Maine Medical Center Research Institute, USA.
University of Pittsburgh, USA.
Autism. 2021 Apr;25(3):656-666. doi: 10.1177/1362361320967524. Epub 2020 Oct 26.
Insomnia subtypes are not well understood in the most severely affected children with autism spectrum disorder. We examined length of hospital stay, autism severity, nonverbal intelligence quotient, and behavioral functioning across insomnia subtypes in 427 psychiatrically hospitalized children with autism spectrum disorder (mean age = 12.8 ± 3.4; 81.3% male). Per parent report, 60% (n = 257) of children had at least one type of insomnia. The distribution of subtypes was difficulty falling asleep (26.1%, n = 67), difficulty staying asleep (24.9%, n = 64), early morning awakening (4.3%, n = 11), and multiple insomnia symptoms (44.7%, n = 115). Difficulty staying asleep and early morning awakenings were associated with longer hospital stays. Early morning awakening was also associated with higher autism symptom severity. In general, children with difficulty staying asleep or multiple insomnia symptoms scored lower on adaptive behaviors (e.g. communication, self-care, socialization) and higher on maladaptive behaviors (e.g. irritability, hyperactivity, emotional reactivity, and emotional dysphoria). Difficulty staying asleep or having multiple insomnia symptoms appears to be most strongly related to impaired behavioral functioning. Conversely, early morning awakenings may be more closely tied with autism spectrum disorder itself. Further research is needed regarding insomnia subtypes at the severe end of the autism spectrum.
在自闭症谱系障碍中病情最严重的儿童中，失眠亚型尚未得到很好的理解。我们研究了 427 名住院精神科自闭症谱系障碍儿童（平均年龄= 12.8 ± 3.4；81.3%为男性）的住院时间、自闭症严重程度、非言语智商和行为功能在失眠亚型上的差异。根据父母报告，60%（n = 257）的儿童至少有一种类型的失眠。亚型的分布为入睡困难（26.1%，n = 67）、睡眠维持困难（24.9%，n = 64）、早醒（4.3%，n = 11）和多种失眠症状（44.7%，n = 115）。睡眠维持困难和早醒与住院时间延长有关。早醒也与自闭症症状严重程度较高有关。一般来说，睡眠维持困难或多种失眠症状的儿童在适应行为（如沟通、自我护理、社交）方面得分较低，在适应不良行为（如易怒、多动、情绪反应和情绪不适）方面得分较高。睡眠维持困难或出现多种失眠症状似乎与行为功能受损最密切相关。相反，早醒可能与自闭症谱系障碍本身更为密切相关。需要进一步研究自闭症谱系障碍严重程度较高时的失眠亚型。
