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Infant sleep characteristics in children with autism spectrum disorder: a population-derived Australian birth cohort
Zaynab Mohamed1,2, Anne-Louise Ponsonby1,2,3, Ambika Wakhlu4
1The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
Insights
Poor infant sleep is linked to higher autism characteristics and diagnosis odds. Early monitoring of sleep problems may help identify potential autism indicators in infants.
Area of Science:
- Developmental Pediatrics
- Neurodevelopmental Disorders
- Sleep Medicine
Background:
- Infant sleep patterns are crucial for neurodevelopment.
- Autism Spectrum Disorder (ASD) is a complex neurodevelopmental condition.
- Understanding early risk factors for ASD is essential for timely intervention.
Purpose of the Study:
- To investigate the prospective association between infant sleep characteristics and later autism characteristics and diagnosis.
- To explore sleep patterns as potential early indicators for autism in a population-derived sample.
Main Methods:
- A population-derived birth cohort study in Victoria, Australia, involving 1074 mother-infant pairs.
- Infant sleep was assessed at 6 and 12 months using the Brief Infant Sleep Questionnaire.
- Autism characteristics were measured using parent-reported questionnaires (CBCL/1½-5, SDQ/P4-10) and DSM-5 diagnoses were confirmed by 11.5 years.
Main Results:
- Increased night sleep duration at 6 months was associated with fewer autism characteristics and lower odds of an autism diagnosis by 11.5 years.
- Increased sleep latency at 12 months was linked to more autism characteristics and higher odds of an autism diagnosis.
- 42% of diagnosed school-aged children reported melatonin use in the past month.
Conclusions:
- Poor infant sleep quality is associated with increased autism characteristics and diagnosis odds.
- These findings suggest that monitoring infant sleep issues could serve as a potential early indicator for autism.
- Further research is needed to understand the shared determinants of poor sleep and autism.
Objectives:
To examine the prospective associations between infant sleep patterns and subsequent autism characteristics and diagnosis in a population-derived sample.
Design, Setting And Participants:
Population-derived birth cohort study in Victoria, Australia's Barwon region, with 1074 mother-infant pairs recruited from June 2010 to 2013.
Main Outcome Measures:
Infant sleep characteristics via the Brief Infant Sleep Questionnaire at 6 months (n=925) and 12 months (n=885). Parent-reported autism characteristics measured using the Child Behaviour Checklist for Ages 1½-5 (CBCL/1½-5; n=676) at 2 years and Strengths and Difficulties Questionnaire for report for ages 4-10 (SDQ/P4-10; n=791) at 4 years. Autism Diagnostic and Statistical Manual for Mental Disorders fifth edition (DSM-5) diagnoses (n=64) were confirmed by 11.5 years.
Results:
At 6 months, each 10% increase (~1 hour) in night sleep duration was associated with fewer autism characteristics at 2 years (4.5% decrease, CBCL/1½-5) and 4 years (4.5% decrease, SDQ/P4-10) and 22% lower autism DSM-5 diagnosis odds by 11.5 years (adjusted mean difference (AMD): -0.02, 95% CI: -0.04 to -0.01; AMD: -0.02, 95% CI: -0.03 to -0.007; adjusted OR (AOR): 0.78, 95% CI: 0.65 to 0.94). At 12 months, each 25% increase in sleep latency (~5 min) was associated with more autism characteristics (1.5% increase, CBCL/1½-5, AMD: 0.006, 95% CI: 0.002 to 0.01) and 7.7% higher autism diagnosis odds (AOR: 1.08, 95% CI: 1.03 to 1.13). Among diagnosed school-aged children, 42% used melatonin in the past month.
Conclusions:
Poor infant sleep quality was linked to increased autism characteristics and diagnosis odds in a population-derived Australian sample. The extent to which this reflects common determinants of poor sleep and autism is not known. These findings suggest early monitoring of sleep issues as a potential autism indicator.
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