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Biological correlates of altered circadian rhythms, autonomic functions and sleep problems in autism spectrum disorder
Open accessAbstract
Autism spectrum disorder (ASD) is a neurodevelopmental condition characterized by a complex and multifaceted neurobehavioral syndrome. In the last decades, several studies highlighted an increased prevalence of sleep problems in ASD, which would be associated with autonomic system and circadian rhythm disruption. The present review aimed to summarize the available literature about sleep problems in ASD subjects and about the possible biological factors implicated in circadian rhythm and autonomic system deregulation in this population, as well as possible therapeutic approaches. Shared biological underpinnings between ASD symptoms and altered circadian rhythms/autonomic functions are also discussed. Studies on sleep showed how ASD subjects typically report more problems regarding insufficient sleep time, bedtime resistance and reduced sleep pressure. A link between sleep difficulties and irritability, deficits in social skills and behavioral problems was also highlighted. Among the mechanisms implicated, alteration in genes related to circadian rhythms, such as CLOCK genes, and in melatonin levels were reported. ASD subjects also showed altered hypothalamic pituitary adrenal (HPA) axis and autonomic functions, generally with a tendency towards hyperarousal and hyper sympathetic state. Intriguingly, some of these biological alterations in ASD individuals were not associated only with sleep problems but also with more autism-specific clusters of symptoms, such as communication impairment or repetitive behaviors Although among the available treatments melatonin showed promising results, pharmacological studies for sleep problems in ASD need to follow more standardized protocols to reach more repeatable and reliable results. Further research should investigate the issue of sleep problems in ASD in a broader perspective, taking into account shared pathophysiological mechanisms for core and associated symptoms of ASD.
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Another brain region implicated in emotional dysregulation is the prefrontal dorsolateral cortex, while other studies reported autonomic nervous system deregulation, such as an alteration in cortisol levels and heart rate, in autism spectrum disorder individuals.
“Another brain region implicated in ED is the prefrontal dorsolateral cortex (72) while, together with genetic and anatomical alterations, other studies reported autonomic nervous system deregulation, such as an alteration in cortisol levels and heart rate, in ASD individuals (73, 75).”
From Emotional dysregulation as a part of the autism spectrum continuum: a literature review from late childhood to adulthood (2023) · cites this paper as [73]
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References 118 · Cited by 48
Research works printed but not linked: 1
- Dell’Osso L, Lorenzi P, Carpita B. The neurodevelopmental continuum towards a neurodevelopmental gradient hypothesis. J Psychopathol. 2019;25(4):179–82.
Metadata
- Authors
- Dell’Osso, L., Massoni, L., Battaglini, S., Cremone, I. M., Carmassi, C., & Carpita, B.
- Affiliations
- University of Pisa (IT)
- Corresponding author
- Carpita, Barbara
- Venue
- Annals of General Psychiatry
- Published
- 2022-05-09
- Volume
- 21
- Issue
- 1
- Pages
- 13-13
- ISSN
- 1744-859X (ISSN-L)
- PMC
- PMC9082467
- OpenAlex
- W4229376361
- Cited by
- 48
- References
- 118
- Citations by year
- 2026: 9 · 2025: 14 · 2024: 8 · 2023: 14 · 2022: 3
- FWCI
- 1.36
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Annals of General Psychiatry (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- CINECA IRIS Institutial research information system (University of Pisa) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Keywords
- autism spectrum disorder, sleep disorders, circadian rhythm disruption, autonomic dysfunction, hypothalamic-pituitary-adrenal axis, hyperarousal, sympathetic nervous system, clock genes, melatonin, bedtime resistance, irritability, sleep deprivation
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