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Bruni O, Biggio G, Malorgio E, Nobili L. Insomnia in children affected by autism spectrum disorder: The role of melatonin in treatment. Sleep Med 2024; 119:511-517. [PMID: 38805858 DOI: 10.1016/j.sleep.2024.05.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 05/08/2024] [Accepted: 05/23/2024] [Indexed: 05/30/2024]
Abstract
The present article explores the connection between insomnia and Autism Spectrum Disorder (ASD), focusing on the efficacy and safety of melatonin treatments as supported by existing research and current guidelines. In this narrative review a group of Italian experts provide an analysis of the various aspects of managing insomnia in children with ASD, highlighting key points that could enhance the quality of life for both patients and their caregivers. This includes the significance of comprehensively understanding the root causes of a child's sleep difficulties for more effective, long-term management. Insomnia, a condition frequently documented in neurodevelopmental disorders such as ASD, greatly affects the lives of patients and caregivers. Recent data show that melatonin-based formulations are effective and safe for treating ASD-related insomnia both short and long term. In particular, prolonged-release melatonin is poised to be the optimal choice for this patient population. This formulation is approved for the treatment of insomnia in children and adolescents aged 2-18 years suffering from ASD and/or Smith-Magenis syndrome, where sleep hygiene measures and behavioral treatments have not been sufficient. In support, emerging research in pediatric settings indicates long-term efficacy and safety, although further research efforts are still needed. Current guidelines recommend managing insomnia and sleep disturbances in ASD using a combination of behavioral and pharmacological methods, primarily melatonin. Recent concerns about accidental melatonin ingestion highlight the need for high purity standards, such as pharmaceutical-grade prolonged-release formulations. The article also summarizes emerging molecular mechanisms from preclinical research, suggesting future therapeutic approaches.
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Affiliation(s)
- Oliviero Bruni
- Dept of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, 00185, Rome, Italy.
| | - Giovanni Biggio
- Department of Life and Environmental Sciences, Institute of Neuroscience, CNR, University of Cagliari, 09042, Cagliari, Italy; Institute of Neuroscience, National Research Council (C.N.R.), University Campus, 09042, Cagliari, Italy.
| | - Emanuela Malorgio
- Italian Federation of Primary Care Pediatricians (Federazione Italiana Medici Pediatri, FIMP), Expert on Sleep Disorders AIMS, Torino, Italy.
| | - Lino Nobili
- IRCCS G. Gaslini Institute. Department of Neuroscience - Rehabilitation - Ophthalmology - Genetics - Child and Maternal Health (DINOGMI) - University of Genova, Italy.
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2
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Bruni O, Angriman M, Miano S, DelRosso LM, Spruyt K, Mogavero MP, Ferri R. Individualized approaches to pediatric chronic insomnia: Advancing precision medicine in sleep disorders. Sleep Med Rev 2024; 76:101946. [PMID: 38735089 DOI: 10.1016/j.smrv.2024.101946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Revised: 02/25/2024] [Accepted: 05/02/2024] [Indexed: 05/14/2024]
Abstract
The manifestations of chronic insomnia undergo age-related changes. In younger infants and children, behavioral insomnia emerges as the most prevalent form and typically responds to behavioral interventions. However, distinct clusters of clinical presentations suggest the presence of various phenotypes, potentially implicating the primary involvement of specific neurotransmitters. These conceptualizations, coupled with genetic studies on pleiotropy and polygenicity, may aid in identifying individuals at risk of persistent insomnia into adulthood and shed light on novel treatment options. In school-age children, the predominant presentation is sleep-onset insomnia, often linked with nighttime fears, anxiety symptoms, poor sleep hygiene, limit-setting issues, and inadequate sleep duration. The manifestations of insomnia in adolescence correlate with the profound changes occurring in sleep architecture, circadian rhythms, and homeostatic processes. The primary symptoms during adolescence include delayed sleep onset, sleep misperception, persistent negative thoughts about sleep, and physiological hyperarousal-paralleling features observed in adult insomnia. An approach centered on distinct presentations may provide a framework for precision-based treatment options. Enhanced comprehension of insomnia's manifestations across diverse developmental stages can facilitate accurate assessment. Efforts to subtype insomnia in childhood align with this objective, potentially guiding the selection of appropriate treatments tailored to individual neurobiological, clinical, and familial features.
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Affiliation(s)
- Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Marco Angriman
- Child Neurology and Neurorehabilitation Unit, Bolzano Hospital, Via Guncina 54, 39100, Bolzano, Italy
| | - Silvia Miano
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ospedale Civico, Via Tesserete 46, 6900, Lugano, Switzerland
| | - Lourdes M DelRosso
- University of California San Francisco, Fresno, 2625 E. Divisadero St. Fresno, CA, 93721, USA
| | - Karen Spruyt
- Université de Paris, NeuroDiderot Inserm, Academic Hospital Robert Debré Ap-Hp in the Building Bingen, 48 Bd Sérurier, 75019, Paris, France
| | - Maria P Mogavero
- Vita-Salute San Raffaele University, Via Olgettina, 58, 20132, Milan, Italy; Sleep Disorders Center, Division of Neuroscience, San Raffaele Scientific Institute, Via Stamira d'Ancona, 20, 20127, Milan, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
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Martinez-Cayuelas E, Gavela-Pérez T, Rodrigo-Moreno M, Losada-Del Pozo R, Moreno-Vinues B, Garces C, Soriano-Guillén L. Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1712-1726. [PMID: 36869970 PMCID: PMC9984759 DOI: 10.1007/s10803-023-05934-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 03/05/2023]
Abstract
This was an exploratory cross-sectional study comparing 45 children with ASD to 24 typically developing drug-naïve controls, group-matched on age, sex, and body mass index. Objective data was obtained using the following: an ambulatory circadian monitoring device; saliva samples to determine dim light melatonin onset (DLMO): and three parent-completed measures: the Child Behavior Checklist (CBCL); the Repetitive Behavior Scale-Revised (RBS-R); and the General Health Questionnaire (GHQ28). The CBCL and RBS-R scales showed the highest scores amongst poor sleepers with ASD. Sleep fragmentation was associated with somatic complaints and self-injury, leading to a higher impact on family life. Sleep onset difficulties were associated with withdrawal, anxiety, and depression. Those with phase advanced DLMO had lower scores for "somatic complaints"; "anxious/depressed" state; and "social problems", suggesting that this phenomenon has a protective role.
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Affiliation(s)
- Elena Martinez-Cayuelas
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario Fundación Jiménez Díaz, Avenida Reyes Católicos n2, 28040 Madrid, Spain
| | - Teresa Gavela-Pérez
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - María Rodrigo-Moreno
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Rebeca Losada-Del Pozo
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Beatriz Moreno-Vinues
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Garces
- Lipid Laboratory, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Leandro Soriano-Guillén
- Department of Pediatrics, Instituto de Investigaciones Sanitarias-Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
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Berenguer C, Rosa E, De Stasio S, Choque Olsson N. Sleep quality relates to language impairment in children with autism spectrum disorder without intellectual disability. Sleep Med 2024; 117:99-106. [PMID: 38522116 DOI: 10.1016/j.sleep.2024.03.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 03/11/2024] [Accepted: 03/16/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVES This study aimed to identify sleep quality profiles of children with autism spectrum disorder (ASD), to compare these profiles with those of typically developing (TD) children, and to verify whether there are differences between them in terms of language skills. METHODS We evaluated the sleep quality and language skills of 47 children with ASD without intellectual disability (ID) and 32 children with TD. Using a hierarchical cluster analysis, we identified two sleep quality ASD profiles (poor and good). We then performed a series of MANCOVAs and ANOVAs to compare the sleep quality and language skills of the two ASD clusters and the TD group. RESULTS A main group effect (TD, "poor" cluster, and "good" cluster) was found in the total sleep quality and all its dimensions. Significant differences were revealed between the "good" and "poor" clusters in the total structural language score (F1,46 = 10.75, p < 0.001) and three of its subscales (speech: F1,46 = 9.19, p < 0.001; syntax, F1,46 = 8.61, p = 0.001; coherence: F1,46 = 11.36, p < 0.001); the total pragmatic language score (F1,46 = 7.00, p = 0.001) and three of its subscales (inappropriate initiation: F1,46 = 8.02, p = 0.001; use of context: F1,46 = 8.07, p = 0.001; nonverbal communication: F1,46 = 7.35, p = 0.001); and the social relations score (F1,46 = 9.97, p = 0.003). CONCLUSIONS Sleep quality in children with ASD (especially a subgroup) is worse than in children with TD. There is an association between sleep quality and language skills, both at the pragmatic and structural levels.
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Affiliation(s)
- Carmen Berenguer
- Department of Developmental and Educational Psychology, ERI-Lectura Faculty of Psychology and Speech Therapy University of Valencia, Blasco Ibanez, 21, 46010, Valencia, Spain.
| | - Eva Rosa
- Department of Basic Psychology, ERI-Lectura, Faculty of Psychology and Speech Therapy, University of Valencia, Blasco Ibanez, 21, 46010, Valencia, Spain.
| | - Simona De Stasio
- Department of Human Studies, LUMSA University, Piazza Delle Vaschette, 101, 00193, Rome, Italy.
| | - Nora Choque Olsson
- Department of Psychology, Stockholm University, 106 91, Stockholm, Sweden.
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Sinha C, Lecavalier L, Johnson CR, Taylor C, Mulligan A, Buckley D, Alder ML, Scahill L. Qualitative Exploration Toward the Development of a Parent-Rated Scale for Insomnia in Children with Autism Spectrum Disorder. J Autism Dev Disord 2024; 54:1792-1803. [PMID: 36856915 DOI: 10.1007/s10803-022-05865-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2022] [Indexed: 03/02/2023]
Abstract
Toward the development of a new parent-rating for insomnia, this multi-site qualitative study explored sleep problems and related impacts in children with autism spectrum disorder (ASD) and their families. To ensure content validity of the measure, we conducted six focus groups with caregivers (N = 25) of 24 children (age 3 to 18 years) with ASD. Based on parent report, all children had a history of mild or greater insomnia. The focus group transcripts were systematically coded to identify major themes. Verbatim comments from caretakers were used to generate 134 candidate items. Further review by the research team and an expert panel followed by individual cognitive interviews with 12 parents reduced the item bank to 40. The thematic analysis of focus group transcripts identified 7 categories: (1) Trouble falling asleep; (2) trouble staying asleep; (3) early morning waking; (4) bedtime routines; (5) parental strategies for bedtime management; (6) impact of sleep problems on the child; and (7) impact of sleep problems on the family. The Flesch Kincaid Grade Level of the 40-item version was 7.2 (seventh grade reading level). Insomnia in children with ASD shares features in common with insomnia in the general pediatric population. However, perhaps owing to autistic features such as insistence on sameness, sensory sensitivities, communication impairments, insomnia in children with ASD appears to have unique behavioral manifestations. Content validity and item clarity of the 40-item bank were supported by expert panel review and cognitive interviews with caregivers of children with ASD.
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Affiliation(s)
- C Sinha
- Emory University School of Medicine, 2015 Uppergate Drive, Atlanta, GA, 30307, USA
| | - L Lecavalier
- The Ohio State University Nisonger Center and Department of Psychology, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - C R Johnson
- Cleveland Clinic Children's Center for Autism, Lerner College of Medicine at Case Western Reserve University, 2801 Martin Luther King Jr. Dr., Cleveland, OH, 44104, USA
| | - C Taylor
- The Ohio State University, 306A Atwell Hall, 453 W. 10th Ave., Columbus, OH, 43210, USA
| | - A Mulligan
- The Ohio State University Nisonger Center, 1581 Dodd Drive, Columbus, OH, 43210, USA
| | - D Buckley
- Marcus Autism Center, Emory University School of Medicine, 1920 Briarcliff Rd. NE, Atlanta, GA, 30307, USA
| | - M L Alder
- Marcus Autism Center, Emory University School of Medicine, 1920 Briarcliff Rd. NE, Atlanta, GA, 30307, USA
| | - L Scahill
- Marcus Autism Center, Emory University School of Medicine, 1920 Briarcliff Rd. NE, Atlanta, GA, 30307, USA.
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Johnson CR, Barto L, Worley S, Rothstein R, Wenzell ML. Follow-up of telehealth parent training for sleep disturbances in young children with autism spectrum disorder. Sleep Med 2024; 119:114-117. [PMID: 38669834 DOI: 10.1016/j.sleep.2024.04.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/15/2024] [Accepted: 04/17/2024] [Indexed: 04/28/2024]
Abstract
OBJECTIVE/BACKGROUND Bedtime and sleep disturbances are ubiquitous in children with autism. The telehealth delivery of a behavior analytic parent training program was earlier reported to be efficacious in improving child sleep and parent sense of competency. Our aim in this brief report was to determine the durability of the telehealth delivered sleep parent training program (SPT) compared to the control condition in this randomized controlled trial. Telehealth delivery could be a means to expand access to such early treatment if efficacious. PARTICIPANTS/METHODS Parents of young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session Sleep Parent Education; SPE). Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures were collected at weeks 5 and 10 and at post-treatment follow-up at 16 weeks. RESULTS Follow-up week 16 data were available for 30 participants randomized to SPT and 24 participants randomized to SPE. Demographics for this follow-up cohort were similar to the full sample. At week 16 follow-up, there was a significant group difference between SPT and SPE the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p = 0.011) with an effect size of 0.68. Further, 8 of the 10 children in SPT who were negative responders at the week 10 endpoint were rated as positive responders at week 16 by the treatment masked IE compared to 2 out of 12 in the SPE group (p = 0.008). CONCLUSIONS Post-treatment follow-up data suggests SPT is durable over time compared to SPE, the active control group. Further, for some participants in SPT, a positive responsive emerged after the treatment endpoint. This brief report adds to the efficacy of SPT as a time-limited intervention for insomnia in young autistic children.
