Montreal Neurological Institute, Azrieli Centre for Autism Research, McGill University, Montreal, Canada.
Biostatistics and Health Informatics Department, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Sleep. 2021 Sep 13;44(9). doi: 10.1093/sleep/zsab122.
Up to 80% of children with autism spectrum disorder (ASD) experience sleep disturbance. Poor sleep impairs executive functioning (EF), a lifelong difficulty in ASD. Evidence suggests EF difficulties in ASD are exacerbated by poor sleep. We examine whether early childhood sleep disturbances are associated with worsening EF trajectories in school-aged children with ASD. A subsample (n = 217) from the Pathways in ASD longitudinal study was analyzed. The Children's Sleep Habits Questionnaire captured sleep duration, onset, and night awakenings before age 5 (mean = 3.5 years). Metacognition (MI) and Behavioral Regulation (BRI) indices, on the Teacher Behavior Rating Inventory of Executive Functioning, were used to measure cognitive and affective components of EF respectively at four time-points (7.8-11.8 years). We applied latent growth curve models to examine associations between sleep and EF, accounting for relevant covariates, including school-age sleep (mean = 6.7 years). Sleep traits had different age-related impacts on behavioral regulation, but not metacognition. Longer sleep onset at 3.5 years was associated with a worsening BRI difficulties slope (b = 2.07, p < 0.04), but conversely associated with lower BRI difficulties at 7.7 years (b = -4.14, p = 0.04). A longer sleep onset at 6.7 years was related to higher BRI difficulties at 7.7 years (b = 7.78, p < 0.01). Longer sleep duration at 6.7 years was associated with higher BRI difficulties at age 7.7 (b = 3.15, p = 0.01), but subscale analyses revealed shorter sleep duration at age 6.7 was linked to a worsening inhibition slope (b = -0.60, p = 0.01). Sleep onset is a robust early correlate of behavior regulation in children with ASD, whereas sleep duration is a later childhood correlate.
高达 80%的自闭症谱系障碍（ASD）儿童存在睡眠障碍。睡眠质量差会损害执行功能（EF），这是 ASD 患者终生存在的困难。有证据表明，ASD 患者的 EF 困难因睡眠质量差而加剧。我们研究了幼儿期睡眠障碍是否与 ASD 儿童在校期间 EF 轨迹的恶化有关。对自闭症途径纵向研究的一个亚样本（n=217）进行了分析。儿童睡眠习惯问卷在 5 岁前（平均=3.5 岁）捕捉睡眠持续时间、起始时间和夜间觉醒次数。在四个时间点（7.8-11.8 岁），使用教师行为评定量表中的认知和行为调节指数，分别测量认知和情感成分的 EF。我们应用潜在增长曲线模型来研究睡眠与 EF 之间的关联，同时考虑了相关的协变量，包括学龄期睡眠（平均=6.7 岁）。睡眠特征对行为调节有不同的年龄相关影响，但对元认知没有影响。3.5 岁时更长的睡眠起始时间与行为调节困难斜率恶化有关（b=2.07，p<0.04），但与 7.7 岁时的行为调节困难呈负相关（b=-4.14，p=0.04）。6.7 岁时更长的睡眠起始时间与 7.7 岁时更高的行为调节困难有关（b=7.78，p<0.01）。6.7 岁时更长的睡眠时间与 7.7 岁时更高的行为调节困难有关（b=3.15，p=0.01），但子量表分析显示 6.7 岁时较短的睡眠时间与抑制斜率恶化有关（b=-0.60，p=0.01）。睡眠起始时间是 ASD 儿童行为调节的一个强有力的早期相关因素，而睡眠持续时间是儿童后期的相关因素。
