Insomnia is a frequent finding in adults with Asperger syndrome

BMC Psychiatry

Tarja Porkka-Heiskanen³  Björn Appelberg²  Lauri Alanko³  Lennart von Wendt¹  Taina Nieminen-von Wendt¹  Nina Lindberg²  Pekka Tani³ 

[1] Hospital for Children and Adolescents, Helsinki University Central Hospital, Finland;Department of Psychiatry, University of Helsinki, Finland;Institute of Biomedicine, University of Helsinki, Finland

关键词: insomnia;    sleep;    Asperger;   

Others  :  1125156
DOI  :  10.1186/1471-244X-3-12

 received in 2003-06-26, accepted in 2003-10-16,  发布年份 2003

【 摘 要 】

Background

Asperger syndrome (AS) is a neurodevelopmental disorder belonging to autism spectrum disorders with prevalence rate of 0,35% in school-age children. It has been most extensively studied in childhood while there is scarcity of reports concerning adulthood of AS subjects despite the lifelong nature of this syndrome. In children with Asperger syndrome the initiation and continuity of sleep is disturbed because of the neuropsychiatric deficits inherent of AS. It is probable that sleep difficulties are present in adulthood as well. Our hypothesis was that adults with AS suffer from difficulty in initiating and maintaining sleep and nonrestorative sleep (insomnia).

Methods

20 AS without medication were compared with 10 healthy controls devoid of neuropsychiatric anamnesis. Clinical examination, blood test battery and head MRI excluded confounding somatic illnesses. Structured psychiatric interview for axis-I and axis-II disorders were given to both groups as well as Beck Depression Inventory and Wechsler adult intelligence scale, revised version.

Sleep quality was assessed with sleep questionnaire, sleep diary during 6 consecutive days and description of possible sleep problems by the participants own words was requested.

Results

compared with controls and with normative values of good sleep, AS adults had frequent insomnia. In sleep questionnaire 90% (18/20), in sleep diary 75% (15/20) and in free description 85% (17/20) displayed insomnia. There was a substantial psychiatric comorbidity with only 4 AS subject devoid of other axis-I or axis-II disorders besides AS. Also these persons displayed insomnia. It can be noted that the distribution of psychiatric diagnoses in AS subjects was virtually similar to that found among patient with chronic insomnia.

Conclusions

the neuropsychiatric deficits inherent of AS predispose both to insomnia and to anxiety and mood disorders. Therefore a careful assessment of sleep quality should be an integral part of the treatment plan in these individuals. Conversely, when assessing adults with chronic insomnia the possibility of autism spectrum disorders as one of the potential causes of this condition should be kept in mind.

