Methods for Extended Sleep EEG Recording in Autism: A Sleep Deprivation–Based, Natural Sleep–Recording Protocol and Feasibility Study

Background: Electroencephalography (EEG) has been used to research individuals with autism spectrum disorder (ASD). Such individuals are known to have a higher prevalence of EEG abnormalities and seizures. Extended EEG recordings, particularly those including sleep, are known to significantly improve the yield of these abnormalities. However, obtaining extended sleep recordings without sedation in autistic individuals is challenging. This study explores practical and feasible protocols for recording EEG in awake and sleep states in children and adolescents with ASD. Methods: Extended EEG recordings using detailed sleep deprivation and recording protocol were done. Results: 132 children and adolescents with ASD and sleep deprivation completed extended EEG recording in natural sleep. Only nine autistic children required melatonin along with sleep deprivation. Conclusions: Extended EEG recording can be achieved by following a rigorous sleep deprivation protocol that is customized, along with providing an autism-friendly recording room environment. This is important in identifying and increasing the yield of epileptiform discharges. We also propose technical guidelines and considerations for EEG recording in children and adolescents with ASD.