Are Gastrointestinal and Sleep Problems Associated with Behavioral

Symptoms of Autism Spectrum Disorder?

The survey included 169 ASD and 172 healthy children.

Some studies suggested that GI symptoms in ASD may be linked with:

1. an imbalance of gut microbiota (Tomova et al., 2015),
2. endocrine stress responses (Ferguson et al., 2016),
3. disruptions in the "gut-brain axis" (Santocchi et al., 2016)
4. deficiencies in serotonin signaling during development (Marler et al., 2016).

Although the high prevalence of GI symptoms in individuals with ASD was frequently
reported, the pathogenesis of GI symptoms in ASD children is unclear (Ferguson et al.,
2016).

Furthermore, there were few studies on the relationship between early life factors of
ASD children and GI symptoms.

Similarly, sleep disturbances are often problematic for ASD children. A study
found autistic children’s sleep disturbances widely effected on daytime life (Malow et
al., 2016). Sleep disturbances include

1. insomnia
2. increased bedtime resistance,
3. sleep disordered breathing
4. morning awakening
5. daytime sleepiness problems (Liu et al.,2006)

Previous study has revealed the changes in the sleep structure of some ASD children,
such as shorter total sleep time and longer sleep latency (Miano et al., 2007). Sleep is an
essential part of a healthy lifestyle, especially in developing children, and plays an
important role in the early development of the brain (Chen et al., 2015), physical
growth, immunity, energy recovery, memory consolidation, as well as emotional and
cognitive functions and behavioral performance.

Thus, it is important to identify which early life factors might influence sleep conditions
of ASD children.

According to the clinical information questionnaire, 81 (47.93%) among the

ASD and 54 (31.39%) among healthy children reported at least one GI symptom,
respectively.

The prevalence of GI symptoms was significantly higher in the ASD than control
groups (OR=2.02; 95% CI: 1.30-3.15, P=0.002).

ASD children were more likely to report bedtime resistance, sleep onset delay, sleep
anxiety, night waking, parasomnias and sleep disordered breathing than control children
(P<0.05) (Table 2)
Discussion:

The proportions of the both co-morbidities, only GI symptoms, only sleep disturbances
and without GI or sleep problems subgroups wereremarkably different between the
ASD and control groups (P<0.001).

The recent review showed that vitamin D plays the role of a sleep modulator (de
Oliveira et al., 2017). A large study on the level of vitamin D in adolescents found that
poor quality sleep was associated with vitamin D deficiency (Ataie-Jafari et al., 2015).
Based on evidence above, identification of factors associated with GI and sleep
problems in ASD children might be beneficial to improve both conditions.

This study had several limitations. First, this study was cross-sectional. Thus
causal inferences cannot be made. Second, the ASD group consisted of children who
came to our center for medical diagnoses or behavioral interventions.

Conclusão:
Three important implications can be drawn from our results.

1. First, both GI and sleep co-morbidities were prevalent in Chinese ASD children.

2. Second, autistic children with GI and/or sleep problems presented more serious
behavioral symptoms, and ASD children with sleep disturbances also had poor
intellectual development.

3. Finally, through multivariate analysis, we found that ASD children’s GI

symptoms were associated with maternal sleep problems during pregnancy,
child’s picky eating, infant formula only and breastfeeding mixed with infant
formula during first 6 months from birth. Meanwhile, ASD children’s sleep
disturbances were associated with extra nutrient supply during lactation and
feeding, and child’s picky eating.

In conclusion, these findings contribute to our understanding of the associations

between GI and/or sleep co-morbidities and the severity of ASD behaviors. Moreover,
our results may contribute to ASD treatments and rehabilitation.