1
|
Maurer JJ, Choi A, An I, Sathi N, Chung S. Sleep disturbances in autism spectrum disorder: Animal models, neural mechanisms, and therapeutics. Neurobiol Sleep Circadian Rhythms 2023; 14:100095. [PMID: 37188242 PMCID: PMC10176270 DOI: 10.1016/j.nbscr.2023.100095] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/16/2023] [Accepted: 04/08/2023] [Indexed: 05/17/2023] Open
Abstract
Sleep is crucial for brain development. Sleep disturbances are prevalent in children with autism spectrum disorder (ASD). Strikingly, these sleep problems are positively correlated with the severity of ASD core symptoms such as deficits in social skills and stereotypic behavior, indicating that sleep problems and the behavioral characteristics of ASD may be related. In this review, we will discuss sleep disturbances in children with ASD and highlight mouse models to study sleep disturbances and behavioral phenotypes in ASD. In addition, we will review neuromodulators controlling sleep and wakefulness and how these neuromodulatory systems are disrupted in animal models and patients with ASD. Lastly, we will address how the therapeutic interventions for patients with ASD improve various aspects of sleep. Together, gaining mechanistic insights into the neural mechanisms underlying sleep disturbances in children with ASD will help us to develop better therapeutic interventions.
Collapse
|
2
|
Pavkovic IM, Kothare SV. Pharmacologic Approaches to Insomnia and Other Sleep Disorders in Children. Curr Treat Options Neurol 2022. [DOI: 10.1007/s11940-022-00712-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
|
3
|
Leung AKC, Leung AAM, Wong AHC, Hon KL. Sleep Terrors: An Updated Review. Curr Pediatr Rev 2020; 16:176-182. [PMID: 31612833 PMCID: PMC8193803 DOI: 10.2174/1573396315666191014152136] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 09/12/2019] [Accepted: 09/21/2019] [Indexed: 12/27/2022]
Abstract
BACKGROUND Sleep terrors are common, frightening, but fortunately benign events. Familiarity with this condition is important so that an accurate diagnosis can be made. OBJECTIVE To familiarize physicians with the clinical manifestations, diagnosis, and management of children with sleep terrors. METHODS A PubMed search was completed in Clinical Queries using the key terms "sleep terrors" OR "night terrors". The search strategy included meta-analyses, randomized controlled trials, clinical trials, observational studies, and reviews. Only papers published in the English literature were included in this review. The information retrieved from the above search was used in the compilation of the present article. RESULTS It is estimated that sleep terrors occur in 1 to 6.5% of children 1 to 12 years of age. Sleep terrors typically occur in children between 4 and 12 years of age, with a peak between 5 and 7 years of age. The exact etiology is not known. Developmental, environmental, organic, psychological, and genetic factors have been identified as a potential cause of sleep terrors. Sleep terrors tend to occur within the first three hours of the major sleep episode, during arousal from stage three or four non-rapid eye movement (NREM) sleep. In a typical attack, the child awakens abruptly from sleep, sits upright in bed or jumps out of bed, screams in terror and intense fear, is panicky, and has a frightened expression. The child is confused and incoherent: verbalization is generally present but disorganized. Autonomic hyperactivity is manifested by tachycardia, tachypnea, diaphoresis, flushed face, dilated pupils, agitation, tremulousness, and increased muscle tone. The child is difficult to arouse and console and may express feelings of anxiety or doom. In the majority of cases, the patient does not awaken fully and settles back to quiet and deep sleep. There is retrograde amnesia for the attack the following morning. Attempts to interrupt a sleep terror episode should be avoided. As sleep deprivation can predispose to sleep terrors, it is important that the child has good sleep hygiene and an appropriate sleeping environment. Medical intervention is usually not necessary, but clonazepam may be considered on a short-term basis at bedtime if sleep terrors are frequent and severe or are associated with functional impairment, such as fatigue, daytime sleepiness, and distress. Anticipatory awakening, performed approximately half an hour before the child is most likely to experience a sleep terror episode, is often effective for the treatment of frequently occurring sleep terrors. CONCLUSION Most children outgrow the disorder by late adolescence. In the majority of cases, there is no specific treatment other than reassurance and parental education. Underlying conditions, however, should be treated if possible and precipitating factors should be avoided.
