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

Abstract

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 in youth with autism spectrum disorders: systematic review and meta-analysis of subjective and objective studies

“…Behavioural factors such as dysfunctional bedtime routines, exacerbated by comorbid anxiety or ADHD, may disrupt sleep, especially sleep onset delay. There is also an increasing body of evidence suggesting the contributing role of biological clock factors (mainly endocrine and genetic) that could be involved in dysregulation of day–night rhythm and sleep patterns in subjects with ASD (see review of ref 62). For instance, ASD was associated with decreased urinary or blood melatonin level,63  probably due to genetic and epigenetic abnormalities affecting the enzymes of the melatonin synthesis and degradation pathways 64.…”

Autism Spectrum Disorders in Mali: Parental concerns about child developmental milestones and late diagnostic age

“…Core symptoms of ASD alone may not explain at which extent parents are concerned and stressed out their child development and well-being. A more comprehensive assessment should consider other aspects such as sleep and eating problems, parenting stress, the speci c burden on mothers with subsequent poor marital relationship [53,[60][61][62][63].…”

Melatonin in Childhood Epilepsy and in Child Neurology

“…Some authors speculate that melatonin as a hormone derived from serotonin may be of a special interest in autism neurobiology [73]. Another interesting finding is that melatonin levels may be negatively correlated with the severity of autistic features.…”