Martinez-Cayuelas Elena, Gavela-Pérez Teresa, Rodrigo-Moreno María, Merino-Andreu Milagros, Vales-Villamarín Claudia, Pérez-Nadador Iris, Garcés Carmen, Soriano-Guillén Leandro
Department of Pediatrics, Instituto de Investigaciones Sanitarias- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain.
Hospital Universitario La Paz, Paseo de la Castellana, Madrid, Spain.
Front Neurol. 2022 Jun 14;13:813692. doi: 10.3389/fneur.2022.813692. eCollection 2022.
Sleep problems are prevalent among individuals with autism spectrum disorder (ASD), and a role has been attributed to melatonin in this multifactorial comorbidity.
A cross-sectional study was conducted on 41 autistic children and adolescents (9.9 ± 3.02) and 24 children and adolescents with a normal intellectual function (8.42 ± 2.43) were used as controls. Subjects were matched for sex, body mass index, and pubertal stage, and all were drug-naive. Circadian and sleep parameters were studied using an ambulatory circadian monitoring (ACM) device, and saliva samples were collected around the onset of sleep to determine dim light melatonin onset (DLMO).
Prepubertal individuals with ASD presented later DLMO and an earlier decline in melatonin during adolescence. A relationship was found between melatonin and both sleep and circadian parameters. Participants and controls with later DLMOs were more likely to have delayed sleep onset times. In the ASD group, subjects with the later daytime midpoint of temperature had a later DLMO. Later melatonin peak time and DLMO time were related to lower general motor activity and lower stability of its rhythms.
The melatonin secretion pattern was different in individuals with ASD, and it showed a relationship with sleep and circadian parameters. Alterations in DLMO have not been previously reported in ASD with the exception of more variable DLMO timing; however, high variability in the study design and sample characteristics prevents direct comparison. The ACM device enabled the measurement of circadian rhythm, a scarcely described parameter in autistic children. When studied in combination with other measures such as melatonin, ACM can offer further knowledge on sleep problems in ASD.
睡眠问题在自闭症谱系障碍（ASD）患者中普遍存在，褪黑素在这种多因素合并症中发挥了作用。
对41名自闭症儿童和青少年（9.9±3.02）进行了一项横断面研究，并将24名智力功能正常的儿童和青少年（8.42±2.43）作为对照。根据性别、体重指数和青春期阶段对研究对象进行匹配，且所有对象均未服用过药物。使用动态昼夜监测（ACM）设备研究昼夜节律和睡眠参数，并在睡眠开始时采集唾液样本以确定暗光褪黑素起始时间（DLMO）。
青春期前的ASD个体表现出较晚的DLMO，且在青春期褪黑素水平下降更早。发现褪黑素与睡眠和昼夜节律参数之间存在关联。DLMO较晚的参与者和对照组更有可能出现入睡时间延迟。在ASD组中，白天体温中点较晚的受试者DLMO也较晚。较晚的褪黑素峰值时间和DLMO时间与较低的总体运动活动及其节律稳定性相关。
ASD个体的褪黑素分泌模式不同，且与睡眠和昼夜节律参数有关。除了DLMO时间更具可变性外，此前尚未有关于ASD中DLMO改变的报道；然而，研究设计和样本特征的高度可变性妨碍了直接比较。ACM设备能够测量昼夜节律，这是自闭症儿童中鲜有描述的参数。当与褪黑素等其他测量方法结合研究时，ACM可以提供关于ASD睡眠问题的更多知识。
