Sleep quality and temperament in association with autism spectrum disorder among infants in Japan

Kimiyo Kikuchi; Takehiro Michikawa; Seiichi Morokuma; Norio Hamada; Yoshiko Suetsugu; Subaru Ikeda; Kazushige Nakahara; Kiyoko Kato; Masayuki Ochiai; Eiji Shibata; Mayumi Tsuji; Masayuki Shimono; Toshihiro Kawamoto; Shouichi Ohga; Koichi Kusuhara; Japan Environment and Children’s Study Group

doi:10.1038/s43856-023-00314-9

Sleep quality and temperament in association with autism spectrum disorder among infants in Japan

Commun Med (Lond). 2023 Jun 16;3(1):82. doi: 10.1038/s43856-023-00314-9.

Authors

Kimiyo Kikuchi^#¹, Takehiro Michikawa^#², Seiichi Morokuma^{3

4}, Norio Hamada^{5

6}, Yoshiko Suetsugu¹, Subaru Ikeda¹, Kazushige Nakahara⁶, Kiyoko Kato^{5

6}, Masayuki Ochiai^{5

7}, Eiji Shibata^{8

9}, Mayumi Tsuji^{8

10}, Masayuki Shimono^{8

11}, Toshihiro Kawamoto⁸, Shouichi Ohga^{5

7}, Koichi Kusuhara^{8

11}; Japan Environment and Children’s Study Group

Collaborators

Japan Environment and Children’s Study Group:
Michihiro Kamijima, Shin Yamazaki, Yukihiro Ohya, Reiko Kishi, Nobuo Yaegashi, Koichi Hashimoto, Chisato Mori, Shuichi Ito, Zentaro Yamagata, Hidekuni Inadera, Takeo Nakayama, Hiroyasu Iso, Masayuki Shima, Youichi Kurozawa, Narufumi Suganuma, Takahiko Katoh

Affiliations

¹ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
² Department of Environmental and Occupational Health, School of Medicine, Toho University, Tokyo, Japan.
³ Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan. [email protected].
⁴ Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan. [email protected].
⁵ Research Center for Environment and Developmental Medical Sciences, Kyushu University, Fukuoka, Japan.
⁶ Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁷ Department of Pediatrics, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁸ Regional Center for Japan Environment and Children's Study, University of Occupational and Environmental Health, Kitakyushu, Japan.
⁹ Department of Obstetrics and Gynecology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
¹⁰ Department of Environmental Health, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.
¹¹ Department of Pediatrics, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Fukuoka, Japan.

^# Contributed equally.

Abstract

Background: Sleep problems and irritable temperaments are common among infants with autism spectrum disorder (ASD). The prospective association between such sleep problems and irritable temperaments and ASDs needs to be determined for elucidating the mechanism and exploring the future intervention study. Thus, in this study, we investigated whether sleep quality and temperament in 1-month-old infants are associated with the onset of ASD in 3-year-old children. We also assessed its sex-stratified associations.

Methods: We conducted a longitudinal study using data from 69,751 mothers and infants from a large-cohort study, the Japan Environment and Children's Study. We examined the prospective association between infant sleep quality and temperament at 1 month of age and ASD diagnosis by 3 years of age.

Results: Here we show infants with longer daytime sleep have a higher risk of later ASD than those with shorter daytime sleep (risk ratio [RR]: 1.33, 95% confidence interval [CI]: 1.01-1.75). Infants who experienced intense crying have a higher risk of ASD than those who did not (RR: 1.31, 95% CI: 1.00-1.72). There is a difference in sex in the association between a bad mood and later ASD. In particular, female infants experiencing bad moods have a higher risk of ASD than others (RR: 3.59, 95% CI: 1.91-6.75).

Conclusions: The study findings provide important information for future intervention to reduce the risk of future ASD.

Plain language summary

Sleep problems and irritable temperaments are common among infants with autism. This study looked at the sleep and temperament of nearly 70,000 1-month-old infants in Japan and whether they were subsequently diagnosed with autism spectrum disorder during the first three years of life. Children who had slept for longer during the day and were more prone to frequent, prolonged, or intense crying were more likely to have been diagnosed with Autism Spectrum Disorder by age 3. The findings of this study might be useful for those monitoring the development of autism spectrum disorder or developing support for those with autism spectrum disorders.