A protocol for measuring sleep at home in children with autism using EEG headbands

Background: Autism spectrum disorders (ASD) are a group of neurodevelopmental disorders characterized by social and communication challenges and the presence of restricted interests, repetitive behaviors, and atypical sensory processing. Sleep disturbances are prevalent in ASD and worsen daytime functioning, yet their neural bases remain poorly understood. We hypothesize that thalamocortical circuit dysfunction contributes to poor sleep in ASD. To test this hypothesis, we employ sleep EEG to determine whether sleep spindles, biomarkers of thalamocortical circuit function, are reduced in ASD and correlate with sleep quality. Since laboratory-based overnight sleep studies are costly, burdensome, and particularly problematic for individuals with ASD, we use wearable EEG headbands to record sleep in the home. This paper describes the methodology of our ongoing study of sleep in adolescents with ASD, including those with profound autism. An optional desensitization protocol helps participants gradually acclimate to the headband, promoting inclusion of individuals with sensory sensitivities and greater support needs. Methods: We plan to enroll 80 adolescents with ASD and 80 of their typically developing peers. Participants and their families are trained remotely to use a wearable EEG headband. They also complete assessments and questionnaires. Participants who need time to acclimate follow a personalized 2-week desensitization protocol with a practice headband. Sleep is monitored at home for 3 consecutive nights, the first of which is for adaptation to sleeping with the headband. Sleep data quality is checked daily and remote technical support is provided as needed. Discussion: At-home sleep monitoring enables larger samples that are needed to characterize the neural underpinnings of sleep disturbances across the autism spectrum. The personalized desensitization protocol promotes inclusivity by accommodating individuals often excluded from research due to sensory or behavioral challenges. These methods are adaptable for other conditions and research goals beyond ASD, such as longitudinal studies across development or characterizing sleep in other neurodevelopmental disorders. Desensitization protocols may also increase the tolerability of diagnostic lab-based sleep studies and other medical procedures, improving both patient experience and quality of care. Clinical trial number: not applicable