The role of bilateral temporal poles activity mediating the association between anxiety symptoms and sleep problems in children with autism spectrum disorder

Sleep problems and anxiety symptoms frequently occur in children with autism spectrum disorder (ASD). This investigation sought to examine the shared neural mechanisms that underly the co-occurrence of anxiety symptoms and sleep problems in this population. A total of 163 children with ASD were recruited. The anxiety symptoms and sleep problems were assessed through the Child Behavior Checklist and Children’s Sleep Habits Questionnaire, respectively. Resting-state functional magnetic resonance imaging(rs-fMRI) was utilized to compute the amplitude of low-frequency fluctuations (ALFF). Mediation analyses were conducted to examine the interrelationships among ALFF, anxiety symptoms, and sleep problems. Sleep problems scores were positively linked to anxiety scores. ALFF in bilateral temporal poles were positively linked to anxiety scores. Mediation analyses revealed the right superior temporal pole mediated the pathway from sleep problems to anxiety symptoms. The left middle temporal pole exhibited a significant mediating effect in both directions of anxiety-sleep relationship. These findings enhance comprehension of neurobiological processes that underlie the co-occurrence of anxiety symptoms and sleep problems, while identifying promising targets for subsequent clinical therapeutic approaches. As all rs-fMRI scans were performed under sedation, our results cannot be generalized to unsedated children or those scanned with different sedative protocols.