The Influence of Sleep Disorders on Neurobiological Structures and Cognitive Processes in Pediatric Population with ASD and Epilepsy: A Systematic Review

Round 1

Reviewer 1 Report

Comments and Suggestions for Authors

Some comments

Line 48. SD ¿?

Section Results  line 220, 256 podria estar como subtitulos

Line 48. SD ?

In section of results line 220, 256 could be as subtitles

I suggest making a figure that integrates the analysis of the study, proposal that includes the different factors (sleep, autism, behavior and neurotransmitters, as treatment).

Author Response

Dear reviewer,

Thank you very much for your comments and the detailed analysis you have conducted on our article. We are immensely grateful for your work and effort. We have followed the article improvement suggestions and made the necessary adjustments. To make it easier for you to locate the changes, we have highlighted in yellow the modifications we made in the attached manuscript.

Once again, we deeply appreciate your attention.

Best regards,

Alejandro Cano Villagrasa

Author Response File: Author Response.pdf

Reviewer 2 Report

Comments and Suggestions for Authors

 Introduction

Line 39: What do you mean by associated neurological signs? Is there a single neurological feature that these diagnoses have in common?

Line 40: Suggested edit “In this second group, epilepsy rates are higher, affecting more than 60% of patients.”

Line 42: You say “in this population group” – who are you referring to? Those with ASD, ASD and epilepsy, or ASD, epilepsy, and these other disorders you mention?

Line 44: Clarify who you mean by they

Line 52: “They have proven effects on cognition and behavior, which become even more evident in patients with this comorbidity. “ – again who is they- sleep disorders or sleep behaviors?

Lines 57-58: Redundant with the end of the previous paragraph. Should these sections go together?

Lines 69-71: Could you reword this sentence a bit? It’s a little confusing as written

Line 76: Can you discuss the relationship between IEDs and chronic sleep deprivation?

Lines 108-109: In your first hypothesis, did you have more specific alterations in mind? Set up to think its serotonin or melatonin. What do you mean by limiting brain activity?

Materials and Methods

Line 118: Can you add what each letter in the PICO model stands for?

In the Jonsson et al description it reads “Asmt associated ASMT with ASD traits”. Is this a typo? Can you write out what ASMT stands for?

Results

Lines 222-225: How many articles in your review found this?

Line 241: Can you add another sentence clarifying the link between serotonin and melatonin here? Or move Line 245 up

Line 246: The way this sentence is phrased makes me think that their patterns of melatonin and serotonin should not be related to the gene that controls ASMT production but I believe they are.

Line 254: Sleep differences weren’t measured by the genetic differences though they may be spurred by them

Line 268: Thinking problems is very vague- can you elaborate more?

Line 283: I’m not sure if “indicated” is the word you mean. Can you clarify?

Lines 288-303: It would improve the flow if you were to move this paragraph up to follow the discussion on negative behavioral outcomes. Then, the section ends on possible treatments for the sleep disorders

Discussion

Line 311-316: This is a very long sentence. Breaking it down would help with overall comprehension.

Line 325: Clarify who they are

Line 327-335: These sentence are confusing and somewhat vague but it feels like one of the most important points of your paper.

Lines 347-357: Excellent points about the strengths of the study

Line 366: Could you be more specific about future research? Would you suggest studies examine GABA, melatonin, serotonin, or all three?

Line 378: Nice concluding paragraph

Minor comments

Line 220: Can you make this a part of the header structure?

Line 256: Can you make this a part of the header structure?

Comments on the Quality of English Language

The language is generally good! There are some specific places where I suggest alternate phrases or words. I also request that you clarify who you mean by "they" in several places. 

Author Response

Dear reviewer,

Thank you very much for your comments and the detailed analysis you have conducted on our article. We are immensely grateful for your work and effort. We have followed the article improvement suggestions and made the necessary adjustments. To make it easier for you to locate the changes, we have highlighted in green the modifications we made in the attached manuscript.

Once again, we deeply appreciate your attention.

Best regards,

Alejandro Cano Villagrasa

Author Response File: Author Response.pdf

Reviewer 3 Report

Comments and Suggestions for Authors

Autism spectrum disorders (ASD) and epilepsy are conditions of increasing prevalence, often accompanied by other comorbidities, such as sleep disorders, which seriously affect the quality of life of people with ASD and epilepsy.

Here authors did a systematic literature review aimed at analyzing the relationship between ASD, epilepsy, and sleep disorders, exploring neurobiological dysfunctions and cognitive alterations. The authors’ results indicated, firstly, that the primary cause of sleep disorders in this population is directly linked to abnormal serotonin behaviors. Secondly, significant alterations in memory, attention, and hyperactivity were observed. Therefore, they concluded that sleep disorders negatively impact the quality of life and neurocognitive development of the pediatric population with ASD and epilepsy.

Overall, this is an interesting and high-quality review. It is well-structured and logical. I think it can be accepted for publication in the current version.

Author Response

Dear reviewer,

Thank you very much for all your comments. We deeply appreciate your attention and the work you've put into analyzing this research article.

Best regards,

Alejandro Cano Villagrasa

Author Response File: Author Response.pdf