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Kotagal S, Malow B, Spruyt K, Wang G, Bolaños Almeida CE, Tavera Saldaña LM, Blunden S, Narang I, Ipsiroglu OS, Bruni O, Strazisar BG, Simakajornboon N, Nunes ML, Cortese S. Melatonin use in managing insomnia in children with autism and other neurogenetic disorders - An assessment by the international pediatric sleep association (IPSA). Sleep Med 2024; 119:222-228. [PMID: 38704869 DOI: 10.1016/j.sleep.2024.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 04/06/2024] [Indexed: 05/07/2024]
Abstract
Though it is widely prescribed for improving sleep of children with autism and other neurogenetic disorders, there is a need for practical guidance to clinicians on the use of melatonin for managing insomnia in this population. Because data were either lacking or inconclusive, a task force was established by the International Pediatric Sleep Association (IPSA) to examine the literature based on clinical trials from 2012 onwards. A summary of evidence pertaining to melatonin's utility and potential side effects, practice-related caveats, and insights for use are published herewith.
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Affiliation(s)
- Suresh Kotagal
- Department of Neurology, Mayo Clinic, Rochester, MN, USA.
| | - Beth Malow
- Departments of Neurology and Pediatrics, Sleep Disorders Division, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen Spruyt
- Université Paris Cité, NeuroDiderot, INSERM, 75019, Paris, France
| | - Guanghai Wang
- Department of Developmental and Behavioral Pediatrics, Pediatric Translational Medicine Institute, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Carlos Ernest Bolaños Almeida
- Pediatric Neurologist and Sleep Medicine MD MsC, Universidad Nacional de Colombia. Sleep Lab Coordinator at HOMI Fundacion, Bogota, Colombia
| | - Lina Marcela Tavera Saldaña
- Universidad Nacional de Colombia and Sleep Medicine, Universidad Nacional Autónoma de México. Sleep Lab Coordinator at Neuroconexión, Armenia, Colombia
| | - Sarah Blunden
- Psychology and Paediatric Sleep, Appleton Institute of Behavioural Science, CQUniversity Australia, Adelaide, Australia; School of Educational Psychology and Counselling, Faculty of Education, Monash University, Melbourne, Australia
| | - Indra Narang
- Division of Respiratory Medicine, Hospital for Sick Children, University of Toronto, 555 University Avenue, Toronto, M4S 2V6, Ontario, Canada
| | - Osman S Ipsiroglu
- Interdisciplinary Sleep Program & BC Children's Hospital Research Institute, Department of Pediatrics, University of British Columbia, Vancouver, BC, Canada; Department of Pediatrics, Medical University of Vienna, Austria 938 W 28th Avenue Vancouver, Vienna, BC, V5Z 4H4, Australia
| | - Oliviero Bruni
- Dept of Developmental and Social Psychology, Sapienza University, Via dei Marsi 78, 00185, Rome, Italy
| | - Barbara Gnidovec Strazisar
- Centre for Paedatric Sleep Disorders, Pediatric Department, General Hospital Celje, University of Maribor, Oblakova ulica 5, 3000, Celje, Slovenia
| | - Narong Simakajornboon
- Sleep Center, Division of Pulmonary and Sleep Medicine, Cincinnati Children's Hospital Medical Center, USA; Department of Pediatric, University of Cincinnati College of Medicine, Cincinnati, 3333 Burnet Ave, MLC 7041, OH, USA, Cincinnati, OH, 45229, USA
| | - Magda Lahorgue Nunes
- Titular de Neurologia da Escola de Medicina, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Brain Institute (InsCer), Brazil
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK
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Bone ME, O'Connor Leppert ML. Autism Spectrum Disorder at Home and in School. Pediatr Clin North Am 2024; 71:223-239. [PMID: 38423717 DOI: 10.1016/j.pcl.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
The diagnosis of autism spectrum disorder (ASD) brings a lifetime of considerations for individuals and their families. The core symptoms of ASD vary in severity and influence behavior and function across all environments. Co-occurring medical, mental health, cognitive, language, learning, and behavioral differences add challenges to those associated with core symptoms. Navigating the preschool, school, and transition ages in the educational setting requires continual reassessment of the strengths, weaknesses, and needs of the student to provide appropriate placement and services.
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Affiliation(s)
- Megan E Bone
- Department of Neurology, Johns Hopkins University School of Medicine; Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA.
| | - Mary L O'Connor Leppert
- Department of Neurodevelopmental Medicine, Kennedy Krieger Institute, Baltimore, MD, USA; Department of Pediatrics, Johns Hopkins University School of Medicine
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Estes A, Hillman A, Chen ML. Sleep and Autism: Current Research, Clinical Assessment, and Treatment Strategies. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:162-169. [PMID: 38680972 PMCID: PMC11046719 DOI: 10.1176/appi.focus.20230028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Autism spectrum disorder is associated with a high rate of sleep problems, affecting over 80% of autistic individuals. Sleep problems have pervasive negative effects on health, behavior, mood, and cognition but are underrecognized in autistic children. Problems initiating and maintaining sleep-hallmarks of insomnia-are common. Sleep-disordered breathing and restless legs syndrome have also been described in autism at a higher prevalence than in community populations. The authors describe current research on sleep in autistic children and potential pathophysiologic mechanisms. They describe practical approaches to sleep assessment and synthesize approaches to addressing sleep problems in autistic children.
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Affiliation(s)
- Annette Estes
- Department of Speech and Hearing Sciences (Estes) and Department of Pediatrics, Division of Pulmonary and Sleep Medicine (Chen), University of Washington, Seattle; University of Washington Autism Center (Estes, Hillman); Pediatric Sleep Disorders Center and Pulmonary and Sleep Medicine Division, Seattle Children's Hospital (Chen)
| | - Arianna Hillman
- Department of Speech and Hearing Sciences (Estes) and Department of Pediatrics, Division of Pulmonary and Sleep Medicine (Chen), University of Washington, Seattle; University of Washington Autism Center (Estes, Hillman); Pediatric Sleep Disorders Center and Pulmonary and Sleep Medicine Division, Seattle Children's Hospital (Chen)
| | - Maida Lynn Chen
- Department of Speech and Hearing Sciences (Estes) and Department of Pediatrics, Division of Pulmonary and Sleep Medicine (Chen), University of Washington, Seattle; University of Washington Autism Center (Estes, Hillman); Pediatric Sleep Disorders Center and Pulmonary and Sleep Medicine Division, Seattle Children's Hospital (Chen)
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10
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Autism Across the Lifespan. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:194-195. [PMID: 38680978 PMCID: PMC11046723 DOI: 10.1176/appi.focus.24022001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
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11
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Aishworiya R, Valica T, Hagerman R, Restrepo B. An Update on Psychopharmacological Treatment of Autism Spectrum Disorder. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2024; 22:198-211. [PMID: 38680976 PMCID: PMC11046717 DOI: 10.1176/appi.focus.24022006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
While behavioral interventions remain the mainstay of treatment of autism spectrum disorder (ASD), several potential targeted treatments addressing the underlying neurophysiology of ASD have emerged in the last few years. These are promising for the potential to, in future, become part of the mainstay treatment in addressing the core symptoms of ASD. Although it is likely that the development of future targeted treatments will be influenced by the underlying heterogeneity in etiology, associated genetic mechanisms influencing ASD are likely to be the first targets of treatments and even gene therapy in the future for ASD. In this article, we provide a review of current psychopharmacological treatment in ASD including those used to address common comorbidities of the condition and upcoming new targeted approaches in autism management. Medications including metformin, arbaclofen, cannabidiol, oxytocin, bumetanide, lovastatin, trofinetide, and dietary supplements including sulforophane and N-acetylcysteine are discussed. Commonly used medications to address the comorbidities associated with ASD including atypical antipsychotics, serotoninergic agents, alpha-2 agonists, and stimulant medications are also reviewed. Targeted treatments in Fragile X syndrome (FXS), the most common genetic disorder leading to ASD, provide a model for new treatments that may be helpful for other forms of ASD. Appeared originally in Neurotherapeutics 2022; 19:248-262.
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Affiliation(s)
- Ramkumar Aishworiya
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Tatiana Valica
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Randi Hagerman
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
| | - Bibiana Restrepo
- Medical Investigation of Neurodevelopmental Disorders (MIND) Institute, University of California Davis, 2825 50th Street, Sacramento, CA 95817, USA (Aishworiya, Valica, Hagerman, Restrepo); Khoo Teck Puat-National University Children's Medical Institute, National University Health System, 5 Lower Kent Ridge Road, Singapore 119074, Singapore; Department of Pediatrics, Yong Loo Lin School of Medicine, National University of Singapore, 1E Kent Ridge Road, Singapore 119228, Singapore (Aishworiya); Association for Children With Autism, Chisinau, Moldova (Valica); Department of Pediatrics, University of California Davis School of Medicine, 4610 X St, Sacramento, CA 95817, USA (Hagerman, Restrepo)
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12
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Sidhu N, Wong Z, Bennett AE, Souders MC. Sleep Problems in Autism Spectrum Disorder. Pediatr Clin North Am 2024; 71:253-268. [PMID: 38423719 DOI: 10.1016/j.pcl.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/02/2024]
Abstract
Sleep problems are common in children with autism spectrum disorder (ASD), with 40% to 80% prevalence. Common disorders include insomnia, parasomnias, and circadian rhythm sleep-wake disorders. These problems have a multifactorial etiology and can both exacerbate and be exacerbated by core ASD symptoms. Sleep problems also impact the health and quality of life of both patients and their caregivers. All children with autism should be regularly screened for sleep problems and evaluated for co-occurring medical contributors. Behavioral interventions with caregiver training remain first-line treatment for sleep disorders in both neurotypical and neurodiverse youth.
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Affiliation(s)
- Navjot Sidhu
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA
| | - Zoe Wong
- The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University
| | - Amanda E Bennett
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA; The Children's Hospital of Philadelphia, Center for Autism Research, Sidney Kimmel Medical College, Thomas Jefferson University; Department of Pediatrics, The University of Pennsylvania Perelman School of Medicine; Autism Integrated Care Program, Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, 3550 Market Street, 3rd Floor, Philadelphia, PA 19104, USA.
| | - Margaret C Souders
- The University of Pennsylvania School of Nursing, The Children's Hospital of Philadelphia
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Johnson KP, Zarrinnegar P. Autism Spectrum Disorder and Sleep. Psychiatr Clin North Am 2024; 47:199-212. [PMID: 38302207 DOI: 10.1016/j.psc.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2024]
Abstract
Children and adolescents with autism spectrum disorder (ASD) experience sleep disturbances, particularly insomnia, at rates much higher than the general population. Daytime behavioral problems and parental stress are associated with the resultant sleep deprivation. Behavioral interventions, parental education, and melatonin are effective treatments. The epidemiology of sleep disturbances in youth with ASD is reviewed in this article as well as the latest in treatments.
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Affiliation(s)
- Kyle P Johnson
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA.
| | - Paria Zarrinnegar
- Division of Child & Adolescent Psychiatry, Oregon Health & Science University, Mailcode: DC-7P, 3181 Southwest Sam Jackson Park Road, Portland, OR 97239, USA
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Clavenna A, Cartabia M, Fortino I, Bonati M. Drug prescription profile in children with autism spectrum disorders. Eur J Clin Pharmacol 2024; 80:297-299. [PMID: 38117333 DOI: 10.1007/s00228-023-03610-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 12/15/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Antonio Clavenna
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy.
| | - Massimo Cartabia
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
| | - Ida Fortino
- Directorate General for Health, Lombardy Region, Milan, Italy
| | - Maurizio Bonati
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Via Mario Negri 2, Milan, 20156, Italy
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Pattison E, Papadopoulos N, Fuller-Tyszkiewicz M, Sciberras E, Hiscock H, Williams K, McGillivray J, Mihalopoulos C, Bellows ST, Marks D, Howlin P, Rinehart N. Randomised Controlled Trial of a Behavioural Sleep Intervention, 'Sleeping Sound', for Autistic Children: 12-Month Outcomes and Moderators of Treatment. J Autism Dev Disord 2024; 54:442-457. [PMID: 36414853 PMCID: PMC9684935 DOI: 10.1007/s10803-022-05809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2022] [Indexed: 11/24/2022]
Abstract
This study examined the sustained and moderating effects of a behavioural sleep intervention for autistic children in a randomised controlled trial. Autistic children (5-13 years) with sleep problems were randomised to the Sleeping Sound intervention or Treatment as Usual (TAU). At 12-month follow-up (n = 150), caregivers of children in the Sleeping Sound group reported greater reduction in child sleep problems compared to TAU (p < .001, effect size: - 0.4). The long-term benefits of the intervention were greater for children taking sleep medication, children of parents who were not experiencing psychological distress, and children with greater autism severity. The Sleeping Sound intervention demonstrated sustained improvements in child sleep. Identified moderators may inform treatment by indicating which subgroups may benefit from further support.
