REM Sleep Deficiency in Autism

Pediatric Patient Prepared for Sleep Study

Parents with children who have autism commonly report significant sleep problems.  Clinicians commonly encounter complaints by parents about the child’s sleep problem and consider behavioral or pharmacologic interventions.  Now a study informs parents and clinicians about the type of sleep abnormalities found in children with autism.

Buckley et al conducted sleep studies using polysomnography in a series of children with the diagnosis of autism between the ages of 2 and 13.   Sleep architecture variables were examined compared to controls as well as a group of children with developmental delay without autism.  This second control group is quite helpful as it helps identify whether sleep abnormalities in autism might be due to generally to a developmental delay.

The autism group had significant cognitive impairment with a mean IQ of 57.    Here are the key statistically significant findings with results presented for autism, typical controls and developmentally delayed controls:

• Total sleep time: 7.7 hours, 8.8 hours, 9.2 hours
• Slow wave sleep %:  21.5%, 18.6%, 13.7%
• REM sleep %: 14.5%, 22.6%, 25.0%
• REM sleep latency: 109 min, 64 min, 69 min

 So autism sleep architecture is characterized by less total sleep with more time spent in stage 3 sleep (slow wave sleep) and less time in REM (dream-related) sleep.  The investigators note this pattern might inform us on some of the neurotransmitter abnormalities in autism.  REM sleep control is a complex system that involves:

• GABA
• Glutamate
• Serotonin from the cells in the brain dorsal raphe
• Epinephrine in the locus ceruleus
• Acetylcholine

 The authors note that acetylcholine is a particular driver of slow wave sleep as well as REM sleep.  They note “A more global (not just in the pontine brainstem where REM is orchestrated) cholinergic deficiency would predict a more permissive environment for slow-wave generation and could conceivably be represented by a higher percentage of this state”.

The authors note their study provides some insight into potential drug strategies in treating children with autism and sleep problems.  Additionally, this pattern deserves additional research and an “objective biomarker for identification of infants at risk for autism”.

Photo of pediatric patient being prepared for a polysomnogram sleep study is licensed under the Creative Commons Attribution-Share Alike 2.5 Generic license.  The author is Robert Lawton.

Buckley AW, Rodriguez AJ, Jennison K, Buckley J, Thurm A, Sato S, & Swedo S (2010). Rapid eye movement sleep percentage in children with autism compared with children with developmental delay and typical development. Archives of pediatrics & adolescent medicine, 164 (11), 1032-7 PMID: 21041596