Collapse
Affiliation(s)
- Alexander K C Leung
- Department of Pediatrics, The University of Calgary and The Alberta Children’s Hospital, Calgary, Alberta, Canada
| | - Amy A M Leung
- Department of Family Medicine, The University of Alberta, Edmonton, Alberta, Canada
| | - Alex H C Wong
- Department of Family Medicine, The University of Calgary, Calgary, Alberta, Canada
| | - Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Hong Kong,Department of Paediatrics and Adolescent Medicine, Hong Kong Children’s Hospital, Hong Kong
| |
Collapse
|
4
|
Lysenko L, Bhat S. Melatonin-Responsive Complex Nocturnal Visual Hallucinations. J Clin Sleep Med 2018; 14:687-691. [PMID: 29609711 DOI: 10.5664/jcsm.7074] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Accepted: 12/05/2017] [Indexed: 11/13/2022]
Abstract
ABSTRACT Complex nocturnal visual hallucinations are vivid, dramatic, intricate visual hallucinations occurring during sleep onset or awakenings at night, generally lasting for a few minutes at most and disappearing with increased levels of light. They may occur in a number of neurological conditions, as well as in normal individuals. The optimal treatment for this condition remains unclear. We describe three patients with complex nocturnal visual hallucinations in whom melatonin brought about a dramatic improvement in symptoms. Our report suggests that melatonin may be a safe, effective treatment for this rare but often distressing and anxiety-provoking condition.
Collapse
Affiliation(s)
| | - Sushanth Bhat
- JFK Neuroscience Institute, Hackensack Meridian Health, JFK Medical Center, Edison, New Jersey
| |
Collapse
|
5
|
Drakatos P, Marples L, Muza R, Higgins S, Gildeh N, Macavei R, Dongol EM, Nesbitt A, Rosenzweig I, Lyons E, d'Ancona G, Steier J, Williams AJ, Kent BD, Leschziner G. NREM parasomnias: a treatment approach based upon a retrospective case series of 512 patients. Sleep Med 2018; 53:181-188. [PMID: 29753639 PMCID: PMC6558250 DOI: 10.1016/j.sleep.2018.03.021] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 03/25/2018] [Accepted: 03/29/2018] [Indexed: 11/18/2022]
Abstract
Background Non-REM parasomnias are not uncommon conditions in the general population. Current treatment options are based on small case series and reports. In this study, we aimed to present the clinical experience from a large cohort of patients. Patients Five hundred and twelve patients with Non-REM parasomnia or parasomnia overlap disorder (POD), who had undergone a video polysomnography and were exposed to treatment, were retrospectively identified. Treatment outcome was assessed based on patients’ reports, and treatment approach on a locally accepted hierarchy of interventions. Results Forty percent of patients were diagnosed with sleepwalking, 23.8% with mixed-phenotype and 10% with POD. Ultimately, 97.2% reported adequate control of their symptoms. Moreover, 60.1% were treated with pharmacotherapy and 32.0% without, consistent across all phenotypes (p = 0.09). Benzodiazepines were the most common drugs prescribed (47.1%, p < 0.05). In the end, 37.7% of our patients were receiving a benzodiazepine as part of their successful treatment, 11.7% an antidepressant, 9.2% a z-drug, and 10.7% melatonin. Finally, 13.2%, 12.1%, and 5.8% of our patients reported good control of their symptoms with sleep hygiene, management of sleep-disordered breathing, and psychological interventions (cognitive behavioral therapy [CBT] or mindfulness-based stress reduction [MBSR]), as monotherapy, respectively. Conclusion The treatment approach to effective treatment of the patients with Non-REM parasomnias or POD offering first sleep hygiene advice, next treatment of concurrent sleep disorders and management of other priming factors like stress and anxiety, and lastly pharmacotherapy for Non-REM parasomnia is supported by our results. Non pharmacological interventions were effective in one third of our patients, and CBT/MBSR and melatonin appeared promising new treatments. This study supports a standardised treatment approach in NREM-parasomnias. Pharmacotherapy alone effectively treated two thirds of the patients. One third of the patients were effectively treated without pharmacotherapy. Treatment of sleep apnea and periodic limb movements in sleep is recommended. Melatonin and psychological therapies are promising treatment options.