【 授权许可】

   
2003 Tani et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 参考文献 】

• [1]American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington DC: American Psychiatric Press; 2000.
• [2]Ehlers S, Gillberg C: The epidemiology of Asperger syndrome. A total population study. J Child Psychol Psychiatr 1993, 34:1327-1350.
• [3]Wing L: The relationship between Asperger's syndrome and Kanner's autism. In In Autism and Asperger syndrome. Edited by Uta Frith. Cambridge University Press; 1999.
• [4]Richdale AL: Sleep problems in autism: prevalence, cause, and intervention. Dev Med Child Neurol 1999, 41:60-66.
• [5]Paavonen J, Nieminen T, Vanhala R, Aronen E, von Wendt L: Sleep problems in Asperger children. [abstract]. Int J Circumpolar Health 2001, 60(suppl 1):71.
• [6]Tantam D: Adolescence and Adulthood of Individuals with Asperger Syndrome. In In Asperger Syndrome. Edited by Klin A, Volkmar FR, Sparrow SS. The Guilford Press New York; 2000.
• [7]Sateia MJ, Doghramji K, Hauri PJ, Morin CM: Evaluation of Chronic Insomnia. Sleep 2000, 23(2):243-308.
• [8]Godbout R, Bergeron C, Stip E, Mottron L: A Laboratory Study of Sleep and Dreaming in a Case of Asperger's Syndrome. Dreaming 1998, 8(2):75-88.
• [9]Gillberg C, Billstedt E: Autism and Asperger syndrome: coexistence with other clinical disorders. Acta Psychiatr Scand 2000, 102(5):321-330.
• [10]Ghaziuddin M, Ghaziuddin N, Greden J: Depression in persons with Autism; Implications for Research and Clinical Care. J Autism Dev Disord 2002, 32(4):299-306.
• [11]Ehlers S, Gillberg C, Wing L: A Screening Questionnaire for Asperger Syndrome and Other High-Functioning Autism Spectrum Disorders in School Age Children. Journal Autism Dev Disord 1999, 29(2):129-141.
• [12]Wechsler D: Wechsler Adult Intelligence Scale-Revised Manual. Cleveland: Psychological Corporation; 1981.
• [13]Spitzer RL, Williams JBW, Gibbon M, First MB: Structured clinical Interview for DSM-III-R, Patient edition. Washington D.C.: American Psychiatric Press, Inc; 1990.
• [14]Beck AT, Steer RA, Garbin MG: Psychometric Properties of the Beck Depression Inventory. Twenty-five years of evaluation. Clin Psychol Rev 1988, 8:77-100.
• [15]Spitzer RL, Williams JBW, Gibbon M, First MB: Structured Clinical Interview for DSM-III-R Axis II Disorders. Washington D.C.: American Psychiatric Press, Inc; 1990.
• [16]Schulz RT, Romanski LM, Tsatsanis K: Neurofunctional Models of Autistic Disorder and Asperger Syndrome: Clues from neuroimaging. In In Asperger Syndrome. Edited by Klin A, Volkmar F and Sparrow SS. The Guilford Press, New York London; 2000.
• [17]Partinen M, Gislason T: Basic Nordic Sleep Questionnaire (BNSQ): a quantitated measure of subjective sleep complaints. J Sleep Res 1995, 4(suppl 1):150-155.
• [18]Espie C: Insomnia: Conceptual Issues in the Development, Persistence, and Treatment of Sleep Disorder in Adults. Annu Rev Psychol 2002, 53:215-243.
• [19]Coates TJ, Killen JD, George J, Marchini E, Silverman S, Thoresen C: Estimated sleep parameters: a multitrait-multimethod analysis. J Consult Clin Psychol 1982, 50:345-352.
• [20]Stein MB, Kroft CDL, Walker JR: Sleep Impairment in Patients With Social Phobia. Psychiatry Res 1993, 49:251-256.
• [21]Tan TL, Kales JD, Kales A, Soldatos CR, Bixler EO: Biopsychobehavioral correlates of Insomnia, IV: Diagnosis Based on DSM-III. Am J Psychiatry 1984, 141:357-362.
• [22]Weissman MM, Greenwald S, Nino-Murcia G, Dement WC: The morbidity of insomnia uncomplicated by psychiatric disorders. Gen Hosp Psychiatry 1997, 19(4):245-50.
• [23]Soderstrom H, Rastam M, Gillberg C: Temperament and character in adults with Asperger syndrome. Autism 2002, 6(3):287-297.
• [24]Tuisku K, Tani P, Nieminen-von Wendt T, von Wendt L, Holi M, Porkka-Heiskanen T, Lauerma H, Lindberg N, Appelberg B, Wahlbeck K: Lower-limb motor restlessness in Asperger's disorder, measured using actometry. Psychiatry Res 2002, in press.
• [25]Godbout R, Bergeron C, Limoges E, Stip E, Mottron L: A laboratory study of sleep in Aspergers syndrome. Neuroreport 2000, 11:127-130.
• [26]Horne JA: Human sleep loss and behaviour implications for the prefrontal cortex and psychiatric disorder. Br J Psychiatry 1993, 162:413-419.
• [27]Dahl RE: The regulation of sleep and arousal: Development and psychopathology. Devt Psychopathol 1996, 8:3-27.
• [28]Ozonoff S, McMahon Griffith E: Neuropsychological Function and the External Validity of Asperger Syndrome. In In Asperger Syndrome. Edited by Klin A, Volkmar F, Sparrow SS. The Guilford Press New York London; 2000.