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Affiliation(s)
- Emily Pattison
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia.
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
| | - Harriet Hiscock
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Katrina Williams
- Murdoch Children's Research Institute, 50 Flemington Road, Parkville, VIC, 3052, Australia
- Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- Department of Paediatrics, Monash University, Monash Children's Hospital, 246 Clayton Road, Clayton, VIC, 3168, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Cathrine Mihalopoulos
- Deakin Health Economics Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Susannah T Bellows
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, VIC, 3220, Australia
| | - Deborah Marks
- Royal Children's Hospital, 50 Flemington Road, Parkville, VIC, 3052, Australia
| | - Patricia Howlin
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, VIC, 3800, Australia
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Leung TNH, Wong KL, Chan AKC, Li AM. Common Childhood Sleep Problems and Disorders. Curr Pediatr Rev 2024; 20:27-42. [PMID: 36043722 DOI: 10.2174/1573396318666220827102018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 05/30/2022] [Accepted: 07/04/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Sleep insufficiency and disturbances affect the physical, cognitive, and emotional well-being of children. OBJECTIVE To perform a narrative review on common sleep problems and disorders encountered in primary care for children and adolescents. METHODS A search of English literature in the Pubmed and Google Scholar databases published from 1 January 2000 till 31 October 2021 was conducted with the keywords "sleep problem" or "sleep disorder" and "child" or "adolescent". Findings in the relevant articles and cross-references were compiled. RESULTS Sleep duration and habits of children vary widely across countries with different cultural backgrounds. There is robust evidence to support the promotion of positive bedtime routines and sleep hygiene as prevention and management of sleep problems. 15-70% of parents reported their children having sleep problems or disturbances. Common sleep complaints include difficulty in initiation or maintenance of sleep, abnormal behaviors or movements, snoring or abnormal breathing, and excessive daytime sleepiness. Comprehensive sleep history and a sleep diary are the first steps for evaluation. Home video and actigraphy may be used as preliminary tools to confirm the history. Referrals to a sleep specialist for polysomnography and other tests are needed, if suspecting specific sleep disorders, such as obstructive sleep apnea and narcolepsy, needs timely intervention. Common sleep disorders in different age groups encountered in primary care are reviewed with clinical features, indications for evaluation, and treatment options summarized. CONCLUSION Screening for sleep problems shall be an integral part of each child's health care visit. It is important to evaluate the impact of common sleep problems and identify specific sleep disorders for early intervention to prevent long-term adverse outcomes.
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Affiliation(s)
- Theresa Ngan Ho Leung
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Kin Lok Wong
- Department of Paediatrics, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - Anthony Kam Chuen Chan
- Department of Paediatrics and Adolescent Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR, China
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Albert Martin Li
- Department of Paediatrics, Faculty of Medicine, Chinese University of Hong Kong, Hong Kong SAR, China
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Bruni O, Breda M, Malorgio E, Brambilla P, Ceschin F, Di Pilla A, Elia M, Ferri R. An online survey among general pediatricians on melatonin use in children with chronic insomnia. Eur J Paediatr Neurol 2024; 48:40-45. [PMID: 38008002 DOI: 10.1016/j.ejpn.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 11/08/2023] [Accepted: 11/12/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVES Although melatonin (MLT) is the molecule most used by pediatricians for sleep problems, scarce evidence exists on its use in healthy pediatric population. The objective of this study was to describe MLT use by Italian pediatricians in healthy children with chronic insomnia. STUDY DESIGN A cross-sectional open survey was administered to Italian pediatricians, between June and November 2022, collecting information about their use of MLT in healthy children: age range of patients, dosages used, time of administration, duration of treatment, association with other treatments, perceived efficacy, and side effects. Data were reported as frequencies with their respective 95% confidence intervals. Chi-square statistics assessed significant differences between pediatricians who had training in pediatric sleep and those who did not. RESULTS Among 428 respondents, 97.4% of pediatricians used MLT; 87.3% of them prescribed MLT in children aged 1-2 years, 62.1% in 2-5 years and 42.5% in 10-18 years. 84.9% of them suggested to take MLT 30 min before bedtime. 37.9% indicated to continue treatment for one month, 30.2% for 2-3 months. 74.1% of pediatricians usually prescribed MLT 1 mg/day. The most frequent treatment associated with MLT was sleep hygiene (85.4%). Almost all pediatricians found MLT effective in reducing difficulties falling asleep. Only 3.2% of them reported mild side effects. CONCLUSIONS MLT is widely prescribed by Italian pediatricians, but no consensus exists about its use in typically developing children. There is a need for clear guidelines to optimize the use of MLT in healthy children.
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Affiliation(s)
- Oliviero Bruni
- Developmental and Social Psychology, Sapienza University of Rome, Via dei Marsi 78, 00185, Rome, Italy.
| | - Maria Breda
- Child Neurology and Psychiatry Unit, Department of Human Neurosciences, Sapienza University, Rome, Italy
| | - Emanuela Malorgio
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Paolo Brambilla
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Flavia Ceschin
- SICuPP -Società Italiana delle Cure Primarie Pediatriche - (Italian Primary Care Pediatrics Society), Italy
| | - Andrea Di Pilla
- Life Sciences and Public Health Department, Catholic University of Sacred Heart, 00168, Rome, Italy
| | - Maurizio Elia
- Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
| | - Raffaele Ferri
- Oasi Research Institute - IRCCS, Via C. Ruggero 73, 94018, Troina, Italy
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Petti T, Gupta M, Fradkin Y, Gupta N. Management of sleep disorders in autism spectrum disorder with co-occurring attention-deficit hyperactivity disorder: update for clinicians. BJPsych Open 2023; 10:e11. [PMID: 38088185 PMCID: PMC10755553 DOI: 10.1192/bjo.2023.589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 08/24/2023] [Accepted: 09/01/2023] [Indexed: 12/31/2023] Open
Abstract
AIMS To update and examine available literature germane to the recognition, assessment and treatment of comorbid autism spectrum disorder (ASD), attention-deficit hyperactivity disorder (ADHD) and sleep disruption, with a predominant focus on children, adolescents and emerging adults. BACKGROUND Considerable overlaps exist among ASD, ADHD and sleep disruption. Literature and guidance for clinicians, administrators, policy makers and families have been limited, as such deliberations were rarely considered until 2013. METHOD This narrative review of the literature addressing sleep disruption issues among those with ASD, ADHD and comorbid ASD and ADHD involved searching multiple databases and use of reverse citations up to the end of September 2022. Emphasis is placed on secondary sources and relevant data for clinical practice. RESULTS Complex clinical presentations of ASD/ADHD/sleep disruption are frequently encountered in clinical practice. Prior to 2013, prevalence, clinical presentation, pathophysiology, prognosis, other sleep-related factors and interventions were determined separately for each disorder, often with overlapping objective and subjective methods employed in the process. High percentages of ADHD and ASD patients have both disorders and sleep disruption. Here, the extant literature is integrated to provide a multidimensional understanding of the relevant issues and insights, allowing enhanced awareness and better care of this complex clinical population. Database limitations are considered. CONCLUSIONS Assessment of ASD symptomatology in youth with ADHD, and the reverse, in cases with disrupted sleep is critical to address the special challenges for case formulation and treatment. Evidence-based approaches to treatment planning and multi-treatment modalities should consider combining psychosocial and biological interventions to address the complexities of each case.
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Affiliation(s)
- Theodore Petti
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Mayank Gupta
- Southwood Psychiatric Hospital, Pittsburgh, Pennsylvania, USA
| | - Yuli Fradkin
- Rutgers University-Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
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Bradford C, Miller JL, Harkin M, Chaaban H, Neely SB, Johnson PN. Melatonin Use in Infants Admitted to Intensive Care Units. J Pediatr Pharmacol Ther 2023; 28:635-642. [PMID: 38025149 PMCID: PMC10681084 DOI: 10.5863/1551-6776-28.7.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 03/04/2023] [Indexed: 12/01/2023]
Abstract
OBJECTIVES Sleep deprivation is a risk factor for delirium development, which is a frequent complication of intensive care unit admission. Melatonin has been used for both delirium prevention and treatment. Melatonin safety, efficacy, and dosing information in neonates and infants is lacking. The purpose of this study was to describe melatonin use in infants regarding indication, dosing, efficacy, and safety. METHODS This descriptive, retrospective study included infants <12 months of age admitted to an intensive care unit receiving melatonin. Data collection included demographics, melatonin regimen, sedative and analgesic agents, antipsychotics, and delirium-causing medications. The primary objective was to identify the melatonin indication and median dose. The secondary objectives included change in delirium, pain, and sedation scores; change in dosing of analgesic and sedative agents; and adverse event identification. Wilcoxon signed rank tests and linear mixed models were employed with significance defined at p < 0.05. RESULTS Fifty-five patients were included, with a median age of 5.5 months (IQR, 3.9-8.2). Most (n = 29; 52.7%) received melatonin for sleep promotion. The median body weight-based dose was 0.31 mg/kg/dose (IQR, 0.20-0.45). There was a statistical reduction in cumulative morphine equivalent dosing 72 hours after melatonin administration versus before, 17.1 versus 21.4 mg/kg (p = 0.049). No adverse events were noted. CONCLUSIONS Most patients (n = 29; 52.7%) received melatonin for sleep promotion at a median dose was 0.31 mg/kg/dose. Initiation of melatonin was associated with a reduction of opioid exposure; however, there was no reduction in pain/sedation scores.
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Affiliation(s)
- Caitlyn Bradford
- Department of Pharmacy Practice (CB), Philadelphia College of Pharmacy, Saint Joseph’s University, Philadelphia, PA
| | - Jamie L. Miller
- Department of Pharmacy: Clinical and Administrative Sciences (JLM, SBN, PNJ), College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Maura Harkin
- Department of Pharmacy (MH), Oklahoma Children’s Hospital at OU Health, Oklahoma City, OK
| | - Hala Chaaban
- Department of Pediatrics (HC), College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephen B. Neely
- Department of Pharmacy: Clinical and Administrative Sciences (JLM, SBN, PNJ), College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Peter N. Johnson
- Department of Pharmacy: Clinical and Administrative Sciences (JLM, SBN, PNJ), College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK
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Banerjee A, Johnson B, Kauer A, Gunderson C, Stevens HE. Common Issues for General Practitioners in the Medical Management of Child and Adolescent Psychiatric Care. J Pediatr Pharmacol Ther 2023; 28:595-602. [PMID: 38025144 PMCID: PMC10681082 DOI: 10.5863/1551-6776-28.7.595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 01/11/2023] [Indexed: 12/01/2023]
Abstract
With a limited number of child and adolescent psychiatrists available to see youth patients, many common psychiatric problems in youth are managed by other providers. Clinical pearls from experts in child and adolescent psychiatry can help general practitioners with this management. Some common issues are discussed here for which practical guidance is offered, ranging from approaches to assessment and how to start and titrate medications for the treatment of attention deficit hyperactivity disorder, depression, and sleep problems.
