Table A3.
Subjective and objective sleep findings in autism spectrum disorders (ASD).
| Author | Description of Study | Demographics | Measures | Significant Results | Additional Comments |
|---|---|---|---|---|---|
| Allik et al., 2006 [71] | Cross-sectional study of subjective and objectively measured sleep in ASD, high functioning autism and Healthy Controls. | ASD (M:F) = 17:2 High functioning autism (M:F) = 11:2 Control (M:F) = 28:4 Age = 8.5–12.8 years |
Sleep Diary for one week | High sleep onset latency, poor sleep efficiency and low sleep quality observed in autism and high functioning autism on sleep diaries. | |
| Actigraphy for one week | No differences in sleep on actigraphy between autism spectrum and healthy controls. | ||||
| Goodlin-Jones et al., 2008 [75] | Cross-sectional study of subjective and objective sleep characteristics in preschool children with autism, children with developmental delay, and healthy controls. | Autism Spectrum Disorder = 68 Age = 2.3–5.6 years Developmental Disability = 57 Age = 2.0–5.7 years Healthy Controls = 69 Age = 2.0–5.1 years |
Children’s Sleep Habits Questionnaire and daily sleep diary | Sleep diary and actigraphy measures were concordant with each other for start of sleep, sleep duration, sleep onset latency, number of naps, nap duration, wake after sleep onset duration, and 24 h sleep duration. | |
| Actigraphy | Children with Autism had significantly shorter 24 h sleep duration, shorter naps, less time in bed than children with developmental disability and healthy children. Developmentally disabled children had more fragmented sleep, with high number and duration of awakenings than autism and healthy controls. |
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| Souders et al., 2009 [73] | Cross-sectional study of subjective and objectively measured sleep in Autism Spectrum Disorder and Healthy Controls. | Autism Spectrum (M:F) = 44:15 Control (M:F) = 26:14 |
Children’s Sleep Habits Questionnaire | Longer sleep onset latency, high sleep anxiety, bedtime resistance, and parasomnias, and short sleep duration in Autism. | |
| Actigraphy for 10 days | Longer Sleep latency, short sleep duration, increased wake after sleep onset duration, and low sleep efficiency in children with Autism. | ||||
| Goldman et al., 2017 [77] | Cross-sectional study of subjective and objective sleep patterns of children with autism spectrum disorders and healthy controls. | Autism spectrum disorder (M:F) = 20:8 Age = 15.6 ± 2.8 years Typically developing children = (M:F) = 6:7 Age = 15.6 ± 2.1 years |
Adolescent Sleep Wake Scale | More difficulty going to bed and falling asleep on self-reports of children with autism spectrum disorder. | |
| Actigraphy | Sleep latency was longer and sleep efficiency lower in autism spectrum disorder. Cortisol and dim light melatonin onset not significantly different between children with autism and healthy controls. |
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| Baker et al., 2013 [76] | Longitudinal study of subjective and objectively measured sleep in High Functioning Autism and healthy controls. | High Functioning Autism (M:F) = 22:5 Control (M:F) = 26:14 Age = 15.5 ± 1.3 years |
Sleep Diary for 7 days, and modified School Sleep Habits Survey | Difficulties with falling asleep and high daytime fatigue in adolescents with high functioning autism. | Night to night variability of sleep latency, sleep onset time, sleep offset time and sleep period higher at follow up. |
| Actigraphy | High sleep onset latency and low sleep efficiency that are both variable in Autism than healthy controls. | ||||
| Fletcher et al., 2017 [78] | Longitudinal study of subjective and objectively measured sleep in Autism and healthy controls | Autism (M:F) = 17:5 Control (M:F) = 14:15 Age = 6–13 years At follow up 7–14 year |
Children’s Sleep Habits Questionnaire | Higher global scores on Children’s sleep habits questionnaire in children with Autism at baseline and follow up | Significant difference in IQ between children with Autism and typically developing children. |
| Actigraphy | Low sleep efficiency, highly variable sleep efficiency in Autism. High variability in wake time and wake after sleep onset in Autism. |
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| Malow et al., 2006 [80] | Cross-sectional study of subjective and objective sleep in children with ASD and healthy controls. | ASD = 21 Healthy Controls = 10 Age = 4–10 years |
Children’s Sleep Habits Questionnaire | High bedtime resistance, sleep onset delay, low sleep duration, high sleep anxiety in children with autism when compared to healthy controls. | |
