School of Psychology and Public Health, Olga Tennison Autism Research Centre, La Trobe University, Bundoora, VIC, Australia.
Diagnosis and Development, Murdoch Children's Research Institute, Parkville, VIC, Australia.
Autism Res. 2019 Jun;12(6):897-910. doi: 10.1002/aur.2094. Epub 2019 Mar 21.
This study aimed to investigate the relationship between sleep, psychopathology (anxiety, depression and presleep arousal) symptoms, and cortisol in adults with autism spectrum disorder (ASD). The sample composed of 29 adults with ASD (51.7% males) and 29 control adults (51.7% males) aged 21-44 years. Thirteen adults with ASD were medicated for a comorbid diagnosis of anxiety and/or depression (ASD-Med), while the remaining 16 adults with ASD were not medicated for such diagnoses (ASD-Only). Participants completed a questionnaire battery, 14-day sleep/wake diary and 14-day actigraphy assessment. On one day during the data collection period, participants collected five saliva samples, hourly, prior to sleep and two morning samples; immediately upon waking and 30 min thereafter for the analysis of cortisol. Cortisol 1 hr prior to habitual sleep onset time was associated with poorer sleep efficiency in both ASD groups and increased wake after sleep onset duration (ASD-Only). Higher subjective somatic arousal was also associated with increased sleep onset latency, regardless of group, and poorer sleep efficiency in the ASD-Only group. ASD-Only participants had significantly greater reductions in evening cortisol concentrations compared to both ASD-Med and control participants. No significant group differences were found for the cortisol awakening response. Findings suggest a hyperarousal hypothesis of insomnia in adults with ASD. Moreover, the low cortisol levels observed in ASD-Only adults suggest dysregulation of the hypothalamic-pituitary-adrenal (HPA) axis. Longitudinal studies exploring the interplay between insomnia, anxiety and HPA axis regulation across the lifespan in those with ASD are warranted. Autism Res 2019, 12: 897-910. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. LAY SUMMARY: Both objective (cortisol) and subjective (somatic) physiological arousal were associated with poor sleep quality in adults on the autism spectrum. Adults with autism spectrum disorder (ASD) who were not medicated for a comorbid diagnosis of anxiety and/or depression also had dampened cortisol secretion, suggesting a dysregulation of the hypothalamic pituitary axis. Longitudinal studies investigating the relationship between sleep, psychopathology symptoms and physiological arousal in autistic individuals are warranted. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
本研究旨在探讨睡眠、精神病理学（焦虑、抑郁和睡前觉醒）症状与皮质醇之间的关系，研究对象为患有自闭症谱系障碍（ASD）的成年人。样本由 29 名男性（51.7%）和 29 名男性（51.7%）的对照组成年人组成，年龄在 21-44 岁之间。13 名 ASD 患者因焦虑和/或抑郁的合并症诊断而接受药物治疗（ASD-Med），而其余 16 名 ASD 患者则未接受此类诊断的药物治疗（ASD-Only）。参与者完成了一份问卷、14 天的睡眠/觉醒日记和 14 天的活动记录仪评估。在数据收集期间的某一天，参与者在睡前和两次早晨每小时采集五次唾液样本，用于皮质醇分析；醒来后立即和 30 分钟后采集样本。习惯入睡时间前 1 小时的皮质醇与两组 ASD 患者的睡眠效率降低以及睡眠后觉醒时间延长（ASD-Only）有关。无论组间如何，较高的主观躯体唤醒也与入睡潜伏期延长和 ASD-Only 组的睡眠效率降低有关。与 ASD-Med 和对照组参与者相比，ASD-Only 组参与者在晚上的皮质醇浓度明显降低。对于皮质醇觉醒反应，没有发现组间的显著差异。研究结果表明，在 ASD 成年人中存在失眠的高唤醒假说。此外，在 ASD-Only 成年人中观察到的低皮质醇水平表明下丘脑-垂体-肾上腺（HPA）轴的调节紊乱。需要进行纵向研究，探索 ASD 患者一生中失眠、焦虑和 HPA 轴调节之间的相互作用。Autism Res 2019, 12: 897-910. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. 简而言之：在自闭症谱系障碍患者中，客观（皮质醇）和主观（躯体）生理唤醒都与睡眠质量差有关。未因焦虑和/或抑郁的合并症诊断而接受药物治疗的自闭症谱系障碍（ASD）成年人的皮质醇分泌也减弱，这表明下丘脑-垂体轴的调节紊乱。需要进行纵向研究，以调查自闭症个体中睡眠、精神病理学症状和生理唤醒之间的关系。Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