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Affiliation(s)
- Ashmita Banerjee
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Burgundy Johnson
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Aaron Kauer
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Carissa Gunderson
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
| | - Hanna E. Stevens
- Department of Psychiatry, University of Iowa Carver College of Medicine, Iowa City, IA
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Johnson CR, Barto L, Worley S, Rothstein R, Alder ML. Telehealth parent training for sleep disturbances in young children with autism spectrum disorder: A randomized controlled trial. Sleep Med 2023; 111:208-219. [PMID: 37806263 DOI: 10.1016/j.sleep.2023.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/29/2023] [Accepted: 08/30/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND AND PURPOSE Young children with autism spectrum disorder (autism) have bedtime and sleep disturbances at much higher frequency and persistency than their neurotypical counterparts. Hence, access to early, effective treatment is critical in view of the importance of sleep in early childhood. Telehealth delivery could be a means to expand access to such early treatment if efficacious. The aim of this randomized control trial (RCT) was to compare a manualized, telehealth delivered, behaviorally based sleep parent training (SPT) intervention for parents of young children with autism and sleep disturbances to a control condition, a telehealth delivered parent education program with one sleep focused session (SPE). We hypothesized that the SPT group would show more improvements on child measures of sleep outcome measures, and daytime behaviors and parent measures of stress and sense of competence. We further aimed to explore the overall feasibility of telehealth delivery of SPT and SPE. PARTICIPANTS AND METHODS Parents of 77 young children, ages 2-7 years, with autism and co-occurring sleep disturbances were enrolled in this study. Participants were randomized to either SPT or a comparison arm that included non-sleep related parent education except for one session. Each participant was individually administered a 5 session program delivered over 10 weeks. Outcome measures, including child sleep measures, child daytime behavior and parent stress and sense of competency were collected at weeks 5 and 10 after the baseline time point. Feasibility indicators (treatment fidelity, parent adherence, and parent attendance), and safety measures were also collected. RESULTS Of 77 randomized participants, data were available for 36 participants randomized to SPT and 38 participants randomized to SPE. The mean age was 3 years, 8 months. Results support the efficacy of this manualized SPT intervention for bedtime and sleep disturbances. Sleep outcome measures were significantly improved in the SPT group compared to SPE on the Modified Simonds & Parraga Sleep Questionnaire-Composite Sleep Index (MSPSQ - CSI) (p < 0.001) with a large effect size of 0.83 at week 10. Positive response to treatment, as determined from the Clinical Global Impression-Improvement scale (CGI-I) at week 10 was observed in 56% of SPT participants compared to 32% in SPE (p = 0.037). There were no significant group differences in either the ABC-I as measure of daytime behaviors or in parental stress. There were group differences in favor of SPT over SPE on the PSOC, a measure of parent sense of competency. Feasibility and safety were further demonstrated with telehealth delivery. CONCLUSIONS This RCT demonstrated the efficacy of a telehealth delivered parent training intervention for bedtime and sleep disturbances in young autistic children compared to an active control condition. Further, parents in SPT reported more confidence in their parenting role than those in the SPE group, but SPT did not result in overall decreases in parental stress. Telehealth delivery allowed for a much broader reach with enrolled participants from 24 states. This study supports a telehealth approach to a manualized behavioral parent mediated intervention for sleep disturbance in young autistic children and offers an alternative to in-person delivered approaches. This telehealth delivery has the potential to improve access for families who have a young autistic child with sleep disturbances. Given the small sample size, determining predictors and moderators of treatment response was not possible and should be examined in a larger trial.
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Bolic Baric V, Skuthälla S, Pettersson M, Gustafsson PA, Kjellberg A. The effectiveness of weighted blankets on sleep and everyday activities - A retrospective follow-up study of children and adults with attention deficit hyperactivity disorder and/or autism spectrum disorder. Scand J Occup Ther 2023; 30:1357-1367. [PMID: 34184958 DOI: 10.1080/11038128.2021.1939414] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 06/02/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Attention deficit hyperactivity disorder (ADHD) and Autism Spectrum Disorder (ASD) are often accompanied by sleep problems influencing social, emotional and cognitive functioning in everyday activities. AIM The aim of this study was to investigate whether the use of a weighted blanket has a positive impact on sleep and everyday activities in individuals with ADHD and/or ASD. MATERIAL AND METHODS The study included 85 individuals diagnosed with ADHD and/or ASD, 48 children aged ≤17 (57%) and 37 adults ≥18 years (44%), who were prescribed with a weighted blanket. The participants responded via a telephone interview. RESULTS Findings demonstrated that a weighted blanket improved abilities related to falling asleep, sleeping the whole night, and relaxing during the day. Using a weighted blanket improved morning/evening daily routine, including preparing/going to sleep and waking up in the morning. CONCLUSIONS Weighted blankets showed positive impact on falling asleep, sleeping the whole night, and relaxing during the day, and they were used frequently by children and adults with ADHD and/or ASD. Findings indicate that a weighted blanket improved morning/evening routine, however this research area needs further investigation using both subjective and objective parameters.
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Affiliation(s)
- Vedrana Bolic Baric
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | | | | | - Per A Gustafsson
- Child and Adolescent Psychiatry, Center for Social and Affective Neuroscience, Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Anette Kjellberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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Sadeh H, Meiri G, Zigdon D, Ilan M, Faroy M, Michaelovski A, Sadaka Y, Dinstein I, Menashe I. Adherence to treatment and parents' perspective about effectiveness of melatonin in children with autism spectrum disorder and sleep disturbances. Child Adolesc Psychiatry Ment Health 2023; 17:123. [PMID: 37891596 PMCID: PMC10612352 DOI: 10.1186/s13034-023-00669-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
OBJECTIVE Melatonin is considered an effective pharmacological treatment for the sleep disturbances that are reported in > 50% of children with autism spectrum disorder (ASD). However, real-life data about the long-term course and effectiveness of melatonin treatment in children with ASD is lacking. METHODS In this retrospective cohort study, we assessed the adherence to melatonin treatment and parents' perspective of its effect on sleep quality and daytime behavior in children with ASD via a parental phone survey of children in the Azrieli National Center for Autism and Neurodevelopment Research (ANCAN) database. Cox regression analysis was used to assess the effect of key demographic and clinical characteristics on treatment adherence. RESULTS Melatonin was recommended for ~ 8% of children in the ANCAN database. These children were characterized by more severe symptoms of autism. The median adherence time for melatonin treatment exceeded 88 months, with the most common reason for discontinuation being a lack of effectiveness (14%). Mild side-effects were reported in 14% of children, and 86%, 54%, and 45% experienced improvements in sleep onset, sleep duration and night awakenings, respectively. Notably, melatonin also improved the daytime behaviors of > 28% of the children. Adherence to treatment was independently associated with improvements in night awakenings and educational functioning (aHR = 0.142, 95%CI = 0.036-0.565; and aHR = 0.195, 95%CI = 0.047-0.806, respectively). CONCLUSIONS Based on parents' report, melatonin is a safe and effective treatment that improves both sleep difficulties and daily behavior of children with ASD.
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Affiliation(s)
- Hadar Sadeh
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
| | - Gal Meiri
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
| | - Dikla Zigdon
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
| | - Michal Ilan
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
| | - Michal Faroy
- Preschool Psychiatric Unit, Soroka University Medical Center, Beer-Sheva, Israel
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
| | - Analya Michaelovski
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
- Zusman Child Development Center, Soroka University Medical Center, Beer-Sheva, Israel
| | - Yair Sadaka
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
- Child Development Clinic, Ministry of Health, Beer-Sheva, Israel
| | - Ilan Dinstein
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel
- Psychology and Brain and Cognition Departments, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Idan Menashe
- Azrieli National Center for Autism and Neurodevelopmental Research, Beer-Sheva, Israel.
- Department of Epidemiology, Biostatistics, and Community Health Sciences, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
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Lai MC. Mental health challenges faced by autistic people. Nat Hum Behav 2023; 7:1620-1637. [PMID: 37864080 DOI: 10.1038/s41562-023-01718-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/07/2023] [Indexed: 10/22/2023]
Abstract
Mental health challenges impede the well-being of autistic people. This Review outlines contributing neurodevelopmental and physical health conditions, rates and developmental trajectories of mental health challenges experienced by autistic people, as well as unique clinical presentations. A framework is proposed to consider four contributing themes to aid personalized formulation: social-contextual determinants, adverse life experiences, autistic cognitive features, and shared genetic and early environmental predispositions. Current evidence-based and clinical-knowledge-informed intervention guidance and ongoing development of support are highlighted for specific mental health areas. Tailored mental health support for autistic people should be neurodivergence-informed, which is fundamentally humanistic and compatible with the prevailing bio-psycho-social frameworks. The personalized formulation should be holistic, considering physical health and transdiagnostic neurodevelopmental factors, intellectual and communication abilities, and contextual-experiential determinants and their interplay with autistic cognition and biology, alongside resilience. Supporting family well-being is integral. Mutual empathic understanding is fundamental to creating societies in which people across neurotypes are all empowered to thrive.
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Affiliation(s)
- Meng-Chuan Lai
- Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health and Azrieli Adult Neurodevelopmental Centre, Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychology, Faculty of Arts and Science, University of Toronto, Toronto, Ontario, Canada.
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada.
- Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK.
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan.
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Singh K, Zimmerman AW. Sleep in Autism Spectrum Disorder and Attention Deficit Hyperactivity Disorder. Semin Pediatr Neurol 2023; 47:101076. [PMID: 37919035 DOI: 10.1016/j.spen.2023.101076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/15/2023] [Indexed: 11/04/2023]
Abstract
SLEEP IN AUTISM SPECTRUM DISORDER AND ATTENTION DEFICIT HYPERACTIVITY DISORDER: Kanwaljit Singh, Andrew W. Zimmerman Seminars in Pediatric Neurology Volume 22, Issue 2, June 2015, Pages 113-125 Sleep problems are common in autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD). Sleep problems in these disorders may not only worsen daytime behaviors and core symptoms of ASD and ADHD but also contribute to parental stress levels. Therefore, the presence of sleep problems in ASD and ADHD requires prompt attention and management. This article is presented in 2 sections, one each for ASD and ADHD. First, a detailed literature review about the burden and prevalence of different types of sleep disorders is presented, followed by the pathophysiology and etiology of the sleep problems and evaluation and management of sleep disorders in ASD and ADHD.
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Affiliation(s)
- Kanwaljit Singh
- International Neonatal Consortium and CPA-1 Program, Director of Pediatric Programs, Critical Path Institute, Tucson, AZ 85718
| | - Andrew W Zimmerman
- Pediatrics and Neurology, UMass Memorial Medical Center, Worcester, MA 01655.
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Consens FB. Circadian Rhythm Sleep-Wake Disorders. Continuum (Minneap Minn) 2023; 29:1149-1166. [PMID: 37590827 DOI: 10.1212/con.0000000000001287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023]
Abstract
OBJECTIVE This article provides an overview of advances in the understanding of circadian rhythms and the health implications of circadian disruption. LATEST DEVELOPMENTS Circadian medicine is a relatively new concept, with widespread overlap with many other areas of medicine. Circadian clocks rely on feedback loops that control the expression of many genes. Functional circadian oscillators exist at multiple physiologic levels and facilitate a multimodal clock mechanism. The suprachiasmatic nucleus is the central circadian pacemaker. Peripheral tissues can be entrained by other stimuli (such as food intake) and can uncouple from the suprachiasmatic nucleus pacemaker; this discovery may provide new therapeutic options for circadian rhythm disorders. Numerous modern developments have altered our circadian clocks and these changes are associated with poor health outcomes. ESSENTIAL POINTS Circadian clocks are ubiquitous throughout our body and regulate multiple body functions. Several studies have highlighted that circadian disruption can result in significant negative mental and physical health consequences. A deeper understanding of the effects of misalignment between our circadian clocks and the external environment may ultimately have therapeutic implications for our health.
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Wang F, He J, Zhou Y, Ye L, Li B, Ma Z, Chen C, Zhang R, Lin Z, Tang J, Jin Z, Jiang Y, Lin N. A phase 1 study of dimdazenil to evaluate the pharmacokinetics, food effect and safety in Chinese healthy subjects. Front Pharmacol 2023; 14:1226014. [PMID: 37601041 PMCID: PMC10432719 DOI: 10.3389/fphar.2023.1226014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Accepted: 07/17/2023] [Indexed: 08/22/2023] Open
Abstract
Background and objective: As a partial positive allosteric modulator of the gamma-aminobutyric acid A (GABAA) receptor, dimdazenil was used for the treatment of insomnia with the potential to alleviate associated side effects compared to full agonists. The objective of this trial is to assess the safety, tolerability, food effect and pharmacokinetics following single and multiple doses of dimdazenil in Chinese healthy subjects. Methods: In this phase 1 trial, 36 healthy subjects aged ≥18 years were assigned to receive a single dose of 1.5, 2.5, or 5 mg dimdazenil, with each dose cohort consisting of 12 subjects, and 14 subjects were assigned to receive a multiple 2.5 mg daily dose of dimdazenil for 5 days. Safety, tolerability, and pharmacokinetic characteristics were evaluated. Results: Of the 50 subjects enrolled and 49 completed the trial, the incidences of treatment-emergent adverse events (AEs) in the single-dose groups of 1.5, 2.5, and 5 mg were 16.7%, 58.3% and 66.7% respectively, while 61.5% in the multiple-dose group. There were no serious AEs, deaths, AEs leading to discontinuation or AEs of requiring clinical intervention in any treatment groups. The most treatment-emergent AEs were dizziness (n = 4, 8.2%), hyperuricemia (n = 2, 6.1%), upper respiratory tract infection (n = 2, 6.1%), diastolic blood pressure decreased (n = 2, 6.1%), blood TG increased (n = 2, 6.1%) and RBC urine positive (n = 2, 6.1%). All AEs were mild-to-moderate and transient, and no severe AEs were documented in any study phase. The PK profile of dimdazenil and its active metabolite Ro46-1927 was linear across 1.5-5 mg oral doses in humans. The median Tmax for dimdazenil was in the range of 0.5-1.5 h, and the apparent terminal t1/2z ranged from 3.50 to 4.32 h. Taking Dimdazenil with food may delay Tmax and decrease Cmax, without affecting the total exposure (AUC). No relevant accumulations of dimdazenil and Ro 46-1927 were observed in multiple-dose group. Conclusion: Dimdazenil was generally well tolerated in healthy Chinese subjects after single and 5 days-multiple dosing. The pharmacokinetic properties of dimdazenil are compatible with a drug for the treatment of insomnia. Clinical Trial Registration: chinadrugtrials.org.cn, identifier CTR20201978.
