SLEEP PROBLEMS AND URINARY 6-SULFATOXYMELATONIN AS POSSIBLE PREDICTORS OF SYMPTOM SEVERITY IN CHILDREN WITH AUTISM SPECTRUM DISORDER: A REVIEW ARTICLE
DOI:
https://doi.org/10.48047/m235ax39Keywords:
Autism Spectrum Disorder, Sleep Problems, Urinary 6-Sulfatoxymelatonin, Melatonin, Symptom SeverityAbstract
Autism spectrum disorder (ASD) is a heterogeneous neurodevelopmental disorder characterized by difficulties in social communication and interaction, together with restricted and repetitive patterns of behavior. Sleep disturbances are highly prevalent in children with ASD and may include difficulty initiating or maintaining sleep, nocturnal awakenings, reduced sleep duration, and daytime sleepiness. These problems may negatively affect behavior, adaptive functioning, and overall symptom severity. Melatonin, a key regulator of circadian sleep–wake rhythms, has also been reported to show altered secretion in some children with ASD. Urinary 6-sulfatoxymelatonin (6-SM; aMT6s), the principal metabolite of melatonin, provides a non-invasive measure of endogenous melatonin secretion and may reflect circadian dysfunction. Evidence suggests that sleep disturbances are associated with greater social-communication impairment, restricted and repetitive behaviors, challenging behaviors, and poorer adaptive functioning. Altered melatonin secretion, particularly lower urinary aMT6s levels, has also been associated with sleep disturbances and greater impairment in verbal communication, social skills, and stereotyped behaviors. These findings suggest a possible relationship between sleep disturbance, circadian dysregulation, and ASD symptom severity. However, current evidence is mainly associative and does not establish causality. Further prospective studies are needed to clarify whether urinary 6-SM has independent predictive value and potential clinical relevance. Therefore, this literature review aimed to examine the relationship between sleep problems, urinary 6-SM levels, and symptom severity in children with ASD, and to explore the potential role of urinary 6-SM as a biological marker of symptom severity.
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