Effects of Transcranial Magnetic Stimulation on Sleep Structure and Quality in Children with Autism

Overview

Journal Front Psychiatry

Specialty Psychiatry

Date 2024 Jul 15

PMID 39006818

Authors

Juan Yan

Yan Zhang

Junjie Wang

Guidong Zhu

Kaijie Fang

Affiliations

Soon will be listed here.

Abstract

Introduction: Sleep disorders are common in children with autism spectrum disorder (ASD). Transcranial magnetic stimulation (TMS) can influence the excitability of neuronal cells in stimulated areas, leading to improvements in sleep and other autistic symptoms. However, studies on clinical mechanisms of TMS in treating sleep disorders associated with ASD are limited. Therefore, we aimed to explore the effects of TMS on sleep structure and quality in children with ASD.

Methods: Between January 2020 and December 2021, recruitment was advertised through child and adolescent outpatient clinics and online platforms by the Hangzhou Seventh People's Hospital and Lishui Second People's Hospital. Sixty children with ASD who met the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, were selected and randomly divided into the active TMS and sham TMS treatment groups. Thirty healthy children of the same age were recruited as controls. The active TMS group received bilateral low-frequency (0.5 Hz) TMS targeting the dorsolateral prefrontal cortex on both sides in children with ASD, whereas the sham TMS group received sham stimulation with the same stimulation time and location as the experimental group. Both groups were treated for 6 weeks, and the participants were assessed using the Sleep Disturbance Scale for Children (SDSC) before treatment, at 3 weeks, and at 6 weeks of intervention. Independent sample tests and difference -tests were used for statistical analysis of the data.

Results: No significant differences were observed in general demographic variables, such as age and sex, between the ASD and control groups (>0.05). Independent sample -test analysis showed that the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis scores were significantly higher in the ASD group than in the control group (<0.05). Before treatment, no significant differences were observed in the factor or total SDSC scores between the sham TMS group and the active TMS group (>0.05). After 15 and 30 treatment sessions, the total SDSC score, difficulty falling asleep, sleep maintenance, sleep-wake transition disorders, and excessive daytime sleepiness scores were significantly higher in the sham TMS group than in the active TMS group (<0.05). The difference t-test analysis showed that after 30 treatment sessions, the reduction rates of the total SDSC score, difficulty falling asleep, sleep maintenance, awakening disorders, sleep-wake transition disorders, excessive daytime sleepiness, and nocturnal hyperhidrosis dimensions were significantly higher in the active TMS group than in the sham TMS group (<0.05).

Conclusion: Low-frequency TMS targeting the dorsolateral prefrontal cortex in children with ASD can effectively improve their sleep status, and significant improvement can be achieved after 6 weeks (30 sessions) of treatment.

References

Schreck K, Mulick J, Smith A . Sleep problems as possible predictors of intensified symptoms of autism. Res Dev Disabil. 2004; 25(1):57-66. DOI: 10.1016/j.ridd.2003.04.007. View

Mazurek M, Sohl K . Sleep and Behavioral Problems in Children with Autism Spectrum Disorder. J Autism Dev Disord. 2016; 46(6):1906-1915. DOI: 10.1007/s10803-016-2723-7. View

Scalise A, Pittaro-Cadore I, Serafini A, Simeoni S, Fratticci L, Ecoretti E . Transcranial magnetic stimulation in sleep fragmentation: a model to better understand sleep disorders. Sleep Med. 2014; 15(11):1386-91. DOI: 10.1016/j.sleep.2014.06.007. View

Van der Heijden K, Stoffelsen R, Popma A, Swaab H . Sleep, chronotype, and sleep hygiene in children with attention-deficit/hyperactivity disorder, autism spectrum disorder, and controls. Eur Child Adolesc Psychiatry. 2017; 27(1):99-111. PMC: 5799342. DOI: 10.1007/s00787-017-1025-8. View

Huang M, Qian Z, Wang J, Vaughn M, Lee Y, Dong G . Validation of the sleep disturbance scale for children and prevalence of parent-reported sleep disorder symptoms in Chinese children. Sleep Med. 2014; 15(8):923-8. DOI: 10.1016/j.sleep.2014.03.023. View