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Affiliation(s)
- Fei Wang
- Phase 1 Clinical Trial Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingjing He
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Yanling Zhou
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Lijun Ye
- Phase 1 Clinical Trial Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Bei Li
- Phase 1 Clinical Trial Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhiyuan Ma
- Phase 1 Clinical Trial Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chunyan Chen
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Ruoxi Zhang
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Zhaocun Lin
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Jinshan Tang
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Zhiping Jin
- Zhejiang Jingxin Pharmaceutical Co., Ltd., Shaoxing, China
| | - Yu Jiang
- Shanghai Research Institute, Zhejiang Jingxin Pharmaceutical Co., Ltd., Shanghai, China
| | - Nengming Lin
- Phase 1 Clinical Trial Center, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- Key Laboratory of Clinical Cancer Pharmacology and Toxicology Research of Zhejiang Province, Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Hangzhou, China
- West lake Laboratory of Life Sciences and Biomedicine of Zhejiang Province, Hangzhou, China
- Cancer Center, Zhejiang University, Hangzhou, China
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28
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Srivastava S, Sahin M, Buxbaum JD, Berry-Kravis E, Soorya LV, Thurm A, Bernstein JA, Asante-Otoo A, Bennett WE, Betancur C, Brickhouse TH, Passos Bueno MR, Chopra M, Christensen CK, Cully JL, Dies K, Friedman K, Gummere B, Holder JL, Jimenez-Gomez A, Kerins CA, Khan O, Kohlenberg T, Lacro RV, Levy LA, Levy T, Linnehan D, Loth E, Moshiree B, Neumeyer A, Paul SM, Phelan K, Persico A, Rapaport R, Rogers C, Saland J, Sethuram S, Shapiro J, Tarr PI, White KM, Wickstrom J, Williams KM, Winrow D, Wishart B, Kolevzon A. Updated consensus guidelines on the management of Phelan-McDermid syndrome. Am J Med Genet A 2023; 191:2015-2044. [PMID: 37392087 PMCID: PMC10524678 DOI: 10.1002/ajmg.a.63312] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 07/02/2023]
Abstract
Phelan-McDermid syndrome (PMS) is a genetic condition caused by SHANK3 haploinsufficiency and characterized by a wide range of neurodevelopmental and systemic manifestations. The first practice parameters for assessment and monitoring in individuals with PMS were published in 2014; recently, knowledge about PMS has grown significantly based on data from longitudinal phenotyping studies and large-scale genotype-phenotype investigations. The objective of these updated clinical management guidelines was to: (1) reflect the latest in knowledge in PMS and (2) provide guidance for clinicians, researchers, and the general community. A taskforce was established with clinical experts in PMS and representatives from the parent community. Experts joined subgroups based on their areas of specialty, including genetics, neurology, neurodevelopment, gastroenterology, primary care, physiatry, nephrology, endocrinology, cardiology, gynecology, and dentistry. Taskforce members convened regularly between 2021 and 2022 and produced specialty-specific guidelines based on iterative feedback and discussion. Taskforce leaders then established consensus within their respective specialty group and harmonized the guidelines. The knowledge gained over the past decade allows for improved guidelines to assess and monitor individuals with PMS. Since there is limited evidence specific to PMS, intervention mostly follows general guidelines for treating individuals with developmental disorders. Significant evidence has been amassed to guide the management of comorbid neuropsychiatric conditions in PMS, albeit mainly from caregiver report and the experience of clinical experts. These updated consensus guidelines on the management of PMS represent an advance for the field and will improve care in the community. Several areas for future research are also highlighted and will contribute to subsequent updates with more refined and specific recommendations as new knowledge accumulates.
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Affiliation(s)
- Siddharth Srivastava
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Mustafa Sahin
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Joseph D. Buxbaum
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Genetics and Genomic Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth Berry-Kravis
- Department of Pediatrics, Rush University Medical Center, Chicago, IL, USA
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, USA
| | | | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, National Institutes of Health, Bethesda, MD, USA
| | | | - Afua Asante-Otoo
- Rehabilitation Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - William E. Bennett
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Catalina Betancur
- Sorbonne Université, INSERM, CNRS, Neuroscience Paris Seine, Institut de Biologie Paris Seine, Paris, France
| | - Tegwyn H. Brickhouse
- Department of Dental Public Health & Policy, School of Dentistry, Virginia Commonwealth University, Richmond, VA, USA
| | - Maria Rita Passos Bueno
- Departamento de Genética e Biologia Evolutiva, Centro de Estudos do Genoma Humano e Células-tronco, Instituto de Biociências, Universidade de São Paulo, São Paulo, SP, Brazil
| | - Maya Chopra
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Celanie K. Christensen
- Division of Developmental Medicine, Department of Pediatrics, Riley Children’s Health, Indianapolis, IN, USA
- Division of Child Neurology, Department of Neurology, Riley Children’s Health, Indianapolis, IN, USA
| | - Jennifer L. Cully
- Department of Pediatrics, College of Medicine and Division of Dentistry and Orthodontics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kira Dies
- Department of Neurology, Boston Children’s Hospital, Boston, MA, USA
- Rosamund Stone Zander Translational Neuroscience Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Kate Friedman
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - J. Lloyd Holder
- Department of Pediatrics-Neurology, Baylor College of Medicine, Houston, TX, USA
| | | | - Carolyn A. Kerins
- Department of Pediatric Dentistry, School of Dentistry, Texas A&M University, Dallas, TX, USA
| | - Omar Khan
- National Institute of Neurological Disease and Stroke, Bethesda, MD, USA
| | | | - Ronald V. Lacro
- Department of Cardiology, Boston Children’s Hospital, Department of Pediatrics, Harvard Medical School, Boston, MA, USA
| | | | - Tess Levy
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Eva Loth
- Kings College London, London, UK
| | - Baharak Moshiree
- Department of Medicine, Wake Forest/Atrium Health, Charlotte, NC, USA
| | - Ann Neumeyer
- Lurie Center for Autism, Massachusetts General Hospital, Lexington MA, USA, Harvard Medical School, Boston, MA USA
| | - Scott M. Paul
- Rehabilitation Medicine Department, NIH Clinical Center, Bethesda, MD, USA
| | - Katy Phelan
- Genetics Laboratory, Florida Cancer Specialists and Research Institute, Fort Myers, FL, USA
| | - Antonio Persico
- Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | - Robert Rapaport
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | - Jeffrey Saland
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Swathi Sethuram
- Department of Pediatrics, Massachusetts General Hospital, Boston, MA, USA
| | | | - Phillip I. Tarr
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO, USA
| | - Kerry M. White
- Division of Developmental Medicine, Department of Pediatrics, Riley Children’s Health, Indianapolis, IN, USA
- Department of Medical and Molecular Genetics, Riley Children’s Health, Indianapolis, IN, USA
| | - Jordan Wickstrom
- Sinai Rehabilitation Center, Lifebridge Health, Baltimore, MD, USA
| | - Kent M. Williams
- Department of Pediatrics, The Ohio State University School of Medicine, Columbus, OH, USA
| | | | | | - Alexander Kolevzon
- Seaver Autism Center for Research and Treatment, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Pediatrics, Kravis Children’s Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Mammarella V, Orecchio S, Cameli N, Occhipinti S, Marcucci L, De Meo G, Innocenti A, Ferri R, Bruni O. Using pharmacotherapy to address sleep disturbances in autism spectrum disorders. Expert Rev Neurother 2023; 23:1261-1276. [PMID: 37811652 DOI: 10.1080/14737175.2023.2267761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Accepted: 10/03/2023] [Indexed: 10/10/2023]
Abstract
INTRODUCTION Sleep disorders are the second most common medical comorbidity in autism spectrum disorder (ASD), with effects on daytime behavior and functioning, mood and anxiety, and autism core features. In children with ASD, insomnia also has a negative impact on the whole family's quality of life. Therefore, treatment of sleep disturbances should be considered as a primary goal in the management of ASD patients, and it is important to clarify the scientific evidence to inappropriate treatments. AREAS COVERED The authors review the current literature concerning the pharmacological treatment options for the management of sleep-related disorders in patients with ASD (aged 0-18 years) using the PubMed and Cochrane Library databases with the search terms: autism, autistic, autism spectrum disorder, ASD, drug, drug therapy, drug intervention, drug treatment, pharmacotherapy, pharmacological treatment, pharmacological therapy, pharmacological intervention, sleep, sleep disturbance, and sleep disorder. EXPERT OPINION Currently, clinicians tend to select medications for the treatment of sleep disorders in ASD based on the first-hand experience of psychiatrists and pediatricians as well as expert opinion. Nevertheless, at the present time, the only compound for which there is sufficient evidence is melatonin, although antihistamines, trazodone, clonidine, ramelteon, gabapentin, or suvorexant can also be considered for selection.
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Affiliation(s)
- Valeria Mammarella
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Silvia Orecchio
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Noemi Cameli
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Sara Occhipinti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Lavinia Marcucci
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Giuliano De Meo
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Alice Innocenti
- Child Neuropsychiatry Unit, Department of Human Neuroscience, Sapienza University, Rome, Italy
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Oliviero Bruni
- Department of Social and Developmental Psychology, Sapienza University, Rome, Italy
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30
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Galion AW, Farmer JG, Connolly HV, Allhusen VD, Bennett A, Coury DL, Lam J, Neumeyer AM, Sohl K, Witmans M, Malow BA. A Practice Pathway for the Treatment of Night Wakings in Children with Autism Spectrum Disorder. J Autism Dev Disord 2023:10.1007/s10803-023-06026-2. [PMID: 37358787 DOI: 10.1007/s10803-023-06026-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/26/2023] [Indexed: 06/27/2023]
Abstract
Children with autism spectrum disorder (ASD) report high rates of sleep problems. In 2012, the Autism Treatment Network/ Autism Intervention Research Network on Physical Health (ATN/AIR-P) Sleep Committee developed a pathway to address these concerns. Since its publication, ATN/AIR-P clinicians and parents have identified night wakings as a refractory problem unaddressed by the pathway. We reviewed the existing literature and identified 76 scholarly articles that provided data on night waking in children with ASD. Based on the available literature, we propose an updated practice pathway to identify and treat night wakings in children with ASD.
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Affiliation(s)
- Anjalee W Galion
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA.
| | - Justin G Farmer
- Massachusetts General Hospital for Children, Boston, MA, USA
| | | | - Virginia D Allhusen
- Division of Neurology, Children's Hospital of Orange County, 1201 W. La Veta Avenue, Orange, CA, 92868, USA
| | - Amanda Bennett
- Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | | | - Janet Lam
- Kennedy Krieger Institute, Baltimore, MD, USA
| | - Ann M Neumeyer
- Massachusetts General Hospital for Children, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Kristin Sohl
- University of Missouri School of Medicine, Columbia, MO, USA
| | | | - Beth A Malow
- Vanderbilt University Medical Center, Nashville, TN, USA
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Mombelli S, Bacaro V, Curati S, Berra F, Sforza M, Castronovo V, Ferini-Strambi L, Galbiati A, Baglioni C. Non-pharmacological and melatonin interventions for pediatric sleep initiation and maintenance problems: A systematic review and network meta-analysis. Sleep Med Rev 2023; 70:101806. [PMID: 37406497 DOI: 10.1016/j.smrv.2023.101806] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/07/2023] [Accepted: 06/10/2023] [Indexed: 07/07/2023]
Abstract
Sleep initiation and maintenance problems are common in the pediatric population and while behavioral interventions are recommended, their efficacy remains to be evaluated in clinical trials. We conducted a systematic review and network meta-analysis to assess the efficacy of non-pharmacological treatments and melatonin for sleep initiation and maintenance problems in healthy pediatric populations. We included 30 studies in the systematic review and 15 in the meta-analysis. Three network meta-analyses were conducted for sleep onset latency (SOL), wake after sleep onset (WASO), and total sleep time (TST). For SOL variable, the results support greater effectiveness of light therapy and melatonin than evidence-based psychological interventions, whether implemented in combination with light therapy or not. Regarding WASO variable, evidence-based psychological interventions and a combination of those techniques plus light treatment were the most efficacious. Finally, for TST variable, a larger effect was shown for the combined treatment of evidence-based psychological intervention with light therapy in comparison to other interventions. In conclusion, we found a high variability between study protocols likely impacting the results of the meta-analysis. Future randomized control trials studies, stratified by pediatric age classes, are needed in order to provide clear suggestions in clinical settings.
