Principles and Practice of Sleep Medicine

Vineland Adaptive Behavior Scales, Second Edition

The purposes of this paper are to provide an overview of the state of the science of sleep in children with autism spectrum disorder (ASD), present hypotheses for the high prevalence of insomnia in children with ASD, and present a practice pathway for promoting optimal sleep. Approximately two thirds of children with ASD have chronic insomnia, and to date, the strongest evidence on promoting sleep is for sleep education, environmental changes, behavioral interventions, and exogenous melatonin. The Sleep Committee of the Autism Treatment Network (ATN) developed a practice pathway, based on expert consensus, to capture best practices for screening, identification, and treatment for sleep problems in ASD in 2012. An exemplar case is presented to integrate key constructs of the practice pathway and address arousal and sensory dysregulation in a child with ASD and anxiety disorder. This paper concludes with next steps for dissemination of the practice pathway and future directions for research of sleep problems in ASD.

/pdf/sleep-in-children-with-autism-spectrum-disorder-4329tfu2n7.pdf

Sleep in Children with Autism Spectrum Disorder

Sleep and autism spectrum disorders.

https://www.cell.com/trends/neurosciences/pdf/S0166-2236(11)00109-3.pdf

Synaptic plasticity in sleep: learning, homeostasis, and disease

Objective To compare objective polysomnographic parameters between 3 cohorts: children with autism, typical development, and developmental delay without autism. Design Overnight polysomnographic recordings were scored for sleep architecture according to American Academy of Sleep Medicine criteria by a board-certified sleep medicine specialist blind to diagnosis for studies collected between July 2006 and September 2009. Setting Subjects were evaluated in the pediatric ward in the Clinical Research Center of the National Institutes of Health. Participants First 60 consecutive children with autism, 15 with typical development, and 13 with developmental delay matched for nonverbal IQ to the autism group, ranging in age from 2 to 13 years, selected without regard to the presence or absence of sleep problem behavior. Main Outcome Measures Total sleep time, latencies to non–rapid eye movement (REM) and REM sleep, and percentages of total sleep time for stages 1 and 2 sleep, slow-wave sleep, and REM sleep. Results There were no differences between the typical vs developmental delay groups. Comparison of children with autism vs typical children revealed shorter total sleep time ( P  = .004), greater slow-wave sleep percentage ( P  = .001), and much smaller REM sleep percentage (14.5% vs 22.6%; P P  = .001), greater stage 1 sleep percentage ( P P P Conclusion A relative deficiency of REM sleep may indicate an abnormality in neural organization in young children with autism that is not directly associated with or related to inherent intellectual disability but may serve as a window into understanding core neurotransmitter abnormalities unique to this disorder.

https://jamanetwork.com/journals/jamapediatrics/articlepdf/383908/poa05049_1032_1037.pdf

Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development.

Background: Rapid eye movement (REM) sleep is greatest in the developing brain, is driven by acetylcholine, and may represent a protected time for neuroplasticity. Recently published data from our lab observed that children with autism spent significantly less time in this state during a single night recording than did typically developing children and those with developmental delay without autism. The objective of this study was to determine whether or not donepezil can increase the REM % in children with diagnosed autism spectrum disorder (ASD) found to have REM % values of at least two standard deviations below expected for age. Methods: Five subjects found to have an ASD (ages 2.5–6.9 years) and demonstrated deficits in REM sleep compared with within-lab controls were enrolled in a dose finding study of donepezil. Each subject was examined by polysomnography for REM sleep augmentation after drug administration. Results: REM sleep as a percentage of Total Sleep Time was increased significantly...

/pdf/an-open-label-trial-of-donepezil-for-enhancement-of-rapid-4r3acf1s89.pdf

Kaitlin Jennison

Papers

Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development.

An open label trial of donepezil for enhancement of rapid eye movement sleep in young children with autism spectrum disorders.