结合发育和睡眠健康指标进行自闭症谱系障碍筛查：一项ECHO研究。
Combining developmental and sleep health measures for autism spectrum disorder screening: an ECHO study.
作者信息
Shuffrey Lauren C, Rennie Brandon, Li Xiuhong, Galai Noya, Pini Nicolò, Akbaryan Anahid, Alshawabkeh Akram, Aschner Judy, Vargas Julianna Collazo, Costello Lauren, D'Sa Viren, Deoni Sean, Dunlop Anne, Elliott Amy J, Fifer William P, Hash Jonica, Koinis-Mitchell Daphne, Lai Jin-Shei, Leventhal Bennett L, Lewis Johnnye, Lucchini Maristella, McArthur Kristen L, Morales Santiago, Nozadi Sara S, O'Connor Thomas G, O'Shea T Michael, Page Grier P, Propper Cathi, Sania Ayesha, Shuster Coral, Zimmerman Emily, Margolis Amy E
机构信息
Department of Child and Adolescent Psychiatry, NYU Grossman School of Medicine, New York, NY, USA.
Department of Pediatrics, University of New Mexico, Albuquerque, NM, USA.
出版信息
Pediatr Res. 2025 Jan;97(1):411-421. doi: 10.1038/s41390-024-03306-0. Epub 2024 Jun 12.
BACKGROUND
Sleep problems are reported for up to 80% of autistic individuals. We examined whether parsimonious sets of items derived from the Modified Checklist for Autism in Toddlers, Revised (M-CHAT-R) and the Brief Infant Sleep Questionnaire (BISQ) are superior to the standard M-CHAT-R in predicting subsequent autism spectrum disorder (ASD) diagnoses.
METHODS
Participants from 11 Environmental influences on Child Health Outcomes (ECHO) cohorts were included. We performed logistic LASSO regression models with 10-fold cross-validation to identify whether a combination of items derived from the M-CHAT-R and BISQ are superior to the standard M-CHAT-R in predicting ASD diagnoses.
RESULTS
The final sample comprised 1552 children. The standard M-CHAT-R had a sensitivity of 44% (95% CI: 34, 55), specificity of 92% (95% CI: 91, 94), and AUROC of 0.726 (95% CI: 0.663, 0.790). A higher proportion of children with ASD had difficulty falling asleep or resisted bedtime during infancy/toddlerhood. However, LASSO models revealed parental reports of sleep problems did not improve the accuracy of the M-CHAT-R in predicting ASD diagnosis.
CONCLUSION
While children with ASD had higher rates of sleep problems during infancy/toddlerhood, there was no improvement in ASD developmental screening through the incorporation of parent-report sleep metrics.
IMPACT
Parental-reported sleep problems are common in autism spectrum disorder (ASD). We investigated whether the inclusion of parental-reports of infant/toddler sleep patterns enhanced the effectiveness of developmental screening for autism. We reported higher rates of difficulty falling asleep and resisting bedtime during infancy and toddlerhood among children later diagnosed with ASD; however, we did not find an improvement in ASD developmental screening through the incorporation of parent-report sleep metrics. In our sample, the standard M-CHAT-R had a sensitivity of 39% among children of mothers with government insurance compared with a sensitivity of 53% among children of mothers with employer-based insurance.
背景
据报告，高达80%的自闭症患者存在睡眠问题。我们研究了从修订版幼儿自闭症修正检查表（M-CHAT-R）和简短婴儿睡眠问卷（BISQ）中得出的精简项目集在预测后续自闭症谱系障碍（ASD）诊断方面是否优于标准的M-CHAT-R。
方法
纳入了来自11个儿童健康结果环境影响（ECHO）队列的参与者。我们进行了具有10倍交叉验证的逻辑套索回归模型，以确定从M-CHAT-R和BISQ中得出的项目组合在预测ASD诊断方面是否优于标准的M-CHAT-R。
结果
最终样本包括1552名儿童。标准的M-CHAT-R敏感性为44%（95%置信区间：34，55），特异性为92%（95%置信区间：91，94），曲线下面积为0.726（95%置信区间：0.663，0.790）。较高比例的ASD儿童在婴儿期/幼儿期存在入睡困难或抗拒就寝时间的问题。然而，套索模型显示，父母报告的睡眠问题并未提高M-CHAT-R预测ASD诊断的准确性。
结论
虽然ASD儿童在婴儿期/幼儿期睡眠问题发生率较高，但通过纳入父母报告的睡眠指标，ASD发育筛查并无改善。
影响
父母报告的睡眠问题在自闭症谱系障碍（ASD）中很常见。我们研究了纳入父母报告的婴儿/幼儿睡眠模式是否能提高自闭症发育筛查的有效性。我们报告称，后来被诊断为ASD的儿童在婴儿期和幼儿期入睡困难和抗拒就寝时间的发生率较高；然而，通过纳入父母报告的睡眠指标，我们并未发现ASD发育筛查有改善。在我们的样本中，标准的M-CHAT-R在有政府保险的母亲的孩子中敏感性为39%，而在有雇主保险的母亲的孩子中敏感性为53%。
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