Xu G, Strathearn L, Liu B, OBrien M, Kopelman T, Zhu J . Prevalence and Treatment Patterns of Autism Spectrum Disorder in the United States, 2016. JAMA Pediatr. 2018; 173(2):153-159. PMC: 6439607. DOI: 10.1001/jamapediatrics.2018.4208. View

Sokhadze E, El-Baz A, Sears L, Opris I, Casanova M . rTMS neuromodulation improves electrocortical functional measures of information processing and behavioral responses in autism. Front Syst Neurosci. 2014; 8:134. PMC: 4123734. DOI: 10.3389/fnsys.2014.00134. View

Malow B, Marzec M, McGrew S, Wang L, Henderson L, Stone W . Characterizing sleep in children with autism spectrum disorders: a multidimensional approach. Sleep. 2007; 29(12):1563-71. DOI: 10.1093/sleep/29.12.1563. View

Lord C, Elsabbagh M, Baird G, Veenstra-VanderWeele J . Autism spectrum disorder. Lancet. 2018; 392(10146):508-520. PMC: 7398158. DOI: 10.1016/S0140-6736(18)31129-2. View

10.

Chen Y, Erigene X, Wu K, Huang W, Yu S, Chen H . [Emotional and behavioral problems associated with sleep problems in preschool aged children]. Zhonghua Liu Xing Bing Xue Za Zhi. 2017; 38(9):1191-1196. DOI: 10.3760/cma.j.issn.0254-6450.2017.09.010. View

11.

Levin A, Scher A . Sleep Problems in Young Children with Autism Spectrum Disorders: A Study of Parenting Stress, Mothers' Sleep-Related Cognitions, and Bedtime Behaviors. CNS Neurosci Ther. 2016; 22(11):921-927. PMC: 6492857. DOI: 10.1111/cns.12651. View

12.

Souders M, Zavodny S, Eriksen W, Sinko R, Connell J, Kerns C . Sleep in Children with Autism Spectrum Disorder. Curr Psychiatry Rep. 2017; 19(6):34. PMC: 5846201. DOI: 10.1007/s11920-017-0782-x. View

13.

Pellicciari M, Cordone S, Marzano C, Bignotti S, Gazzoli A, Miniussi C . Dorsolateral prefrontal transcranial magnetic stimulation in patients with major depression locally affects alpha power of REM sleep. Front Hum Neurosci. 2013; 7:433. PMC: 3731627. DOI: 10.3389/fnhum.2013.00433. View

14.

Williams P, Sears L, Allard A . Sleep problems in children with autism. J Sleep Res. 2004; 13(3):265-8. DOI: 10.1111/j.1365-2869.2004.00405.x. View

15.

Port R, Oberman L, Roberts T . Revisiting the excitation/inhibition imbalance hypothesis of ASD through a clinical lens. Br J Radiol. 2019; 92(1101):20180944. PMC: 6732925. DOI: 10.1259/bjr.20180944. View

16.

Gupta R, Goel D, Kandpal S, Mittal N, Dhyani M, Mittal M . Prevalence of Sleep Disorders Among Primary School Children. Indian J Pediatr. 2016; 83(11):1232-1236. DOI: 10.1007/s12098-016-2138-7. View

17.

George M, Wassermann E, Williams W, Callahan A, Ketter T, Basser P . Daily repetitive transcranial magnetic stimulation (rTMS) improves mood in depression. Neuroreport. 1995; 6(14):1853-6. DOI: 10.1097/00001756-199510020-00008. View

18.

Uzunova G, Pallanti S, Hollander E . Excitatory/inhibitory imbalance in autism spectrum disorders: Implications for interventions and therapeutics. World J Biol Psychiatry. 2015; 17(3):174-86. DOI: 10.3109/15622975.2015.1085597. View

19.

Peterman J, Carper M, Elkins R, Comer J, Pincus D, Kendall P . The effects of cognitive-behavioral therapy for youth anxiety on sleep problems. J Anxiety Disord. 2016; 37:78-88. DOI: 10.1016/j.janxdis.2015.11.006. View

20.

Jiang B, He D, Guo Z, Mu Q, Zhang L . Efficacy and placebo response of repetitive transcranial magnetic stimulation for primary insomnia. Sleep Med. 2019; 63:9-13. DOI: 10.1016/j.sleep.2019.05.008. View