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Affiliation(s)
- Samantha Mombelli
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Valeria Bacaro
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy; Department of Psychology, University of Bologna, Bologna, Italy
| | - Sara Curati
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy
| | - Francesca Berra
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Marco Sforza
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Vincenza Castronovo
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Luigi Ferini-Strambi
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Andrea Galbiati
- Department of Clinical Neurosciences, Neurology-Sleep Disorders Center, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy.
| | - Chiara Baglioni
- Department of Human Sciences, University of Rome Guglielmo Marconi, Rome, Italy; Department of Psychiatry and Psychotherapy, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, DE, Germany; Clinic for Sleep Psychotherapy, School of Cognitive Psychotherapy, SPC, Rome, Italy
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32
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Boutin JA, Kennaway DJ, Jockers R. Melatonin: Facts, Extrapolations and Clinical Trials. Biomolecules 2023; 13:943. [PMID: 37371523 DOI: 10.3390/biom13060943] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 06/29/2023] Open
Abstract
Melatonin is a fascinating molecule that has captured the imagination of many scientists since its discovery in 1958. In recent times, the focus has changed from investigating its natural role as a transducer of biological time for physiological systems to hypothesized roles in virtually all clinical conditions. This goes along with the appearance of extensive literature claiming the (generally) positive benefits of high doses of melatonin in animal models and various clinical situations that would not be receptor-mediated. Based on the assumption that melatonin is safe, high doses have been administered to patients, including the elderly and children, in clinical trials. In this review, we critically review the corresponding literature, including the hypotheses that melatonin acts as a scavenger molecule, in particular in mitochondria, by trying not only to contextualize these interests but also by attempting to separate the wheat from the chaff (or the wishful thinking from the facts). We conclude that most claims remain hypotheses and that the experimental evidence used to promote them is limited and sometimes flawed. Our review will hopefully encourage clinical researchers to reflect on what melatonin can and cannot do and help move the field forward on a solid basis.
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Affiliation(s)
- J A Boutin
- Laboratory of Neuronal and Neuroendocrine Differentiation and Communication, University of Normandy, INSERM U1239, 76000 Rouen, France
| | - D J Kennaway
- Robinson Research Institute and Adelaide School of Medicine, University of Adelaide, Adelaide Health and Medical Science Building, North Terrace, Adelaide, SA 5006, Australia
| | - R Jockers
- Institut Cochin, Université Paris Cité, INSERM, CNRS, 75014 Paris, France
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Yano N, Hosokawa K. The importance of comprehensive support based on the three pillars of exercise, nutrition, and sleep for improving core symptoms of autism spectrum disorders. Front Psychiatry 2023; 14:1119142. [PMID: 37260760 PMCID: PMC10228143 DOI: 10.3389/fpsyt.2023.1119142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 03/15/2023] [Indexed: 06/02/2023] Open
Abstract
Autism spectrum disorder (ASD) is classified as a neurodevelopmental disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM)-V, which first described ASD, lists persistent deficits in social communication and interrelationships, as well as limited and recurrent modes of behavior, interests, and activities as diagnostic items. Until recently, understanding the pathophysiology of ASD has been mostly from a neurophysiological perspective, and interventions have been mostly behavioral and psychological. In recent years, however, it has become clear that ASD also affects many bodily systems, including the immune system, the sensorimotor system, and the gut-brain axis, and that these factors simultaneously influence it. In light of this background, a new "connectivome theory" has been proposed as a hypothesis for understanding ASD. "Exercise," "nutrition," and "sleep," which are discussed in this mini-review, have a particularly strong relationship with the immune, musculoskeletal, and gut systems among the pathologies mentioned in the "connectivome theory," furthermore, many reports suggest improvements in stereo-responsive behavior and social and communication skills, which are the core symptoms of ASD. In addition, these interventions are characterized by being less subject to location and cost limitations and excel in the continuity of therapeutic intervention, and the three interventions may have a reciprocal positive impact and may function as three pillars to support ASD.
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Affiliation(s)
- Nozomu Yano
- Graduate School of Health Sciences, Doctoral Course, Kagoshima University Graduate School, Kagoshima, Japan
| | - Kenji Hosokawa
- Department of Child Care and Education, Odawara Junior College, Nagoya, Japan
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Martinez-Cayuelas E, Merino-Andreu M, Losada-Del Pozo R, Gavela-Pérez T, Garcés C, Soriano-Guillén L. Response to Melatonin Treatment in Children With Autism spectrum Disorder and Relationship to Sleep Parameters and Melatonin Levels. J Child Neurol 2023:8830738231173606. [PMID: 37192744 DOI: 10.1177/08830738231173606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/18/2023]
Abstract
Melatonin is one of the most used pharmacologic treatments for sleep problems in autism spectrum disorder, though its relationship with circadian and sleep parameters is still not well stablished. A naturalistic study was conducted in children with autism spectrum disorder, previously drug-naïve, before and after treatment with immediate-release melatonin. Circadian rhythms and sleep parameters were studied using an ambulatory circadian-monitoring device, and saliva samples were collected enabling determination of dim light melatonin onset. Twenty-six children with autism spectrum disorder (age 10.50 ± 2.91) were included. Immediate-release melatonin modified circadian rhythm as indicated by wrist skin temperature, showing an increase at night. A positive correlation was found between time of peak melatonin and sleep efficiency improvement values. Sleep-onset latency and efficiency improved with immediate-release melatonin. Immediate-release melatonin could be an effective treatment to improve sleep onset and restore a typical pattern of wrist temperature, which appears to be lost in autism spectrum disorder.
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Affiliation(s)
- Elena Martinez-Cayuelas
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Milagros Merino-Andreu
- Neurophisiology, Sleep Unit, Hospital Universitario La Paz, Paseo de la Castellana, 261. 28046, Madrid, Spain
| | - Rebeca Losada-Del Pozo
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Teresa Gavela-Pérez
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Carmen Garcés
- Lipid Laboratory, Instituto de Investigación Sanitaria-Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
| | - Leandro Soriano-Guillén
- Department of Pediatrics, Instituto de Investigación Sanitaria- Fundación Jiménez Díaz. Universidad Autónoma de Madrid, Madrid, Spain
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Shurtz L, Schwartz C, DiStefano C, McPartland JC, Levin AR, Dawson G, Kleinhans NM, Faja S, Webb SJ, Shic F, Naples AJ, Seow H, Bernier RA, Chawarska K, Sugar CA, Dziura J, Senturk D, Santhosh M, Jeste SS. Concomitant medication use in children with autism spectrum disorder: Data from the Autism Biomarkers Consortium for Clinical Trials. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:952-966. [PMID: 36086805 PMCID: PMC9995606 DOI: 10.1177/13623613221121425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
LAY ABSTRACT Children with autism spectrum disorder are prescribed a variety of medications that affect the central nervous system (psychotropic medications) to address behavior and mood. In clinical trials, individuals taking concomitant psychotropic medications often are excluded to maintain homogeneity of the sample and prevent contamination of biomarkers or clinical endpoints. However, this choice may significantly diminish the clinical representativeness of the sample. In a recent multisite study designed to identify biomarkers and behavioral endpoints for clinical trials (the Autism Biomarkers Consortium for Clinical Trials), school-age children with autism spectrum disorder were enrolled without excluding for medications, thus providing a unique opportunity to examine characteristics of psychotropic medication use in a research cohort and to guide future decisions on medication-related inclusion criteria. The aims of the current analysis were (1) to quantify the frequency and type of psychotropic medications reported in school-age children enrolled in the ABC-CT and (2) to examine behavioral features of children with autism spectrum disorder based on medication classes. Of the 280 children with autism spectrum disorder in the cohort, 42.5% were taking psychotropic medications, with polypharmacy in half of these children. The most commonly reported psychotropic medications included melatonin, stimulants, selective serotonin reuptake inhibitors, alpha agonists, and antipsychotics. Descriptive analysis showed that children taking antipsychotics displayed a trend toward greater overall impairment. Our findings suggest that exclusion of children taking concomitant psychotropic medications in trials could limit the clinical representativeness of the study population, perhaps even excluding children who may most benefit from new treatment options.
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Affiliation(s)
| | | | | | | | - April R Levin
- Boston Children’s Hospital, USA
- Harvard University, USA
| | | | | | - Susan Faja
- Boston Children’s Hospital, USA
- Harvard University, USA
| | - Sara J Webb
- University of Washington, USA
- Seattle Children’s Research Institute, USA
| | - Frederick Shic
- University of Washington, USA
- Seattle Children’s Research Institute, USA
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Distefano G, Calderoni S, Apicella F, Cosenza A, Igliozzi R, Palermo G, Tancredi R, Tritto G, Craig F, Muratori F, Turi M. Impact of sleep disorders on behavioral issues in preschoolers with autism spectrum disorder. Front Psychiatry 2023; 14:1181466. [PMID: 37181873 PMCID: PMC10169650 DOI: 10.3389/fpsyt.2023.1181466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 04/06/2023] [Indexed: 05/16/2023] Open
Abstract
Background Sleep disorders are one of the most common problems in children with Autism Spectrum Disorder (ASD). However, they often tend to be underdiagnosed and incorrectly treated in clinical practice. This study aims to identify sleep disorders in preschool children with ASD and to explore their relationship with the core symptoms of autism, the child's developmental and cognitive level as well as the psychiatric comorbidities. Methods We recruited 163 preschool children with a diagnosis of ASD. The Children's Sleep Habits Questionnaire (CSHQ) assessed sleep conditions. Multiple standardized tests were used to evaluate intellectual abilities, the presence of repetitive behaviors (through the Repetitive Behavior Scale-Revised), as well as the emotional-behavioral problems and the psychiatric comorbidities (through the Child Behavior Checklist -CBCL 11/2-5). Results The results showed that poor disorders had consistently higher scores in all areas assessed by the CSHQ and on the CBCL across all domains. The correlational analysis showed that severe sleep disorders were associated with higher scores in internalizing, externalizing, and total problems at the CBCL syndromic scales, and in all DSM-oriented CBCL subscales. Moreover, we found that the association between sleep disorders and restricted and repetitive behaviors (RRBs) is explained by the anxiety-related symptoms. Conclusion Based on these findings, the study recommends that screening for sleep problems followed by early intervention should constitute a routine part of clinical practice for children with ASD.
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Affiliation(s)
- Giacomo Distefano
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Sara Calderoni
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
- IRCCS Fondazione Stella Maris, Pisa, Italy
| | | | | | | | | | | | | | - Francesco Craig
- Department of Cultures, Education and Society, University of Calabria, Cosenza, Italy
| | | | - Marco Turi
- Department of Human and Social Studies, University of Salento, Lecce, Italy
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Favole I, Davico C, Marcotulli D, Sodero R, Svevi B, Amianto F, Ricci FS, Arduino GM, Vitiello B. Sleep disturbances and emotional dysregulation in young children with autism spectrum, intellectual disability, or global developmental delay. Sleep Med 2023; 105:45-52. [PMID: 36963320 DOI: 10.1016/j.sleep.2023.02.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 02/25/2023] [Accepted: 02/28/2023] [Indexed: 03/26/2023]
Abstract
OBJECTIVE Sleep disturbance and emotional dysregulation (ED) are common and often functionally impairing in young children with neurodevelopmental disorders (NDD). This study investigated the relationship between sleep disturbance and ED in a sample of preschoolers with ASD, intellectual disability, or global developmental delay, and examined possible predictors of their persistence over time. METHODS All children under 6 years of age clinically referred between July 2018 and May 2022 to two neuropsychiatric specialized centers for NDD received a comprehensive diagnostic evaluation, including the Child Behavior Checklist 1.5-5 (CBCL), the Autism Diagnostic Observation Schedule-2 (ADOS-2), and standardized tests of cognitive and global development. Sleep disturbances were assessed with the CBCL-sleep score, and ED with the CBCL Attention, Aggression, and Anxious/Depressed scales (CBCL-AAA). A reassessment of sleep and ED was conducted after 6 months or longer, including the Child Sleep Habits Questionnaire (CSHQ). Multivariate analyses and mixed linear regression models were conducted. RESULTS A total of 136 children, 75.7% male, median age 38.27 months, IQR 15.39, 41.2% with global developmental disorder (GDD) or intellectual disability (ID) participated in the study. Of them, 64.7% were diagnosed with autism spectrum disorder (ASD) and 35.3% with other NDD (w/o ASD). Sleep disturbances (CBCL-Sleep) and ED (CBCL-AAA) were positively correlated (p < 0.001), after accounting for age, ID/GDD and autism symptom severity, in both the entire sample and separately in each diagnostic group (ASD and NDD w/o ASD). Seventy-five children (55%) were reassessed a mean 17.2 months afterwards. There was persistence of the positive correlation between sleep problems and ED (p < 0.001) in both the entire sample and each diagnostic group. The longitudinal mixed linear model showed that ED at follow-up was predicted by baseline sleep problems (p = 0.008), ED (p < 0.001), and ASD severity (p = 0.015). CONCLUSIONS Sleep disturbances are significantly associated with ED in young children with NDD, either with or without ASD, both cross-sectionally and prospectively over time. Sleep problems represent an important comorbidity and a potential treatment target for improving emotional stability in NDD.
