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The effect of sex on sleep neurophysiology in typical and altered neurodevelopment
Nataliia Kozhemiako1, Naihua N Gong1, Shaun M Purcell2
1Department of Psychiatry, Brigham and Women's Hospital, Harvard Medical School, Boston, USA.
Insights
Childhood sleep EEG shows significant sex differences, but these patterns differ in neurodevelopmental disorders (NDDs). Understanding these sex-specific sleep alterations in NDDs is crucial for pediatric research.
Area of Science:
- Neuroscience
- Pediatric Sleep Medicine
- Genetics and Neurodevelopment
Background:
- Sleep electroencephalography (EEG) patterns vary with age and sex, but pediatric data, especially concerning neurodevelopmental disorders (NDDs), is limited.
- Existing research primarily focuses on adult sleep neurophysiology, leaving a gap in understanding sex-specific sleep characteristics in children with NDDs.
Purpose of the Study:
- To investigate sex differences in whole-night sleep EEG patterns in a large pediatric cohort.
- To compare sleep EEG characteristics between children with and without NDDs (autism spectrum disorder, attention deficit hyperactivity disorder, intellectual disabilities) across sexes.
Main Methods:
- Analysis of a large pediatric clinical dataset (N=2359) including children with and without NDDs.
- Examination of sleep macro- and microarchitecture, spectral power, sleep spindles, and slow oscillations.
- Replication of findings in an independent cohort and analysis of EEG-based brain age and sleep disorder prevalence.
Main Results:
- Significant sex differences in sleep macroarchitecture, spectral power, spindles, and slow oscillations were found in typically developing children.
- Non-NDD boys had more fragmented sleep than girls; this was not seen in NDD groups.
- Lower fast spindle density in boys, irrespective of NDD diagnosis, may link to male NDD susceptibility; sex differences in sleep EEG varied across NDD types.
Conclusions:
- Childhood sleep EEG features display notable sex differences, which may be altered in NDD populations.
- Sex-specific sleep alterations in NDDs underscore the importance of considering sex in pediatric sleep research and clinical practice.
- Findings suggest potential sex-based mechanisms contributing to NDD development and presentation.
Study Objectives:
Sleep electroencephalography (EEG) patterns exhibit complex variations influenced by multiple factors, including age and sex. While sex effects in sleep neurophysiology are well-described in adults, evidence in pediatric populations is limited, particularly in the context of neurodevelopmental disorders (NDDs).
Methods:
Here, we analyzed a large pediatric clinical dataset to examine sex differences in whole-night sleep EEG among children without NDDs (N = 1523, 2.5-17.5 years) and those with autism spectrum disorder (ASD,N = 196), attention deficit hyperactivity disorder (ADHD,N = 523), and intellectual disabilities (IntDis,N = 167). We investigated sleep macro- and microarchitecture, including spectral power, density and morphology of spindles and slow oscillations, and their temporal coupling.
Results:
Significant sex differences in the non-NDD sample were observed across features of sleep macroarchitecture, spectral power, sleep spindles, and slow oscillations, with the majority of findings replicated in an independent cohort. More specifically, non-NDD boys exhibited more fragmented sleep compared to girls, but this pattern was not observed among children with NDDs. In contrast, fast spindle density was lower in boys regardless of NDD diagnosis, which may contribute to males' increased susceptibility to developing NDDs. No sex differences were observed in EEG-based brain age predictions. Medical record analysis revealed limited sex differences in the prevalence of sleep disorders. We found strong evidence of altered sleep EEG characteristics in boys and girls with IntDis. Several sleep EEG metrics showed nominal group-by-sex interactions with ASD and ADHD girls displaying more pronounced alterations, pointing to a varying degree of sleep disturbance.
Conclusions:
Our findings demonstrate that many sleep EEG features exhibit significant sex differences during childhood, but these differences may be distinct in NDD populations. The sex-specific sleep alterations in NDDs highlight the potential importance of considering sex in pediatric sleep research.
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