The evaluation of the relationship between serum melatonin levels, sleep habits and the clinical features of children with autism spectrum disorder; case control study

Evaluation of the Relationship Between Melatonin Levels, Sleeping Habits and Clinical Symptoms in Children with Autism Spectrum Disorder; Case Control Study Objective: The aim of our study, which was designed as a pilot study, was to measure endogenous melatonin levels and to investigate the relationship between sleep habits and clinical symptoms between the groups diagnosed with autism spectrum disorder and healthy controls. Material and Method: Our study was planned as a prospective controlled study. In our study, patients aged 2-8 years who applied to Çukurova University Faculty of Medicine Department of Pediatric Mental Health and Diseases Clinic and were diagnosed with Autism spectrum disorder according to DSM-V were included in the patient group. In the control group, healthy children of similar age and gender were evaluated. Vitamin D levels, ferritin, serum iron and iron binding capacity as well as endogenous melatonin levels were measured in all patients. In addition, a Children's Sleep Habits Questionnaire was filled in all of the patients. Autism Behavior Checklist (ABC) and The Modified Checklist for Autism in Toddlers (M-CHAT) were applied to the autism spectrum disorder group. The relationship between the blood values obtained and the completed questionnaire results was evaluated. Endogenous melatonin levels were compared between the patients with autism spectrum disorder and the control group. Results: A total of 71 participants were included in our study. 81.7% (n=58) of the participants were male. The mean age of the autism spectrum disorder group was 44.4±20.4 months and the mean age of the control group was 51.2±20 months (p=0.104). It was observed that there was no significant difference between the two groups in terms of laboratory data obtained from the participants. Data from the sleep questionnaire were compared between the two groups; The "daytime sleepiness" subscale score was higher in the control group and the "bed-wetting" subscale score was higher in the autism spectrum disorder group (p=0.036 and p=0.008, respectively). No significant difference was observed between the two groups in other scales. It was observed that the participants were clinically divided into mild moderate and severe autism spectrum disorders, and the vitamin D level was significantly lower in patients with severe clinical disease (p=0.005). There was no significant correlation between the survey results obtained from the participants and the melatonin levels obtained. Melatonin levels were on average 823.2±237.9 U/L in the autism spectrum disorder group and 677.4±254.7 U/L in the control group. This difference between the two groups was found to be statistically significant (p=0.027). Participants were compared by dividing according to their gender, and only male patients were found to be different between the two groups (p=0.020). It was observed that there was no significant difference between girls in terms of melatonin levels (p=0.608). Conclusion: In the light of the data we obtained in our study, it was observed that children with autism spectrum disorder had sleep problems and therefore, endogenous melatonin levels measured during the day were higher than healthy children. In addition, the difference in endogenous melatonin levels according to gender suggests that melatonin treatment modalities applied in ASD patients can be arranged according to gender. Key Words: Autism Spectrum Disorder, Melatonin, Sleep Disorders