Collapse
Affiliation(s)
- Panagis Drakatos
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Lucy Marples
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Rexford Muza
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Sean Higgins
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Nadia Gildeh
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Raluca Macavei
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Eptehal M Dongol
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Alexander Nesbitt
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Ivana Rosenzweig
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom; Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College London, United Kingdom
| | - Elaine Lyons
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Grainne d'Ancona
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Joerg Steier
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom; Faculty of Life Sciences and Medicine, King's College London, United Kingdom
| | - Adrian J Williams
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Brian D Kent
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom
| | - Guy Leschziner
- Sleep Disorders Centre, Guy's Hospital, Great Maze Pond, London, SE1 9RT, United Kingdom; Sleep and Brain Plasticity Centre, Department of Neuroimaging, IoPPN, King's College London, United Kingdom; Department of Basic and Clinical Neurosciences, IoPPN, King's College London, United Kingdom.
| |
Collapse
|
6
|
Tordjman S, Davlantis KS, Georgieff N, Geoffray MM, Speranza M, Anderson GM, Xavier J, Botbol M, Oriol C, Bellissant E, Vernay-Leconte J, Fougerou C, Hespel A, Tavenard A, Cohen D, Kermarrec S, Coulon N, Bonnot O, Dawson G. Autism as a disorder of biological and behavioral rhythms: toward new therapeutic perspectives. Front Pediatr 2015; 3:1. [PMID: 25756039 PMCID: PMC4337381 DOI: 10.3389/fped.2015.00001] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2014] [Accepted: 01/05/2015] [Indexed: 12/13/2022] Open
Abstract
There is a growing interest in the role of biological and behavioral rhythms in typical and atypical development. Recent studies in cognitive and developmental psychology have highlighted the importance of rhythmicity and synchrony of motor, emotional, and interpersonal rhythms in early development of social communication. The synchronization of rhythms allows tuning and adaptation to the external environment. The role of melatonin in the ontogenetic establishment of circadian rhythms and the synchronization of the circadian clocks network suggests that this hormone might be also involved in the synchrony of motor, emotional, and interpersonal rhythms. Autism provides a challenging model of physiological and behavioral rhythm disturbances and their possible effects on the development of social communication impairments and repetitive behaviors and interests. This article situates autism as a disorder of biological and behavioral rhythms and reviews the recent literature on the role of rhythmicity and synchrony of rhythms in child development. Finally, the hypothesis is developed that an integrated approach focusing on biological, motor, emotional, and interpersonal rhythms may open interesting therapeutic perspectives for children with autism. More specifically, promising avenues are discussed for potential therapeutic benefits in autism spectrum disorder of melatonin combined with developmental behavioral interventions that emphasize synchrony, such as the Early Start Denver Model.
Collapse
Affiliation(s)
- Sylvie Tordjman
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Katherine S Davlantis
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA
| | - Nicolas Georgieff
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Le Vinatier , Lyon , France
| | - Marie-Maude Geoffray
- Department of Child and Adolescent Psychiatry, Centre Hospitalier Le Vinatier , Lyon , France
| | - Mario Speranza
- Department of Child and Adolescent Psychiatry, Centre Hospitalier de Versailles, Université de Versailles Saint-Quentin-en-Yvelines , Le Chensay , France
| | - George M Anderson
- Child Study Center, Yale University School of Medicine , New Haven, CT , USA
| | - Jean Xavier
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, CNRS FRE 2987, University Pierre and Marie Curie , Paris , France
| | - Michel Botbol
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Service Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent, CHU de Brest, Université de Bretagne Occidentale , Brest , France
| | - Cécile Oriol
- Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Eric Bellissant
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Julie Vernay-Leconte
- Pôle Hospitalo-Universitaire de Psychiatrie Adulte (PHUPA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Claire Fougerou
