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Prevalence of parasomnia in autistic children with sleep disorders

Xue Ming¹, Ye-Ming Sun, Roberto V Nachajon

¹Department of Neuroscience, UMDNJ-New Jersey Medical School, Newark, NJ.

Clinical Medicine. Pediatrics

|July 3, 2013

Insights

Children with autism spectrum disorder (ASD) experience high rates of non-REM parasomnias, including sleep terrors and confusional arousals, confirmed by polysomnography (PSG). Questionnaires show high sensitivity but low specificity for diagnosing these sleep disorders in ASD.

Area of Science:

Neuroscience
Developmental Psychology
Sleep Medicine

Background:

Sleep disturbances, particularly parasomnias, are frequently reported in children with autism spectrum disorders (ASD) via questionnaires.
Existing polysomnographic (PSG) studies have limited data on non-REM and REM parasomnias in ASD.
This study addresses the gap in objective sleep disorder characterization in ASD.

Purpose of the Study:

To investigate the prevalence and characteristics of sleep disorders, specifically parasomnias, in children with ASD using polysomnography (PSG) and questionnaires.
To compare sleep patterns and parasomnia prevalence between children with ASD and a neurotypical comparison group.
To evaluate the diagnostic accuracy of questionnaires for parasomnias in ASD compared to PSG findings.

Main Methods:

A cohort of 23 children with ASD and 23 age-matched neurotypical children underwent overnight polysomnography (PSG) and completed sleep questionnaires.
Sleep disorders, including parasomnias and abnormalities in sleep architecture, were assessed using PSG.
Questionnaire data on sleep complaints and parasomnia history were collected and compared with PSG results.

Main Results:

Significantly higher prevalence of non-REM parasomnias was observed in children with ASD via both PSG (14/23) and questionnaires (16/23).
Disorders of Partial Arousal (sleep terrors, confusional arousals) were the most common parasomnias in ASD children during PSG, with multiple episodes noted in many.
Children with ASD exhibited abnormal sleep architecture, including increased arousals, prolonged REM latency, and reduced REM percentage.

Conclusions:

Parasomnias, particularly non-REM types like Disorders of Partial Arousal, are highly prevalent in children with ASD, objectively confirmed by PSG.
While questionnaires show high sensitivity for detecting potential parasomnias in ASD, their specificity is limited when compared to PSG.
Clinical assessment should include a detailed history for parasomnia symptoms in ASD, especially when PSG is not feasible, to aid diagnosis.

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Abstract:

The prevalence of sleep related complaints is reported by questionnaire studies to be as high as 83.3% in children with autism spectrum disorders (ASD). Questionnaire studies report the presence of various parasomnia in ASD. However, no polysomnographic study reports non-REM parasomnias and only a single study reports REM related parasomnias in ASD. We investigated the prevalence and characteristics of sleep disorders by polysomnographic study and questionnaires in a cohort of 23 children with ASD and 23 age-matched children of a non-autistic comparison group. The results showed significantly more non-REM parasomnias in 14 children with ASD on polysomnograms (PSG) and 16 ASD children by questionnaire, a finding that was not associated with medication use, other comorbid medical or psychiatric disorders, or sleep disordered breathing. Of the 14 children with ASD who had PSG evidence of parasomnia, 11 of them had a history suggestive of parasomnia by questionnaire. There was a high sensitivity but a low specificity of parasomnia in ASD by questionnaire in predicting the presence of parasomnia in the PSG. Of the parasomnias recorded in the laboratory, 13 ASD children had Disorders of Partial Arousal, consistent with sleep terrors or confusional arousals. Furthermore, multiple episodes of partial arousal occurred in 11 of the 13 ASD children who had PSG evidence of Disorders of Partial Arousal. Of the 11 ASD children with multiple episodes of partial arousal, 6 ASD children had multiple partial arousals during both nights' PSG study. Sleep architecture was abnormal in children with ASD, characterized by increased spontaneous arousals, prolonged REM latency and reduced REM percentage. These results suggest a high prevalence of parasomnia in this cohort of children with ASD and a careful history intake of symptoms compatible with parasomnia could be prudent to diagnose parasomnia in ASD children when performing a PSG is not possible.

Keywords:

Autism spectrum disorders confusional arousal disorders of partial arousal parasomnia sleep terror

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