First Night Effect Analysis in a Cohort of Young Children with Autism Spectrum Disorder

Abstract

Study Objectives: To evaluate for the fi rst night effect (FNE) in a group of young children with autism. Design: Analysis of polysomnographic data from a 2-night sleep laboratory study. Setting: Clinical Center of the National Institutes of Health. Patients or Participants: 15 children (aged 2-10 years) with a diagnosis of an ASD. Interventions: None. Measurements and Results: Polysomnographic analysis showed the presence of a FNE for wake after sleep onset minutes, stage 2, and sleep effi ciency, but not for REM sleep parameters or TST. Conclusions S C I E N T I F I C I N V E S T I G A T I O N ST he fi rst night effect (FNE) refers to the well-accepted phenomenon of a poorer quality of sleep on the fi rst night when subjects undergo two or more consecutive nights in the sleep lab. Typically, FNE effects include lower sleep effi ciency, less total sleep time, less REM sleep, longer latency to REM sleep, and more intermittent awake time on night one.1,2 While this phenomenon is well recognized among adult populations, there are few exclusively pediatric studies that have examined FNE, and fewer still that have included young children with disorders affecting development.The largest pediatric study examining the FNE was performed in 1984. It was a laboratory-based evaluation of 87 healthy children between the ages of 6 and 15 years. This experiment reported an increase in TST and a decrease in sleep latency for night two. It also revealed similar second night fi ndings as had been seen in adult cohorts, namely, better sleep effi ciency, fewer wake after sleep onset (WASO) minutes, decreased REM latency, and increased REM percentage.3 Palm et al. conducted a 2-night at home study in 1989 on 18 healthy children between 8 and 12 years and did not fi nd such an effect. 4 Instead, there was an increase in sleep latency, an increase in percentage of stage 1 sleep, and an increase in REM latency, all on the second night.The majority of FNE data in children have come from studies using patient populations that frequently undergo overnight polysomnography (PSG) as part of a routine diagnostic assessment. Several studies have examined the FNE among children with suspected sleep disordered breathing (SDB) and obese children who are at risk for developing SDB. Scholle et al. evaluated 131 children between the ages of 2 and 17 years with suspected SDB for 2 nights in the laboratory. 5 The work concluded that while there was a FNE effect for WASO and REM percentage, a second night was not needed for pertinent respiratory parameters. Similarly, Verhulst et al. examined 70 children between the ages of 2 and 17 years, also referred for SDB, and found a FNE for REM sleep parameters but not for respiratory measures.6 Li et al. compared 46 obese children to 44 normal weight children between the ages of 7 and 15 years. 7 The groups were later further broken down for the presence or absence of SDB, and sleep architecture was examined using a 2-night, laboratory-based study. Children with and without SDB had increased TST and greater ...

Sleep Differences Among Children With Autism Spectrum Disorders and Typically Developing Peers

“…Hering et al 31 reported 1 child in the autistic group on carbamazepine. 61 For this reason, all but 2 of the studies using PSG excluded the first night from analysis. Souders et al did not require children to be medication free and included children on medications to treat allergies, asthma, and gastrointestinal complaints, as well as stimulant medications, SSRIs, atypical neuroleptics, anticonvulsants, and medications to aid sleep such as melatonin and clonidine.…”

Sleep, Plasticity and the Pathophysiology of Neurodevelopmental Disorders: The Potential Roles of Protein Synthesis and Other Cellular Processes

“…The nature of the sleep disturbances varies across patients, but includes decreased total sleep [29–35], increased sleep latency [26,29,36–40], more fragmented sleep/decreased sleep efficiency [36,38–42], increased stage non-rapid eye movement 1 (N1) sleep [38,40], decreased slow-wave sleep (SWS) [38,40], decreased rapid eye movement (REM) sleep latency [31,35] and decreased REM sleep [33,34,41]. …”

First-Night Effect on Sleep in Different Female Reproductive States

“…Previously, SE has been shown to decrease, TST shorten, WASO increase, and SL and REM latency lengthen during a first PSG night in populations aged 2-93 years (Buckley et al, 2013;Curcio et al, 2004;Kis et al, 2014;Moser, Kloesch, Fischmeister, Bauer, & Zeitlhofer, 2010;Newell et al, 2012;Prihodova et al, 2010;Scholle et al, 2003;Toussaint et al, 1995;Wauquier et al, 1991;Zheng et al, 2012). Tamaki et al 2005) also showed a slower and more fragmented sleep onset during a first night in a sleep laboratory.…”