Sleep disorders in autism

Abstract

Autism spectrum disorder is among the most prevalent neurodevelopmental disorders and represent both a diagnostic and therapeutic challenge. Since symptoms of autism spectrum disorder appear early in childhood, there is a need for appropriate paediatrician training. Studies reveal the multifactorial aetiology of the disorders, which hinders the identification of a definite cause of autism and, consequently, the development of appropriate treatment modality. Growing attention is currently given to studies of conditions co-occurring with autism spectrum disorder, including attention deficit hyperactivity disorder, eating disorders, tics, epilepsy, aggression and self-aggression or sleep disorders. It is estimated that circadian rhythm abnormalities (primarily insomnia, night terrors, nightmares, early waking and excessive daytime somnolence) affect 50-80% of children with autism spectrum disorder. The group of patients with autism spectrum disorder shows a higher prevalence of difficulties with concentration, an impaired intellectual capacity and problems with effective therapy of epileptic seizures. Studies point to the multifactorial aetiology of sleep structure abnormalities including neurotransmitter dysfunction and imbalance of hormones (mainly melatonin and cortisol), gastrointestinal disorders or inadequate sleep hygiene habits. Following the introduction of treatment of circadian rhythm abnormalities a lower prevalence of behavioural disorders, aggression and self-aggression, together with an improvement in memory and concentration, have been noted. Also, promising results have been obtained in studies involving psychoeducation and training of parents in the development of good bedtime routines. Inquiring about the presence of sleep disturbances in patients is always necessary during diagnostic appointments. The prevalence of the problem in the population of children and adolescents with autism spectrum disorder - and its impact on daily functioning - clearly indicate the need to establish appropriate non-pharmacological and pharmacological approaches in the course of further research.