Neonatal irritable sleep-wake rhythm as a predictor of autism spectrum disorders

Abstract

Recently, it has been suggested that sleep problems in autism spectrum disorder (ASD) not only are associated symptoms, but may be deeply related to ASD pathogenesis. Common clinical practice relating to developmental disorders, has shown that parents of children with ASD have often stated that it is more difficult to raise children in the neonatal period because these children exhibit sleep problems. This study investigated the possibility that abnormal neonatal sleep-wake rhythms are related to future ASD development. We administered questionnaires to assess parent(s) of children with ASD and controls. A retrospective analysis was conducted among 121 children with ASD (94 male and 27 female children) recruited from the K-Development Support Center for Children (K-ASD), 56 children with ASD (40 male and 16 female children) recruited from the H-Children's Sleep and Development Medical Research Center (H-ASD) and 203 children (104 male and 99 female children) recruited from four nursery schools in T-city (control). Irritable/over-reactive types of sleep-wake rhythms that cause difficulty in raising children, such as 1) frequently waking up, 2) difficulty falling asleep, 3) short sleep hours, and 4) continuous crying and grumpiness, were observed more often in ASD groups than in the control group. Additionally, the number of the mothers who went to bed after midnight during pregnancy was higher in the ASD groups than in the control group. Sleep-wake rhythm abnormalities in neonates may be considerable precursors to future development of ASD. Formation of ultradian and postnatal circadian rhythms should be given more attention when considering ASD development. Although this is a retrospective study, the results suggest that a prospective study regarding this issue may be important in understanding and discovering intervention areas that may contribute to preventing and/or properly treating ASD.

Keywords: Autism spectrum disorder; Neonate; Predictor; Prevention; Sleep-wake rhythm; Ultradian rhythm.

Fig. 1

Differences in the number of irritable-type neonates between the ASD and control groups.

Fig. 2

The number of mothers who went to bed after midnight during pregnancy in the ASD and control groups.

Fig. 3

Differences in neonatal sleep patterns between the K-ASD and control groups.

Fig. 4

Differences in neonatal sleep patterns between the H-ASD and control groups.

Fig. 5

Structural equation model used in the K-ASD and control groups. Lines with numbers indicate significant paths with standardized partial regression coefficients (P < 0.05). Arrows represent an association between two factors. A positive value represents a positive correlation and a negative value represents a negative correlation. ASD, autism spectrum disorder.

Fig. 6

Structural equation model used in the H-ASD and control groups. Lines with numbers indicate significant paths with standardized partial regression coefficients (P < 0.05). Arrows represent an association between two factors. A positive value represents a positive correlation and a negative value represents a negative correlation. ASD, autism spectrum disorder.