnia and daytime sleepiness. Additionally, variability in child total sleep time was associated with parental stress. Conclusions Poor sleep in children/adolescents with Angelman syndrome was associated with poor parental sleep and higher parental stress. Further work is warranted to identify the underlying causes of the poor sleep, and to relate these findings to daytime functioning, behaviour and the family unit.

Children with autism often suffer from sleep disturbances, and compared to age-matched controls, have decreased melatonin levels, as indicated by urine levels of the primary melatonin metabolite, 6-sulfatoxymelatonin (6-SM). We therefore investigated the relationship between 6-SM levels and sleep architecture in children with autism spectrum disorders (ASD). Twenty-three children, aged 4–10 years, completed two nights of polysomnography and one overnight urine collection for measurement of urinary 6-SM excretion rate. Parents completed the Children’s Sleep Habits Questionnaire. We found that higher urinary 6-SM excretion rates were associated with increased N3 sleep, decreased N2 sleep, and decreased daytime sleepiness. The results warrant further examination to examine the effects of supplemental melatonin on sleep architecture and daytime sleepiness.

Children with neurodevelopmental disorders may have difficulty tolerating devices that monitor sleep, presenting challenges in measuring sleep disturbances in this population. Although wrist actigraphy has advantages over polysomnography, some children remain unable to tolerate wrist placement. This study piloted an alternative site for actigraphy in 8 children with autism, ages 6–10 years. Results are presented from the 2 locations (custom pocket shoulder location and wrist location) using Bland–Altman limits of agreement and other statistical measures to compare sleep onset latency, total sleep time, sleep efficiency, and wake after sleep onset. The use of an alternative actigraphy site for children with autism, who have difficulty tolerating actigraphy placement, appears promising and worthy of further study.