| Two-night polysomnography | Low sleep efficiency, high sleep latency observed in children with Autism. | ||||
| Miano et al., 2007 [79] | Cross-sectional study of subjective and objective sleep in children with ASD and healthy controls. | ASD (M:F) = 16 Age = 9.4 ± 4.5 years Controls (M:F) = 9:9 Age = 10.2 ± 2.9 years |
Sleep Questionnaires | Difficulty initiating sleep and maintaining sleep, and daytime sleepiness in ASD. | |
| Polysomnography | Short total sleep time, short REM latency, reduced time in bed in ASD than healthy controls. | ||||
| Giannotti et al., 2011 [74] | Cross-sectional study of subjective and objectively measured sleep in Autism (regressed and non-regressed) and Healthy Controls. | Autism (regressed) M:F = 16:6 Age = 5.5 ± 2.1 years Autism (non-regressed) M:F = 14:4 Age = 5.1 ± 3.9 years Healthy Children M:F = 9:3 Age = 5.8 ± 2.4 years |
Children’s Sleep Habits Questionnaire | Shorter total sleep time, later bedtimes and later waketimes in the regressed and non-regressed children High number of awakenings at night, bedtime resistance, sleep onset delay, later bedtimes and waketimes that are severe in regressed than non-regressed children with Autism. |
Autism children had mild mental retardation and borderline intellectual functioning. |
| Polysomnography for two consecutive nights | Total sleep time, sleep efficiency less in regressed and non-regressed Autism than typically developing children. Awakenings per hour, REM sleep less in regressed than non-regressed children than typically developing children. Slow wave sleep, REM percentage less in regressed autism than typically developing children. Stage 2 sleep high in regressed autism than typically developing children. |
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| Lambert et al., 2016 [72] | Cross-sectional study of subjective and objective measures of sleep in children with autism and healthy controls. | Autism = 11 Age = 6–13 years Control = 13 Age = 7–12 years |
Children’s Sleep Habits Questionnaire | No differences in subjective measures of children with Autism and healthy controls. | Low slow wave sleep and light sleep associated with high repetitive behaviors. The groups differed significantly in anxiety, affective and attentional problems. |
| Polysomnography | Longer sleep latency, low slow wave sleep, low sleep spindles and K complexes in Autism Higher stage transitions from stage 1 to wake and low microarousals per hour of sleep in Autism. |
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| Harder et al., 2016 [91] | Cross-sectional study of objective sleep patterns in ASD and Healthy Controls. | Autism Disorder (M:F) = 21:0 Age = 4–10 years Typically Developing Children (M:F) = 18:5 Age = 4–10 years |
Polysomnography | Low stage 3 sleep in children with Autism than healthy controls. | |
| Heart rate variability | Children with ASD had higher HR during N2, and REM sleep. ASD children had higher values of normalized Low Frequency (Heart rate variability) in REM and normalized lower High Frequency heart rate variability in REM. Higher Low Frequency to High Frequency ratio in REM. |
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| Tordjman et al., 2005 [82] | Cross-sectional study of circadian measures of sleep in ASD and healthy controls. | Autism Disorder (M:F) = 33:17 Age = 11.5 ± 4.5 years Typically Developing Children (M:F) = 49:39 Age = 11.0 ± 4.4 years |
Urinary melatonin | Nocturnal melatonin secretion rate lower in autism, specifically in prepubertal children, marked in males. Melatonin levels negatively correlated with impairment in verbal communication and play. |
Children diagnosed by Autism Diagnostic Observation Schedule. Twenty children taking medication. |
| Corbett et al., 2014 [83] | Cross-sectional study of objective measures of sleep in children with autism and healthy controls. | ASD = 46 Age = 10.3 ± 1.7 years Typically developing children = 48 Age = 9.9 ± 1.6 years |
Salivary cortisol | No differences in Cortisol Awakening Response between children with autism and typically developing children. | |
| Tordjman et al., 2014 [81] | Cross-sectional study of circadian measures of sleep in ASD and healthy controls. | Autism Disorder (M:F) = 36:19 Age = 11.3 ± 4.1 years Typically Developing Children (M:F) = 22:10 Age = 11.7 ± 4.9 years |
Salivary cortisol collected five times a day | Salivary cortisol measured high in Autism and flat cortisol daytime and night slopes in children and adolescents with Autism. Higher cortisol levels in children with severe impairments in social interaction. |
Children diagnosed by Autism Diagnostic Observation Schedule. |
M: Male; F: female; ASD: Autism Spectrum Disorder; IQ: intelligence quotient; HR: heart rate; REM: rapid eye movement.