Sleep architecture is associated with core symptom severity in autism spectrum disorder

Abstract

Objective While caregiver-reported sleep disturbances are common in children and adolescents with autism spectrum disorder (ASD), few studies have measured objective sleep in ASD compared to controls, and their findings are mixed. We investigated 1) differences in sleep architecture, specifically slow-wave sleep (SWS) and rapid eye movement sleep (REM), between ASD and typically developing controls (TD); and 2) if any observed differences in sleep were associated with core ASD symptoms. Methods We used ambulatory polysomnography (PSG) in 53 participants with ASD (ages 6 to 18) and 66 age-matched TD in their home sleeping environment. The primary outcome measures were SWS and REM sleep. Core behavioral ASD symptoms were assessed using the Autism Diagnostic Interview-Revised (ADI-R). Spectral power bands during sleep, and additional behavioral measures, were examined in exploratory analyses. Results Compared to TD, participants with ASD exhibited a higher SWS ratio and lower REM ratio. Within the ASD group, higher SWS was associated with more severe symptoms on the Restricted, Repetitive, and Stereotyped Behaviors subscale of the ADI-R. No association was observed between REM ratio and any ASD symptom. Conclusions Increased SWS and reduced REM sleep ratio differentiated ASD from TD. However, only increased SWS was associated with more severe core ASD symptoms. Increased SWS may reflect neuronal immaturity specific to ASD in this age group. These findings may inform the underlying mechanisms of clinical symptoms observed in children and adolescents with ASD.

Spindle Chirp and other Sleep Oscillatory Features in Young Children with Autism

“…Similar to Kurz et al(41) and Mylonas et al(20) we observed a comparable distribution of sleep stages between the two groups. This is in contrast to several other studies which showed an increased SWS and decreased REM sleep ratio(40), including Buckley et al 2010 who reported on a smaller, earlier version of this dataset. By the time of our analysis the TD group size had doubled and the ASD group increased by half, which may explain these different observations.…”

“…By the time of our analysis the TD group size had doubled and the ASD group increased by half, which may explain these different observations. Of note our ASD group displayed a decreased TST, similar to that inBuckley et al 2010 andKawai et al 2022.…”

“…Several past studies have evaluated association between sleep metrics and autism symptomatology (11) (40) (57). The sleep oscillatory features which we observed to be different between our ASD and TD groups, namely fast and slow spindle chirp, SO amplitude and SO-spindle coupling angle, did not demonstrate an association with ADOS severity score.…”

“…There is a growing body of literature regarding observed sleep changes in ASD compared to age-matched healthy controls. Many of these show changes in sleep architecture (11) (12) (40), decreased spindle density and frequency (13) (14) (15) (17) and decreased SO-spindle coordination (20), though some studies failed to observe these differences (16) (41). These studies have tended to include older adolescent and adult participants; of fourteen trials reviewed the average age was approximately 12.5 years (range 1.08-27 years).…”

Polyphenols: Natural Food-Grade Biomolecules for the Treatment of Nervous System Diseases from a Multi-Target Perspective

“…People with autism are more likely to experience sleep issues than those in the general population, because they have a genetic mutation that affects melatonin levels, a natural hormone that regulates sleep. Only 15% of their sleep time is spent in the rapid eye movement (REM) stage of sleep, which is essential for learning and memory retention [ 23 ]. Sleep disorders also influence the brain’s production of neurotransmitters, including dopamine and serotonin (5-hydroxytryptamine, or 5-HT), as well as other irregularities.…”