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Anne Hespel
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - Aude Tavenard
- Clinical Investigation Center, INSERM CIC 0203, University Hospital, Rennes 1 University , Rennes , France ; Department of Clinical Pharmacology, University Hospital, Rennes 1 University , Rennes , France
| | - David Cohen
- Department of Child and Adolescent Psychiatry, Assistance Publique - Hôpitaux de Paris, Groupe Hospitalier Pitié-Salpêtrière, CNRS FRE 2987, University Pierre and Marie Curie , Paris , France
| | - Solenn Kermarrec
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France ; Pôle Hospitalo-Universitaire de Psychiatrie de l'Enfant et de l'Adolescent (PHUPEA), Centre Hospitalier Guillaume Régnier, Université de Rennes 1 , Rennes , France
| | - Nathalie Coulon
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France
| | - Olivier Bonnot
- Laboratoire Psychologie de la Perception, Université Paris Descartes, CNRS, UMR 8158 , Paris , France
| | - Geraldine Dawson
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine , Durham, NC , USA
| |
Collapse
|
7
|
Tordjman S, Najjar I, Bellissant E, Anderson GM, Barburoth M, Cohen D, Jaafari N, Schischmanoff O, Fagard R, Lagdas E, Kermarrec S, Ribardiere S, Botbol M, Fougerou C, Bronsard G, Vernay-Leconte J. Advances in the research of melatonin in autism spectrum disorders: literature review and new perspectives. Int J Mol Sci 2013; 14:20508-42. [PMID: 24129182 PMCID: PMC3821628 DOI: 10.3390/ijms141020508] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 09/03/2013] [Accepted: 09/13/2013] [Indexed: 12/31/2022] Open
Abstract
Abnormalities in melatonin physiology may be involved or closely linked to the pathophysiology and behavioral expression of autistic disorder, given its role in neurodevelopment and reports of sleep-wake rhythm disturbances, decreased nocturnal melatonin production, and beneficial therapeutic effects of melatonin in individuals with autism. In addition, melatonin, as a pineal gland hormone produced from serotonin, is of special interest in autistic disorder given reported alterations in central and peripheral serotonin neurobiology. More specifically, the role of melatonin in the ontogenetic establishment of circadian rhythms and the synchronization of peripheral oscillators opens interesting perspectives to ascertain better the mechanisms underlying the significant relationship found between lower nocturnal melatonin excretion and increased severity of autistic social communication impairments, especially for verbal communication and social imitative play. In this article, first we review the studies on melatonin levels and the treatment studies of melatonin in autistic disorder. Then, we discuss the relationships between melatonin and autistic behavioral impairments with regard to social communication (verbal and non-verbal communication, social interaction), and repetitive behaviors or interests with difficulties adapting to change. In conclusion, we emphasize that randomized clinical trials in autism spectrum disorders are warranted to establish potential therapeutic efficacy of melatonin for social communication impairments and stereotyped behaviors or interests.
Collapse
Affiliation(s)
- Sylvie Tordjman
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
- Laboratory of Psychology of Perception, CNRS UMR 8158, Paris 75270, France; E-Mail:
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +33-6-15-38-07-48; Fax: +33-2-99-64-18-07
| | - Imen Najjar
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
| | - Eric Bellissant
- Inserm CIC 0203 Clinical Investigation Centre, University Hospital, Rennes 1 University, Rennes 35033, France; E-Mails: (E.B.); (C.F.)
- Department of Clinical Pharmacology, University Hospital, Rennes 1 University, Rennes 35033, France
| | - George M. Anderson
- Laboratory of Developmental Neurochemistry, Yale Child Study Center, New Haven, CT 06519, USA; E-Mail:
- Department of Laboratory Medicine, Yale University School of Medicine, New Haven, CT 06519, USA
| | - Marianne Barburoth
- Laboratory of Psychology of Perception, CNRS UMR 8158, Paris 75270, France; E-Mail:
| | - David Cohen
- Hospital-University Department of Child and Adolescent Psychiatry, Pitié-SalpétrièreHospital, Paris 6 University, Paris 75013, France; E-Mail:
| | - Nemat Jaafari
- CIC INSERM U 802, CHU de Poitiers, Unité de recherche clinique intersectorielle en psychiatrie du Centre Hospitalier Henri Laborit, Poitiers 86022, France; E-Mail:
| | - Olivier Schischmanoff
- INSERM UMR U978, University of Paris 13, Bobigny 93009, France; E-Mails: (O.S.); (R.F.)
- Laboratoire de Biochimie et Biologie Moléculaire, Hôpital Avicenne, APHP, Bobigny 93009, France
| | - Rémi Fagard
- INSERM UMR U978, University of Paris 13, Bobigny 93009, France; E-Mails: (O.S.); (R.F.)
