Evaluating the effect of repetitive transcranial magnetic stimulation on sleep difficulties in children with autism spectrum disorder: a randomized controlled trial

Uchenna Ezedinma; Scott Burgess; Evan Jones; Jyoti Singh; Andrew Ladhams; Gary Campbell; Shauna Fjaagesund; Piotr Swierkowski; Adewuyi A Adeyinka; Alexandra P Metse; Terri Downer; Florin Oprescu

doi:10.1093/sleepadvances/zpaf088

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Evaluating the effect of repetitive transcranial magnetic stimulation on sleep difficulties in children with autism spectrum disorder: a randomized controlled trial

Journal article

Open access

Peer reviewed

Evaluating the effect of repetitive transcranial magnetic stimulation on sleep difficulties in children with autism spectrum disorder: a randomized controlled trial

Uchenna Ezedinma, Scott Burgess, Evan Jones, Jyoti Singh, Andrew Ladhams, Gary Campbell, Shauna Fjaagesund, Piotr Swierkowski, Adewuyi A Adeyinka, Alexandra P Metse, …

Sleep Advances, Vol.6(4), pp.1-14

2025

DOI: https://doi.org/10.1093/sleepadvances/zpaf088

PMID: 41445722

Appears in UniSC Diversity and Inclusion Research Collection

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Abstract

alpha rhythm

repetitive transcranial magnetic stimulation

autism spectrum disorder

sleep difficulties

polysomnography

children

UniSC Diversity Area - Life Stages

UniSC Diversity Area - Disability and Inclusion

Study Objectives Evaluate the effect and safety of alpha rhythm-guided repetitive transcranial magnetic stimulation (α-rTMS) on sleep difficulties in children with autism spectrum disorder (ASD). Methods Twenty children (6–12 years old; 16 males; 4 females) with ASD level 2 were randomly assigned (1:1 ratio) to a treatment group (TG) or a waitlist control group (WLCG) (T1). The TG received ten α-rTMS sessions over two weeks, while the WLCG acted as control for that period (T2). Next, the WLCG received α-rTMS for two weeks (T3). All study participants were followed up at one (T4) and four (T5) months. Sleep difficulties were measured using the Children’s Sleep Habit Questionnaire (CSHQ), Actigraphy, and Polysomnography (PSG). Results Group-by-time interactions indicated that the TG had greater improvements than the WLCG in total CSHQ score (p=.008) and, bedtime resistance (p=.003), sleep onset delay (p=.004), and sleep duration (p=.003) subdomain scores. When the WLCG received the α-rTMS, there were improvements in their sleep-disordered breathing (p=.001), parasomnia (p=.002) and sleep duration (p=.018) subdomain scores, while PSG data showed improved Waking After Sleep Onset (WASO) (p=.014), Sleep efficiency (p=.046), and N2 stage (p=.039). The improved CSHQ scores persisted, with actigraphy data showing significant improvement in WASO at T4 and T5. Side effects of α-rTMS were mild and transient. Conclusions This RCT study presents preliminary evidence on the effect and safety of α-rTMS in improving subjective sleep difficulties in children with ASD, with effects lasting up to four months post-intervention. Further studies using a larger sample size and sham-controlled group are warranted. Clinical Trial Registration The trial was registered on July 11, 2023 within the Australian New Zealand Clinical Trials Registry (ANZCTR) https://www.anzctr.org.au/TrialSearch.aspx with registration number: ACTRN12623000757617.

Details

Title: Evaluating the effect of repetitive transcranial magnetic stimulation on sleep difficulties in children with autism spectrum disorder: a randomized controlled trial
Authors: Uchenna Ezedinma (Corresponding Author) - University of the Sunshine Coast, Queensland, Thompson Institute
Scott Burgess - Queensland Children's Lung and Sleep Specialists (Australia)
Evan Jones
Jyoti Singh - Brain Treatment Centre Australia
Andrew Ladhams - The University of Queensland
Gary Campbell - University of the Sunshine Coast, Queensland, School of Health - Public Health
Shauna Fjaagesund - University of the Sunshine Coast, Queensland, Thompson Institute
Piotr Swierkowski
Adewuyi A Adeyinka - Southern Cross University
Alexandra P Metse - University of the Sunshine Coast, Queensland, School of Health - Psychology
Terri Downer - University of the Sunshine Coast, Queensland, School of Health - Midwifery
Florin Oprescu - University of the Sunshine Coast, Queensland, School of Health - Public Health
Publication details: Sleep Advances, Vol.6(4), pp.1-14
Publisher: Oxford University Press
Date published: 2025
DOI: 10.1093/sleepadvances/zpaf088
ISSN: 2632-5012
PMID: 41445722
Copyright note: © The Author(s) 2025. Published by Oxford University Press on behalf of Sleep Research Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
Data Availability: Mediated access to non-identifiable study data is available from the corresponding author on written approval from funders to further protect the privacy and sensitivity of the health information of child participants.
Grants: Evaluating an alternative therapy to sleep disorders in children with autism spectrum disorder, 0980027787, University of the Sunshine Coast (Australia, Sunshine Coast) - UniSC
Grant note: The study received funding from TMS IP Pty, Queensland’s Children Sleep Specialist Clinic, Australia.
Organisation Unit: School of Business and Creative Industries; Healthy Ageing Research Cluster; Centre for International Development, Social Entrepreneurship and Leadership; School of Health; Thompson Institute; Engage Research Lab; School of Health - Psychology; School of Health - Midwifery; School of Health - Public Health
Language: English
Record Identifier: 991192532802621
Output Type: Journal article

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Collaboration types: Domestic collaboration
Web Of Science research areas: Clinical Neurology; Neurosciences

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