EJIHPE | Free Full-Text | The Influence of Sleep Disorders on Neurobiological Structures and Cognitive Processes in Pediatric Population with ASD and Epilepsy: A Systematic Review
Based on this, the aim of this systematic literature review was to compile relevant data from research on the relationship between sleep disorders and the pediatric population with ASD and epilepsy. Furthermore, the specific objectives were to analyze the neurobiological alterations related to sleep disorders and describe the cognitive performance related to the pediatric population diagnosed with ASD and epilepsy. The hypotheses of this systematic review were as follows: (I) It is expected that the neurobiological and neurochemical alterations described in children with ASD and epilepsy will disrupt brain activity and give rise to various sleep disorders, and (II) it is expected that sleep disorders in this population will limit cognitive competencies and alterations in basic and higher-order cognitive processes will be observed.
2. Materials and Methods
2.1. Search Strategy
An electronic search was conducted between March 2023 and July 2023 in the following databases: Medline, PubMed, PsycINFO, Web of Science, and Google Scholar. The search was limited to peer-reviewed articles published in journals and/or available online and written in Spanish or English. To ensure that the included articles were current, the search was limited to the last 20 years. The following terms in the article title, abstract, and keywords were considered in the study’s search: epilepsy, ASD, and sleep disorders.
Regarding the search strategy, the following terms were used, combined with Boolean operators: “(epilepsy) AND (ASD) AND (sleep disorders)”, “(epilepsy comorbidity) AND (ASD) AND (cognitive impairments)”, “(causes of sleep disorders) AND (ASD and epilepsy)”.
2.2. Study Selection Process
In the second stage of study selection, a comprehensive analysis of articles meeting the specified inclusion criteria was carried out. In this process, the following inclusion criteria were considered: (I) study participants had an official diagnosis of ASD; (II) the article accurately described the parameters of the evaluation conducted on the participants; and (III) individual characteristics of sleep disorders in study participants were specified.
The process of selecting studies included in this systematic review was conducted by two researchers and consisted of four phases. In the first phase, scientific literature in the fields of psychology and medicine was reviewed in major databases. In the second phase, each researcher reviewed the title and abstract of each eligible article in accordance with the pre-established inclusion and exclusion criteria. In the third phase, articles meeting the inclusion and exclusion criteria underwent a detailed analysis using a thorough reading of the full text. Finally, in the fourth phase, the examination and exclusion of articles that did not address the topic of interest in this systematic review were completed, evaluating the main information from the selected articles.
2.3. Final Study Selection
Lastly, regarding the methodological design of the selected studies, quasi-experimental studies with assessments at one or multiple points in time, both cross-sectional and intra-group and inter-group longitudinal assessments to evaluate differences, were conducted.
The primary objective of this systematic review was to analyze the available evidence regarding the relationship between sleep disorders and neurobiological and cognitive alterations in the pediatric population with ASD. Additionally, the specific objectives were to examine the neurobiological alterations that occur due to sleep disorders and to describe the dysfunctions in cognitive processes in children diagnosed with ASD and epilepsy.
The strengths and limitations of this study should be considered. A limitation of this study is that it relied on a review of existing literature, so the availability and quality of the included studies may have influenced the results. Since no original research was conducted and no new data were collected, there is a possibility that some relevant studies were omitted or that the results are influenced by publication bias. Additionally, the quality and methodology of the studies included in the review may vary, which can affect the reliability of the findings. Therefore, the results should be interpreted with caution and take into account the inherent limitations of the literature review. However, a strength of this study is that it considered recent and relevant research, providing an updated insight into the neurobiological causes of sleep disorders, cognitive impairments, and emotional disturbances in families with children with ASD and epilepsy. By including previous high-quality studies, a solid foundation was established for understanding the phenomena studied, and a broader coverage of the existing literature was achieved. Furthermore, by reviewing both international and national studies, a global perspective of research in the field was obtained, increasing the generalizability of the results. Another strength of this study is that it addressed multiple aspects related to sleep disorders, cognitive impairments, and emotional disturbances in the studied population. By examining the neurobiological causes and potential relationships between these phenomena, a more comprehensive and holistic understanding of the issue was achieved. This allows for the identification of key areas for intervention and the development of more effective therapeutic strategies.
The results of this study have important implications both in the clinical and research domains. In the clinical realm, it highlights the importance of assessing and addressing sleep disorders and neurological and cognitive impairments in individuals with ASD and epilepsy. Healthcare professionals should consider these areas and adopt a comprehensive approach to improve the quality of life for affected individuals and their families. Regarding future research, there is a suggestion to delve deeper into the understanding of the underlying neurobiological causes of sleep disorders in this population. It is necessary to review the action of neurotransmitters such as serotonin, GABA, and other substances like dopamine, which play a crucial role in sleep behavior disorders. In addition, studies exploring specific therapeutic interventions aimed at improving the quality of sleep patterns in individuals with ASD and epilepsy are needed. Furthermore, protocols for assessing cognitive processes affected by sleep disorders, such as memory, attention, or executive functions, should be established. Longitudinal studies can also be conducted to better comprehend the evolution of sleep disorders and cognitive impairments over time in individuals with ASD and epilepsy, comparing cognitive impairments and neurobiological activity based on types of sleep disorders. These investigations might allow for the assessment of the long-term effectiveness of different intervention approaches and provide insights into how these phenomena develop and change over time.
In conclusion, this review underscores the importance of understanding the neurobiological causes of sleep disorders and neurobiological and cognitive impairments in individuals with ASD and epilepsy. The results support the existence of relationships between these phenomena and emphasize the need for a comprehensive approach to the assessment and treatment of these conditions. Further research is required to deepen our understanding and develop more effective interventions that comprehensively address sleep disorders and neurobiological and cognitive impairments in individuals with ASD and epilepsy.
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