Autism Spectrum Disorder: Sleep Characteristics in Children and Adolescents, and Their Relationship with Probable Sleep Bruxism, Anxiety, and Cortisol and Melatonin Levels-A Cross-Sectional Study of Children in Brazil.

This study looked at sleep problems in 85 autistic children in Brazil. Most children (83%) were taking medication and had sleep issues like teeth grinding (73%) and anxiety (48%). Children who needed more support, took medication, or had anxiety had worse sleep. The researchers also measured stress and sleep hormones in saliva and found they were linked to specific sleep problems, especially in older children.

This cross-sectional Brazilian study examined sleep characteristics in 85 autistic children and adolescents aged 2-16 years, investigating relationships with medication use, support needs, sleep bruxism, anxiety, and hormone levels. Results showed that 83.5% used medication, 72.9% had probable sleep bruxism, and 48.2% experienced anxiety. Children requiring higher support levels, those on medication, and those with anxiety demonstrated significantly more negative sleep characteristics. Salivary cortisol and melatonin levels were associated with specific sleep patterns, particularly in older children (7-16 years).

The study provides insight into the complex relationships between sleep problems, physiological markers, and clinical characteristics in autism.

Sleep problems are highly prevalent in autism and worsen with greater support needs. Comprehensive sleep assessment should include evaluation of bruxism, anxiety, and medication effects. Hormone level monitoring may help understand sleep dysfunction mechanisms, particularly in school-age children.

Cross-sectional design prevents causal conclusions. Single-site Brazilian sample limits generalizability. Reliance on questionnaire-based sleep assessment rather than objective measures. Small subgroup sizes for hormone analysis may limit statistical power. Medication effects not systematically controlled.

The study described the sleep characteristics (SC) of children/adolescents with Autism Spectrum Disorder (ASD), and examined their association with medication use, support level, chronotype, probable sleep bruxism (PSB), anxiety, salivary levels of cortisol (SalC) and melatonin (SalM). Methods: Following anamnesis and dental examination, anxiety was assessed using the SCARED questionnaire. The SCs were determined by two age-appropriate questionnaires, and the percentage of negative SCs (%Neg) was recorded. Saliva samples were collected to measure SalC and SalM levels.

The sample comprised 85 ASD patients aged 2-16 years, of whom 80%, 50.6% were classified as support level 2, 83.5% used medication, 84.7% had an afternoon chronotype, 72.9% presented PSB, and 48.2%, anxiety. The mean %Neg was significantly higher in patients using medication (49.29 ± 15.88; p = 0.03) and those requiring more support (level 1: 41.57 ± 14.45; level 2: 50.78 ± 15.54; level 3: 55.11 ± 23.44; p = 0.019). Patients with anxiety showed a higher %Neg (51.31 ± 16.33) than those without anxiety (43.65 ± 15.79). The mean SalC and SalM levels were 13.29 ± 13.39 and 299.91 ± 241.77, respectively..

In children aged 2-6 years, one rhythmicity SC and two separation-related SCs were associated with SalC (p < 0.05); lower SalM levels were found in patients who "slept alone" (p = 0.02). In older patients, "moving while sleeping" was associated with lower SalC (p = 0.05), and three additional SCs were linked to reduced SalM levels (p < 0.05). The presence of negative SCs in ASD patients was more common in those taking medication, requiring more support, and presenting anxiety. Furthermore, SalC and SalM levels were associated with specific SCs, especially among individuals aged (7-16).