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Affiliation(s)
- Irene Favole
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Chiara Davico
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Daniele Marcotulli
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy.
| | - Roberta Sodero
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Barbara Svevi
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - Federico Amianto
- Department of Neuroscience, University of Turin, 10100, Turin, Italy
| | - Federica S Ricci
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
| | - G Maurizio Arduino
- Autism Center, Developmental Psychology and Psychopathology, ASL CN1, Cuneo, Italy
| | - Benedetto Vitiello
- Section of Child and Adolescent Neuropsychiatry, Department of Public Health and Pediatric Sciences, University of Turin, 10126, Turin, Italy
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Sleep in Children With Neurodevelopmental Disabilities During COVID-19: An Integrative Review. J Pediatr Health Care 2023; 37:153-166. [PMID: 36334949 PMCID: PMC9550660 DOI: 10.1016/j.pedhc.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/04/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Sleep issues occur at higher rates in children with neurodevelopmental disorders than in the typical population. Little is known about the impact of COVID-19 on sleep issues in this population METHOD: This integrative review aimed to characterize studies during the COVID-19 pandemic (2020-2022) addressing the prevalence and management of sleep issues in children and youth with neurodevelopmental disorders.Comprehensive database searches were used to identify articles, and 31 studies were considered suitable for this review. RESULTS Most studies reported worsening sleep disturbances during COVID-19 restrictions. All studies were conducted when clinics were closed; only two studies addressed treatment options such as music therapy and sleep hygiene education and found improvement in sleep issues. DISCUSSION Future research needs to concentrate on developing interventions to assist families remotely and empower families with a toolkit of preparedness in times of crisis.
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Khoshnevis S, Smolensky MH, Haghayegh S, Castriotta RJ, Hermida RC, Diller KR. Recommended timing of medications that impact sleep and wakefulness: A review of the American Prescribers' Digital Reference. Sleep Med Rev 2023; 67:101714. [PMID: 36509029 DOI: 10.1016/j.smrv.2022.101714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 11/01/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
An appreciable number of medicines have a recommended unique single time-of-day or asymmetrical or unequal-interval multiple-daily administration schedule. Many prescription and over-the-counter (OTC) products, according to administration time, can exert positive or negative impact on nighttime sleep and daytime wakefulness. Intuitively, medicines used to manage nighttime sleep and daytime wake disorders should be taken, respectively, at night before bedtime and morning after arising. However, some utilized for other medical conditions, if improperly timed, may compromise nocturnal sleep and diurnal attentiveness. We conducted a comprehensive review of the American Prescribers' Digital Reference, internet version of the Physician's Desk Reference, for the recommended scheduling of medications and OTC remedies that can impact sleep and wakefulness. The search revealed several hundred therapies of various classes -- α2-receptor agonists, antidepressants, barbiturates, central nervous system stimulants, benzodiazepines, dopamine agonists, dopamine norepinephrine reuptake inhibitors, selective norepinephrine reuptake inhibitors, eugeroics, γ-aminobutyric acid modulators, H1 and H3-receptor antagonists, melatonin analogues, OTC melatonin-containing products, non-benzodiazepine benzodiazepine-receptor agonists, dual orexin-receptor antagonists, and serotonin modulators -- that have a recommended unique dosing schedule. The tables and text of this article are intended to guide the proper scheduling of these medicines to optimize desired and/or minimize undesired effects.
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Affiliation(s)
- Sepideh Khoshnevis
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA.
| | - Michael H Smolensky
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Department of Internal Medicine, Division of Cardiology, McGovern School of Medicine, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Shahab Haghayegh
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Richard J Castriotta
- Division of Pulmonary, Critical Care and Sleep Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Ramon C Hermida
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA; Bioengineering & Chronobiology Laboratories, Atlantic Research Center for Telecommunication Technologies (atlanTTic), University of Vigo, Vigo, Spain
| | - Kenneth R Diller
- Department of Biomedical Engineering, Cockrell School of Engineering, The University of Texas at Austin, Austin, TX, USA
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Tamburello A, Penn J, Negron-Muñoz R, Kaliebe K. Prescribing Psychotropic Medications for Justice-Involved Juveniles. JOURNAL OF CORRECTIONAL HEALTH CARE 2023; 29:94-108. [PMID: 36637811 DOI: 10.1089/jchc.21.09.0086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Psychiatric disorders are exceedingly common in justice-involved youth. Relevant justice systems are varied, evolving, complex, and underserved. The intent of this article is to highlight the research and best practices related to managing the psychiatric disorders of justice-involved youths with a particular focus on pharmacotherapy. We review relevant features of the justice system and related case law, how prescribing for these individuals varies from both community settings and for incarcerated adults, effective assessment and medication selection, informed consent, management of nonadherence and medication diversion, and applied evidence for specific psychiatric problems common in these patients. Psychiatrists caring for justice-involved youth will benefit from tools, like this article, for training and orientation to provide timely and effective treatment services and consultation in these settings.
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Affiliation(s)
- Anthony Tamburello
- University Correctional Health Care Rutgers University-Robert Wood Johnson Medical School Department of Psychiatry, Piscataway, New Jersey, USA
| | - Joseph Penn
- Department of Psychiatry and Behavioral Sciences, University of Texas Medical Branch, Correctional Managed Care Mental Health Services, Conroe, Texas, USA
| | - Rosa Negron-Muñoz
- Department of Child and Adolescent Psychiatry, University of South Florida, Tampa, Florida, USA
| | - Kristopher Kaliebe
- Department of Psychiatry and Behavioral Neurosciences, University of South Florida, Tampa, Florida, USA
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Bonuccelli A, Santangelo A, Castelli F, Magherini G, Volpi E, Costa E, Alesci E, Massimetti G, Operto FF, Peroni DG, Orsini A. Efficacy of Liposomal Melatonin in sleep EEG in Childhood: A Double Blind Case Control Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:552. [PMID: 36612875 PMCID: PMC9819026 DOI: 10.3390/ijerph20010552] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/15/2022] [Accepted: 12/21/2022] [Indexed: 06/17/2023]
Abstract
Electroencephalography (EEG) is pivotal in the clinical assessment of epilepsy, and sleep is known to improve the diagnostic yield of its recording. Sleep-EEG recording is generally reached by either partial deprivation or by administration of sleep-inducing agents, although it is still not achieved in a considerable percentage of patients. We conducted a double-blind placebo-controlled study, involving a hundred patients between 1 and 6 years old, randomized into two groups: Group 1 received liposomal melatonin (melatosome) whereas Group 2 received a placebo. Sleep latency (SL), defined as the time span between the onset of a well-established posterior dominant rhythm, considered as a frequency of 3 to 4 Hz, increasing to 4-5 Hz by the age of 6 months, to 5-7 Hz by 12 months, and finally to 8 Hz by 3 years, and the first EEG sleep figures detected, were measured for each patient. A significant difference in SL was observed (10.8 ± 5 vs. 18.1 ± 13.4 min, p-value = 0.002). Within each group, no differences in sleep latency were detected between genders. Furthermore, no difference in EEG abnormality detection was observed between the two groups. Our study confirmed the efficacy and safety of melatonin administration in sleep induction. Nonetheless, liposomal melatonin presents a greater bioavailability, ensuring a faster effect and allowing lower dosages. Such results, never before reported in the literature, suggest that the routine employment of melatonin might improve clinical practice in neurophysiology, reducing unsuccessful recordings.
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Affiliation(s)
- Alice Bonuccelli
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Andrea Santangelo
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Francesca Castelli
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Giulia Magherini
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elena Volpi
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elisa Costa
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Elena Alesci
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Gabriele Massimetti
- Department of Clinical and Experimental Medicine, University of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Francesca Felicia Operto
- Child and Adolescent Neuropsychiatry Unit, Department of Medicine, Surgery and Dentistry, University of Salerno, 84081 Baronissi, Italy
| | - Diego Giampiero Peroni
- Pediatric Clinic, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Alessandro Orsini
- Pediatric Neurology, University Hospital of Pisa, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
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Saletin JM, Koopman-Verhoeff ME, Han G, Barker DH, Carskadon MA, Anders TF, Sheinkopf SJ. Sleep Problems and Autism Impairments in a Large Community Sample of Children and Adolescents. Child Psychiatry Hum Dev 2022:10.1007/s10578-022-01470-0. [PMID: 36515855 DOI: 10.1007/s10578-022-01470-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/15/2022]
Abstract
Sleep problems are common in individuals with autism spectrum disorder (ASD). How sleep problems reflect specific ASD phenotypes is unclear. We studied whether sleep problems indexed functional impairment in a heterogeneous community sample of individuals with ASD. We analyzed 977 probands (233 females; age = 11.27 ± 4.13 years) from the Rhode Island Consortium for Autism Research and Treatment dataset, a unique public-private-academic collaboration involving all major points of service for families in Rhode Island. We found that individuals with a confirmed diagnosis of ASD were more likely to have sleep problems. However, across the whole sample and above and beyond a formal diagnosis, sleep problems were dimensionally associated with worse social impairment and poorer adaptive functioning. By using a large dataset reflective of the diversity of presentations in the community, this study underscores the importance of considering sleep problems in clinical practice to improve adaptive functioning in individuals with ASD.
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Affiliation(s)
- Jared M Saletin
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA.
- Emma Pendleton Bradley Hospital, East Providence, RI, USA.
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA.
| | - M Elisabeth Koopman-Verhoeff
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Gloria Han
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Department of Anesthesiology, Vanderbilt Medical Center, Nashville, TN, USA
| | - David H Barker
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- The Bradley Hasbro Children's Research Center, Providence, RI, USA
| | - Mary A Carskadon
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
- Sleep Research Laboratory, Emma Pendleton Bradley Hospital, Providence, RI, USA
| | - Thomas F Anders
- Department of Psychiatry and Human Behavior, Alpert Medical School of Brown University, Providence, RI, USA
- Emma Pendleton Bradley Hospital, East Providence, RI, USA
| | - Stephen J Sheinkopf
- Brown Center for the Study of Children at Risk, Women & Infants Hospital, Providence, RI, USA
- Thompson Center for Autism and Neurodevelopment, University of Missouri, Columbia, MO, USA
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Choi K, Lee YJ, Park S, Je NK, Suh HS. Efficacy of melatonin for chronic insomnia: Systematic reviews and meta-analyses. Sleep Med Rev 2022; 66:101692. [PMID: 36179487 DOI: 10.1016/j.smrv.2022.101692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 12/24/2022]
Abstract
We conducted systematic reviews and meta-analyses to evaluate the efficacy of melatonin versus placebo or other hypnotic agents in improving sleep quality and quantity in patients with chronic insomnia. A literature search on Ovid-MEDLINE, EMBASE, and the Cochrane Library was performed up to November 2020. Sleep onset latency, total sleep time, sleep efficiency, sleep quality and quality of life were examined as outcomes. We identified 24 randomized controlled trials of chronic insomnia including four studies of patients with comorbid insomnia. All studies were compared with placebo. Due to heterogeneity, we conducted subgroup analyses by age group. In non-comorbid insomnia, melatonin was only significantly effective in sleep onset latency and total sleep time in children and adolescents. In adults group, melatonin was not significantly effective in improving sleep onset latency, total sleep time, and sleep efficiency. In comorbid insomnia, melatonin significantly improved sleep onset latency in all age groups, but there was only one study in adults group. In conclusion, melatonin did not appear to be effective in adults but might be effective in children and adolescents with chronic insomnia for both comorbid insomnia and non-comorbid insomnia. Further studies are needed to establish the efficacy and safety of melatonin by age groups.
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Affiliation(s)
- Kyungseon Choi
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, South Korea; College of Pharmacy, Kyung Hee University, Seoul, South Korea
| | - Yu Jeong Lee
- College of Pharmacy, Pusan National University, Busan, South Korea; Department of Pharmacy, Pusan National University Hospital, Busan, South Korea
| | - Seonyoung Park
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Nam Kyung Je
- College of Pharmacy, Pusan National University, Busan, South Korea
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, South Korea; College of Pharmacy, Kyung Hee University, Seoul, South Korea.
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Pattison E, Mantilla A, Fuller-Tyszkiewicz M, Marks D, Sciberras E, McGillivray J, Papadopoulos N, Rinehart N. Acceptability of a behavioural sleep intervention for autistic children: A qualitative evaluation of Sleeping Sound. Sleep Med 2022; 100:378-389. [PMID: 36201889 DOI: 10.1016/j.sleep.2022.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/07/2022] [Accepted: 09/13/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE The aim of the current study was to evaluate parental perceptions of the acceptability of a brief behavioural sleep intervention for autistic children (aged 5-13 years) using the Theoretical Framework of Acceptability (TFA). METHODS Qualitative data were collected during a large randomised controlled trial evaluating the efficacy of the Sleeping Sound intervention: 123 families were randomised to the intervention group, of which 115 (93%) completed at least one intervention session and 82 (67%) provided qualitative evaluation data in the 3-month follow-up survey. Consultation records from intervention sessions and parent surveys were qualitatively analysed post hoc using a hybrid approach to thematic analysis. RESULTS Findings were categorised under the seven themes of the TFA (affective attitude, burden, ethicality, intervention coherence, opportunity costs, perceived effectiveness, self-efficacy) in addition to three themes that were defined following inductive and deductive coding (barriers to implementation, facilitators to implementation, suggestions for improvement). Participants spoke positively about their experience participating in the intervention and perceived the intervention to be appropriate and effective. Most parents (95.5%) reported that they would recommend the Sleeping Sound intervention to other families of autistic children. Barriers to implementation included child and parent anxiety, child health problems, parental preferences, family circumstances, and other (e.g., school holidays). Facilitators to implementation included family support and consistency with strategies. CONCLUSIONS The Sleeping Sound intervention was considered acceptable to parents of autistic children as evidenced by largely positive feedback regarding their experience. The results highlighted areas for improvement which can be used to inform future iterations of the intervention.
