Defining the Sleep Phenotype in Children With Autism

Abstract

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...

The Relationship Between Sleep Problems and Daytime Behavior in Children of Different Ages With Autism Spectrum Disorders

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Child Sleep Ontogeny and Application of the Standardized Questionnaire for the Evaluation of Child Behaviour During Sleep

“…Сопротивление укладыванию. Опросник характеризуется удовлетворительными показателями внутреннего согласия, внутренней валидности и надежности [56], позволяя объектив-но оценить нарушения сна у детей [57]. Выявленные с его помощью нарушения сна подтверждаются объ-ективными методами диагностики, в частности ак-тиграфией [58].…”

Pattern of Diagnosis and Co-occurring Symptoms in Adopted Children With Autism Spectrum Disorder

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