Gao Lei, Wang Chen, Song Xiao-Rong, Tian Li, Qu Zhi-Yi, Han Yu, Zhang Xin
Department of Maternal, Child and Adolescent Health, School of Public Health, Tianjin Medical University, Tianjin, China.
Department of Cerebral Functional Therapy, Tianjin Anding Hospital (Tianjin Mental Health Center), Tianjin, China.
Front Psychiatry. 2022 Jan 24;12:820598. doi: 10.3389/fpsyt.2021.820598. eCollection 2021.
Sleep disorder emerges as a common comorbidity in children with autism spectrum disorder (ASD), and the interaction between the core symptoms of ASD and its sleep disorder remains unclear. Repetitive transcranial magnetic stimulation (rTMS) was used on the bilateral dorsolateral prefrontal cortex (DLPFC) to investigate the efficacy of rTMS on the core symptoms of ASD and comorbid sleep problems as well as the mediation role of the ASD symptoms between rTMS intervention and sleep improvement. A total of 41 Chinese children with ASD and who met the criteria in the fifth edition of the American Diagnostic and Statistical Manual of Mental Disorders were recruited, and 39 of them (mean age: 9.0 ± 4.4 years old; the male-female ratio was 3.9: 1) completed the study with the stimulating protocol of high frequency on the left DLPFC and low frequency on the right DLPFC. They were all assessed three times (before, at 4 weeks after, and at 8 weeks after the stimulation) by the Children's Sleep Habits Questionnaire (CSHQ), Strengths and Difficulties Questionnaire (SDQ), Childhood Autism Rating Scale, Repetitive Behavior Questionnaire-2, and Short Sensory Profile (SSP). The repeated-measures ANOVA showed that the main effect of "intervention time" of CSHQ ( = 25.103, < 0.001), SSP ( = 6.345, = 0.003), and SDQ ( = 9.975, < 0.001) was statistically significant. By Bayesian mediation analysis, we only found that the total score of SSP mediated the treating efficacy of rTMS on CSHQ (αβ = 5.11 ± 1.51, 95% CI: 2.50-8.41). The percentage of mediation effect in total effect was 37.94%. Our results indicated the treating efficacy of rTMS modulation on bilateral DLPFC for both autistic symptoms and sleep disturbances. The sensory abnormality of ASD mediated the improvement of rTMS on sleep problems of ASD.
睡眠障碍是自闭症谱系障碍（ASD）儿童中常见的共病，ASD核心症状与其睡眠障碍之间的相互作用仍不清楚。采用重复经颅磁刺激（rTMS）作用于双侧背外侧前额叶皮质（DLPFC），以研究rTMS对ASD核心症状和共病睡眠问题的疗效，以及ASD症状在rTMS干预与睡眠改善之间的中介作用。共招募了41名符合美国精神障碍诊断与统计手册第五版标准的中国ASD儿童，其中39名（平均年龄：9.0±4.4岁；男女比例为3.9:1）完成了研究，刺激方案为左侧DLPFC高频刺激和右侧DLPFC低频刺激。通过儿童睡眠习惯问卷（CSHQ）、长处与困难问卷（SDQ）、儿童自闭症评定量表、重复行为问卷-2和简短感觉概况量表（SSP）对他们进行了三次评估（刺激前、刺激后4周和刺激后8周）。重复测量方差分析显示，CSHQ（F = 25.103，P < 0.001）、SSP（F = 6.345，P = 0.003）和SDQ（F = 9.975，P < 0.001）的“干预时间”主效应具有统计学意义。通过贝叶斯中介分析，我们仅发现SSP总分介导了rTMS对CSHQ的治疗效果（αβ = 5.11±1.51，95%CI：2.50 - 8.41）。中介效应在总效应中的百分比为37.94%。我们的结果表明，rTMS调节双侧DLPFC对自闭症症状和睡眠障碍均有治疗效果。ASD的感觉异常介导了rTMS对ASD睡眠问题的改善。