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Affiliation(s)
- Emily Pattison
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Ana Mantilla
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
| | - Matthew Fuller-Tyszkiewicz
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia.
| | - Deborah Marks
- Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Emma Sciberras
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia; Murdoch Children's Research Institute, 50 Flemington Road, Parkville, Victoria, 3052, Australia; Department of Paediatrics, University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, 1 Gheringhap Street, Geelong, Victoria, 3220, Australia
| | - Nicole Papadopoulos
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
| | - Nicole Rinehart
- Krongold Clinic, School of Educational Psychology and Counselling, Faculty of Education, Monash University, 19 Ancora Imparo Way, Clayton, Victoria, 3800, Australia
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Zhu H, Li M, Pan B, Yang Q, Cao X, Wang Q, Chen Y, Ding G, Tian J, Ge L. A critical appraisal of clinical practice guidelines on insomnia using the RIGHT statement and AGREE II instrument. Sleep Med 2022; 100:244-253. [PMID: 36116294 DOI: 10.1016/j.sleep.2022.08.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 08/24/2022] [Accepted: 08/28/2022] [Indexed: 01/11/2023]
Abstract
OBJECTIVE Clinical Practice Guidelines (CPGs) have an indispensable role in guiding the selection of various treatments for insomnia, however, little is known about the quality of released insomnia CPGs. This study aims to critically appraise the quality of existing insomnia CPGs and identify quality limitations. METHODS PubMed, Web of Science, Embase, China National Knowledge Infrastructure, Wanfang, China Biology Medicine disc, and 6 databases of international guideline developing institutions were systematically searched. CPGs on the diagnosis or treatment of insomnia were included. Reviewers independently extracted basic information and development methods, and assessed methodological quality and reporting quality using the Appraisal of Guidelines for Research and Evaluation (AGREE) II tool and Reporting Items for practice Guidelines in Healthcare (RIGHT) checklist respectively. Intraclass correlation coefficients (ICCs) were used to measure the agreement among reviewers and assess inter-rater reliability. RESULTS Twenty-six CPGs were identified that focused on adults, children, or children with autistic spectrum disorder, patients in the intensive care unit, patients with cancer and pregnant, lactating or menopausal women. Twenty-two CPGs used nine grading systems to rate the level of evidence and strength of recommendation. 53.85% CPGs were classified as "recommended with modification" according to the AGREE II scores (ICC from 0.64 to 0.90), and 2 CPGs were "recommended". The "clarity of presentation" domain achieved the highest mean score (67.9% ± 11.04%) but the "applicability" domain (37.1% ± 12.67%) achieved the lowest. The average reporting rate of RIGHT items in all guidelines was 67.87%. CONCLUSIONS The quality of guidelines varied substantially. Guideline developers should realize the importance of guideline applicability, patients' preferences and values.
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Affiliation(s)
- Hongfei Zhu
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Mengting Li
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Bei Pan
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
| | - Qiuyu Yang
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Xiao Cao
- Evidence Based Nursing Centre, School of Nursing, Lanzhou University, Lanzhou, China
| | - Qi Wang
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China
| | - Yaolong Chen
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Chinese GRADE Centre, Lanzhou University, Lanzhou, China
| | - Guowu Ding
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China.
| | - Jinhui Tian
- Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China.
| | - Long Ge
- Department of Social Medicine and Health Management, School of Public Health, Lanzhou University, Lanzhou, China; Evidence Based Social Science Research Centre, School of Public Health, Lanzhou University, Lanzhou, China; WHO Collaborating Center for Guideline Implementation and Knowledge Translation, Lanzhou, China; Key Laboratory of Evidence Based Medicine and Knowledge Translation of Gansu Province, Lanzhou, China; Chinese GRADE Centre, Lanzhou University, Lanzhou, China.
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Rolling J, Rabot J, Schroder CM. Melatonin Treatment for Pediatric Patients with Insomnia: Is There a Place for It? Nat Sci Sleep 2022; 14:1927-1944. [PMID: 36325278 PMCID: PMC9621019 DOI: 10.2147/nss.s340944] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 09/18/2022] [Indexed: 01/24/2023] Open
Abstract
Sleep is a vital physiological function that is impaired in ranges from 10% in the typically developing pediatric population to over 80% in populations of children with neurodevelopmental disorders and/or psychiatric comorbidities. Pediatric insomnia disorder is an increasing public health concern given its negative impact on synaptic plasticity involved in learning and memory consolidation but also on mood regulation, hormonal development and growth, and its significant impact on quality of life of the child, the adolescent and the family. While first-line treatment of pediatric insomnia should include parental education on sleep as well as sleep hygiene measures and behavioural treatment approaches, pharmacological interventions may be necessary if these strategies fail. Melatonin treatment has been increasingly used off-label in pediatric insomnia, given its benign safety profile. This article aims to identify the possible role of melatonin treatment for pediatric insomnia, considering its physiological role in sleep regulation and the differential effects of immediate release (IR) versus prolonged release (PR) melatonin. For the physician dealing with pediatric insomnia, it is particularly important to be able to distinguish treatment rationales implying different dosages and times of treatment intake. Finally, we discuss the benefit-risk ratio for melatonin treatment in different pediatric populations, ranging from the general pediatric population to children with different types of neurodevelopmental disorders, such as autism spectrum disorder or ADHD.
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Affiliation(s)
- Julie Rolling
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
| | - Juliette Rabot
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
| | - Carmen M Schroder
- Department of Child and Adolescent Psychiatry, Strasbourg University Hospitals, Strasbourg, France
- CNRS UPR3212- Research Team “Light, Circadian Rhythms, Sleep Homeostasis and Neuropsychiatry”, Institute of Cellular and Integrative Neurosciences, Strasbourg, France
- Excellence Centre for Autism and Neurodevelopmental Disorders STRAS&ND, Strasbourg, France
- Sleep Disorders Centre & International Research Centre for ChronoSomnology (Circsom), University Hospitals Strasbourg, Strasbourg, France
- Expert Centre for High-Functioning Autism, Fondation FondaMental, Strasbourg, France
- Autism Resources Centre 67 for Children and Adolescents, Strasbourg, France
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Duan D, He L, Chen H, Lei Y, Wu W, Li T. Efficacy of auricular plaster therapy for sleep disorders in preschool children with autism spectrum disorders: Study protocol for a randomized controlled trial. Front Neurol 2022; 13:973609. [PMID: 36262834 PMCID: PMC9574001 DOI: 10.3389/fneur.2022.973609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Accepted: 09/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Children with autism spectrum disorders (ASDs) suffer from sleep disorders to a considerable degree; however, there is no safe and effective treatment available in clinical practice. The objective of the trial is to assess the clinical effectiveness of auricular plaster therapy (APT) in treating sleep disorders in children with ASD. Method This is a single-center, patient-assessor blind, randomized controlled trial. A total of 44 preschool children with sleep disorders with ASD will be included in this study. Eligible participants will be randomly assigned to either the auricular plaster group or the sham auricular plaster group in a 1:1 ratio. Participants in the different groups will receive APT or sham APT, respectively, for a total of 30 sessions over 30 days. The primary outcome includes the Children's Sleep Habits Questionnaire (CSHQ), while secondary outcomes include the Autism Behavior Checklist (ABC) and polysomnography (PSG) for total sleep time, sleep latency, awakening duration, and sleep structures. The CSHQ and ABC will be assessed at baseline, 10, 20, 30, 60, 90, and 120 days after randomization, whereas PSG will be assessed at baseline and 30 days after randomization. The follow-up period will be scheduled to be 60, 90, and 120 days after randomization. Discussion The results of this study may provide evidence of the efficacy of APT, as well as offer new alternatives for the treatment of sleep disorders in children with ASD. Trial registration CHiCTR.org.cn (ChiCTR2100048257). Registered on July 5, 2021.
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Affiliation(s)
- Duoxi Duan
- Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Lin He
- Foreign Language School, Southwest Medical University, Luzhou, China
| | - Hong Chen
- Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Ying Lei
- Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Wei Wu
- Department of Anesthesiology, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
| | - Tao Li
- Department of Integrated Traditional Chinese and Western Medicine, The Second Affiliated Hospital of Chengdu Medical College, China National Nuclear Corporation 416 Hospital, Chengdu, China
- *Correspondence: Tao Li
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48
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Álvarez C. Alteraciones del sueño en trastornos del neurodesarrollo. REVISTA MÉDICA CLÍNICA LAS CONDES 2022. [DOI: 10.1016/j.rmclc.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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49
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Micsinszki SK, Ballantyne M, Cleverley K, Green P, Brennenstuhl S, Stremler R. Examining factors associated with sleep quality in parents of children 4-10 years with autism spectrum disorder. Disabil Rehabil 2022:1-13. [PMID: 35979804 DOI: 10.1080/09638288.2022.2103594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Parents of children with autism spectrum disorder often report poorer sleep compared to parents of typically developing children. When parents do not obtain enough quality sleep, functioning may be compromised placing the onus of care on already stressed parents. However, improving sleep duration may not improve sleep quality and is not always feasible. This study aimed to measure sleep quality in parents of children with autism spectrum disorder, determine if stress and children's sleep are associated with sleep quality and whether resources, appraisals, and coping moderate these relationships. MATERIALS AND METHODS Multivariable regression was used to determine the effects of stress and children's sleep problems on sleep quality and test modifying effects. RESULTS Mean (SD) Pittsburgh Sleep Quality Index scores was 8.81 (3.76), with 77.6% of parents scoring above the clinical cut-off. Mean (SD) Children's Sleep Habits Questionnaire scores was 54.03 (8.32), with 96.3% of parents rating their child's sleep above the clinical cut-off. Children's sleep was the only significant predictor and none of the expected effect modifiers were significant. CONCLUSION Children's sleep may be an important target to improve parent sleep quality but requires systematic assessment with interventional research. Implications for rehabilitationBoth parents and their 4-10-year-old children with ASD experience high levels of sleep disturbances.Clinicians can start the conversation early with parents about their children's sleep by providing them with information to increase awareness and recognize healthy sleep habits in their children.Clinicians are important in the assessment, management, and evaluation of pediatric sleep problems, which may have significant spillover effects on parents of children with ASD.There is a need for more resources and training to be available to clinicians to assess children and their parents for sleep problems, which could extend beyond the assessment of sleep and consider parent's daytime functioning and mental health.
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Affiliation(s)
| | - Marilyn Ballantyne
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Kristin Cleverley
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Centre for Addiction and Mental Health, Toronto, Canada
| | - Pamela Green
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada
| | - Sarah Brennenstuhl
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Robyn Stremler
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.,The Hospital for Sick Children (SickKids), Toronto, Canada
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50
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Kholghi G, Eskandari M, Shokouhi Qare Saadlou MS, Zarrindast MR, Vaseghi S. Night shift hormone: How does melatonin affect depression? Physiol Behav 2022; 252:113835. [PMID: 35504318 DOI: 10.1016/j.physbeh.2022.113835] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 04/19/2022] [Accepted: 04/28/2022] [Indexed: 12/23/2022]
Abstract
Melatonin is the main hormone secreted by the pineal gland that modulates the circadian rhythm and mood. Previous studies have shown the therapeutic effects of melatonin, or its important analogue, agomelatine, on depression. In this review study, we aimed to discuss the potential mechanisms of melatonin involved in the treatment of depression. It was noted that disrupted circadian rhythm can lead to depressive state, and melatonin via regulating circadian rhythm shows a therapeutic effect. It was also noted that melatonin induces antidepressant effects via promoting antioxidant system and neurogenesis, and suppressing oxidative stress, neuroinflammation, and apoptosis. The interaction effect between melatonin or agomelatine and serotonergic signaling has a significant effect on depression. It was noted that the psychotropic effects of agomelatine are induced by the synergistic interaction between melatonin and 5-HT2C receptors. Agomelatine also interacts with glutamatergic signaling in brain regions involved in regulating mood and circadian rhythm. Interestingly, it was concluded that melatonin exerts both pro- and anti-inflammatory effects, depending on the grade of inflammation. It was suggested that synergistic interaction between melatonin and 5-HT2C receptors may be able to induce therapeutic effects on other psychiatric disorders. Furthermore, dualistic role of melatonin in regulating inflammation is an important point that can be examined at different levels of inflammation in animal models of depression.
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Affiliation(s)
- Gita Kholghi
- Department of Psychology, Faculty of Human Sciences, Tonekabon Branch, Islamic Azad University, Tonekabon, Iran
| | - Maliheh Eskandari
- Faculty of Basic Sciences, Central Tehran Branch, Islamic Azad University, Tehran, Iran
| | | | - Mohammad-Reza Zarrindast
- Department of Pharmacology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Salar Vaseghi
- Medicinal Plants Research Center, Institute of Medicinal Plants, ACECR, Karaj, Iran.
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