SLEEP IN CHILDREN WITH AUTISTIC SPECTRUM DISORDER: A QUESTIONNAIRE AND POLYSOMNOGRAPHIC STUDY.

Objective: To evaluate sleep in children with autistic spectrum disorder (ASD) by means of sleep questionnaires and polysomnography; moreover, to analyze their cyclic alternating pattern (CAP). Methods: Thirty-one patients with ASD (28 males, 3 females, aged 3.7–19 years) and age-matched normal controls were included. ASD children were evaluated by a standard sleep questionnaire that consisted of 45 items in a Likert-type scale covering several areas of sleep disorders and by overnight polysomnography in the sleep laboratory after one adaptation night. Results: The questionnaire results showed that parents of ASD children reported a high prevalence of disorders of initiating and maintaining sleep, enuresis, repetitive behavior when falling asleep, and daytime sleepiness. Polysomnographically, ASD children showed reduced time in bed, total sleep time, sleep period time and rapid eye movement (REM) latency. ASD subjects had a CAP rate during slow-wave sleep (SWS) lower than normal controls, together with a lower percentage of A1 subtypes. Conclusions: ASD children questionnaires showed a higher percentage of disorders of initiating and maintaining sleep than normal controls; this was not completely confirmed by sleep staging. CAP measures showed subtle alterations of NREM sleep which could be detected with an appropriate methodology of analysis. The reduction of A1 subtypes during SWS might play a role in the impairment of cognitive functioning in these subjects

Narcolepsy is a paediatric disease: Use red flags to recognise it

Rationale - Narcolepsy is a chronic rare disease that frequently develops in children. It is characterised by excessive daily sleepiness, cataplexy, sleep paralysis, hypnagogic and hypnopompic hallucinations as well as disturbed nocturnal sleep. Moreover, psychiatric disorders, obesity and early puberty can complete the clinical picture. Narcolepsy diagnosis is often delayed and many patients receive wrong diagnoses and inappropriate treatments. Objective - The Associazione Italiana Narcolettici e Ipersonni (AIN) promoted the “Red Flags Project” in order to increase early detection by doctors that visit subjects with narcolepsy symptoms. The project has been developed by a multidisciplinary panel including main Scientific Societies involved in narcolepsy diagnosis, with the methodological contribution of the Neurological Sciences Institute of Bologna University and Istituto Superiore di Sanità. Method - The project has been divided into three phases. Phase 1: preparation of a questionnaire aimed at defining diagnostic delay, barriers and solutions and questionnaire filling in by Scientific Societies representatives and AIN members. Phase 2: shaping of typical and atypical narcolepsy pictures in adults and in children, on whose basis Red Flags have been defined. Phase 3: the panel has produced suggestions aimed at Red Flags spreading and barriers overcoming. Results - Narcolepsy Red Flags are 5 paradigmatic clinical pictures: 3 for children and 2 for adults. The limited early symptoms knowledge of doctors, in particular on symptoms different from sleep attacks, is the main barrier to diagnosis. Conclusions - “Red Flags Project” deals with diagnostic delay, proposing paradigmatic clinical pictures, in order to arouse diagnostic suspect and suggest targets of Red Flags spreading