Longer Slow Wave Sleep And Exacerbated Core Symptom Severity In Autism Spectrum Disorder

Abstract Introduction Sleep disturbances in individuals with autism spectrum disorder (ASD) are common, yet previous studies have reported inconsistent findings on the associations between sleep architecture and core features of ASD. Our goal is to examine 1) the difference in sleep architecture, especially SWS, between children with ASD and typically developing controls (TD), 2) the association between SWS and core symptoms in ASD, and 3) the association of slow wave activity (SWA) spectral power and ASD symptoms. Methods We used ambulatory polysomnography (PSG) to record the sleep architecture in 61 children and adolescents (age 6 to 18) with ASD and 73 typically developing controls (TD) in their sleeping environment. We performed an analysis to examine 1) the difference in sleep architecture between ASD and TD, and 2) the association of SWS with core symptoms of ASD with the Autism Diagnostic Interview-Revised (ADI-R) and Repetitive Behavior Scale (RBS). Results Children and adolescents with ASD showed a higher SWS ratio and lower REM ratio than TD. Delta (1–4 Hz) relative power during total sleep was higher in ASD than TD. Further, a higher ratio of SWS predicted more severe behavioral symptoms as measured by the ADI-R and the Ritualized Behavior subscale of the RBS. Delta power did not show a significant association with core symptoms. Conclusion A higher ratio of SWS may reflect the neuronal immaturity specific to ASD in this age group. It may help us understand the underlying mechanism of the clinical symptoms in children with ASD. Support (if any) Support for this work was provided to Dr. O’Hara by a grant from the Simons Foundation Autism Research Initiative (SFARI). Dr. Kawai is supported by the National Institute on Aging of the National Institutes of Health K23AG053465, and his contribution to this manuscript was made possible by an award from the American Sleep Medicine Foundation (#157-BS-16), a foundation of the American Academy of Sleep Medicine, 2018 NARSAD Young Investigator Grant from the Brain & Behavior Research Foundation, and Autism Working Group Award from Mosbacher Family Foundation. All authors gratefully acknowledge all participants and their families.