- Laboratoire de Biochimie et Biologie Moléculaire, Hôpital Avicenne, APHP, Bobigny 93009, France
| | - Enas Lagdas
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
| | - Solenn Kermarrec
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
| | - Sophie Ribardiere
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
| | - Michel Botbol
- Service Hospitalo-Universitaire de Psychiatrie de l’Enfant et de l’Adolescent de Brest, UBO, Brest 29238, France; E-Mail:
| | - Claire Fougerou
- Inserm CIC 0203 Clinical Investigation Centre, University Hospital, Rennes 1 University, Rennes 35033, France; E-Mails: (E.B.); (C.F.)
- Department of Clinical Pharmacology, University Hospital, Rennes 1 University, Rennes 35033, France
| | - Guillaume Bronsard
- Maison Départementale de l’Adolescent et Centre Médico-Psycho-Pédagogique, Conseil Général des Bouches-du-Rhône; Laboratoire de Santé Publique EA3279, Faculté de Médecine de la Timone, Marseille 13256, France; E-Mail:
| | - Julie Vernay-Leconte
- Hospital-University Department of Child and Adolescent Psychiatry, Guillaume Régnier Hospital, Rennes 1 University, Rennes 35000, France; E-Mails: (I.N.); (E.L.); (S.K.); (S.R.); (J.V.-L.)
| |
Collapse
|
8
|
Doyen C, Mighiu D, Kaye K, Colineaux C, Beaumanoir C, Mouraeff Y, Rieu C, Paubel P, Contejean Y. Melatonin in children with autistic spectrum disorders: recent and practical data. Eur Child Adolesc Psychiatry 2011; 20:231-9. [PMID: 21359552 DOI: 10.1007/s00787-011-0162-8] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2010] [Accepted: 02/03/2011] [Indexed: 01/02/2023]
Abstract
Over the last 20 years, melatonin, a pineal hormone synthesized from serotonin, has been implicated in various studies on the autism spectrum disorder (ASD) and altered melatonin levels were detected in subgroups of subjects with ASD. Its effect on sleep disturbances got the attention of clinicians and several investigations were carried out to determine the usefulness and safety of melatonin administration in this disorder. Hypotheses were also raised regarding the possibility that the dysfunctional synthesis and secretion of melatonin detected in subgroups of subjects with ASD may increase the risk as well the severity of ASD. The purpose of this paper is to review our pharmacokinetic knowledge on melatonin and present results from recent studies on sleep disorders in autism, their treatment with melatonin and the impact of melatonin prescription in children with ASD evaluated in a Diagnostic Center for Autism Spectrum Disorder in Paris, France.
Collapse
Affiliation(s)
- C Doyen
- Department of Child and Adolescent Psychopathology, Sainte Anne Hospital, 14 rue Cabanis, Paris, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Guénolé F, Godbout R, Nicolas A, Franco P, Claustrat B, Baleyte JM. Melatonin for disordered sleep in individuals with autism spectrum disorders: systematic review and discussion. Sleep Med Rev 2011; 15:379-87. [PMID: 21393033 DOI: 10.1016/j.smrv.2011.02.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Revised: 02/05/2011] [Accepted: 02/07/2011] [Indexed: 11/29/2022]
Abstract
Sleep disturbance is common in autism spectrum disorders (ASD) and melatonin is widely prescribed in such cases despite a lack of guidelines. The aim of this paper is to provide a systematic review of efficacy and safety of exogenous melatonin for treating disordered sleep in individuals with ASD. We performed a Pubmed(®) documentary search enlarged by a manual review of references, which finally supplied 12 citations (4 case reports, 3 retrospective studies, 2 open-label clinical trials, and 3 placebo-controlled trials). As a whole, we found that the literature supports the existence of a beneficial effect of melatonin on sleep in individuals with ASD, with only few and minor side effects. However, considering the small number of studies and their methodological limits, these conclusions cannot yet be regarded as evidence-based. Randomized controlled trials and long-term follow-up data are still lacking to better assess efficacy and safety of exogenous melatonin for disordered sleep in individuals with ASD.
Collapse
Affiliation(s)
- Fabian Guénolé
- CHU de Caen, Service de Psychiatrie de l'enfant et de l'adolescent, Avenue Clemenceau, Caen F-14000, France.
| | | | | | | | | | | |
Collapse
|