Çocuk ve Ergenlerde Otizm Spektrum Bozukluğu ve Uyku
Özet
Otizm Spektrum Bozukluğu (OSB) olan çocuk ve ergenlerde uyku sorunları, %40 ile %80 arasında değişen yüksek prevalans oranlarıyla nörogelişimsel sürecin kritik bir parçasıdır. Bu popülasyonda görülen uyku bozuklukları; melatonin sentezindeki anormallikler, sirkadiyen ritim genlerindeki farklılıklar ve duyusal hiperreaktivite gibi biyolojik faktörlerin yanı sıra çevresel ve ailevi etkenlerden kaynaklanmaktadır. Aktigrafi ve polisomnografi çalışmaları, OSB'li çocukların tipik gelişim gösteren akranlarına göre daha kısa uyku süresi, daha uzun uyku latansı ve düşük uyku verimliliği yaşadığını, özellikle REM uykusu anormalliklerinin belirgin olduğunu ortaya koymaktadır. Uyku kalitesindeki düşüş; agresyon, hiperaktivite ve sosyal geri çekilme gibi çekirdek otizm semptomlarını şiddetlendirirken, bilişsel işlevleri ve ebeveynlerin yaşam kalitesini de olumsuz etkilemektedir. Değerlendirme sürecinde kapsamlı bir uyku öyküsü ve objektif ölçümler temel alınmalı; yönetim stratejilerinde ise öncelikle yatak odası düzenlemeleri ve rutinler gibi farmakolojik olmayan yöntemlere odaklanılmalıdır. Davranışsal müdahalelerin yetersiz kaldığı durumlarda, özellikle uyku başlangıcını kolaylaştıran melatonin başta olmak üzere, klinik gözetim altında sınırlı farmakolojik destekler tercih edilerek yaşam kalitesinin artırılması hedeflenmektedir.
Sleep problems in children and adolescents with Autism Spectrum Disorder (ASD) are a critical component of the neurodevelopmental process, with high prevalence rates ranging from 40% to 80%. Sleep disorders in this population stem from biological factors such as abnormalities in melatonin synthesis, differences in circadian rhythm genes, and sensory hyperreactivity, as well as environmental and familial influences. Actigraphy and polysomnography studies reveal that children with ASD experience shorter sleep duration, longer sleep latency, and lower sleep efficiency compared to typically developing peers, with REM sleep abnormalities being particularly prominent. Reduced sleep quality exacerbates core autism symptoms like aggression, hyperactivity, and social withdrawal, while also negatively impacting cognitive functions and the quality of life for parents. The assessment process should rely on a comprehensive sleep history and objective measurements; management strategies must primarily focus on non-pharmacological methods, such as bedroom adjustments and routines. In cases where behavioral interventions prove insufficient, limited pharmacological supports, particularly melatonin—which facilitates sleep onset—are preferred under clinical supervision to improve overall quality of life.
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