The Relationship Between Sleep and Health-Related Quality of Life Amongst Children with Autism Spectrum Disorders

Background: Evidence shows that children with Autism Spectrum Disorders (ASD) experience significantly more physical and psychological health problems than typically developing peers.  While these co-morbidities make ASD particularly difficult to diagnose and treat, they also create considerable health-related quality of life issues (HRQoL) for children and their families.  Sleep problems are amongst the most prevalent of these co-morbidities, with an estimated 40- 80% of children with ASDs experiencing some type of sleep-related disturbance.

Objectives: This study examined the relationship between health-related quality of life and sleep problems in a large cohort of children with ASD.  Aspects of HRQoL explored included physical and school functioning and emotional and social well-being.  Sleep domains assessed included sleep duration, night waking, parasomnias, sleep disordered breathing, daytime sleepiness, bedtime resistance, sleep anxiety, and sleep-onset delay.

Methods: We recruited 100 parents of children with ASD through the Autism Treatment Network (ATN) and 2 large academic medical centers.  HRQoL and sleep characteristics were assessed via parent-proxy, using the generic (non-condition specific) version of the Pediatric Quality of Life Inventory (PedsQL 4.0) and the Child Sleep Habits Questionnaire (CSHQ).  Key clinical characteristics, such as behavior problems and ASD diagnosis and severity, were also analyzed.  We examined descriptive data and used linear regressions with HRQoL summary variables as the outcome and sleep problem summary and sub-scale scores as the key independent variables.  We ran regressions with the sleep problem scores alone and controlling for covariates (socio-demographic characteristics, behavioral problem scores, and autism severity scores).

Results: Regression analyses showed a consistent relationship between health-related quality of life and sleep problems, with several significant associations found amongst PedsQL and CSHQ scores.  HRQoL total and summary scores were significantly associated with the CSHQ total score, with worse sleep problems indicative of poorer quality of life.  Significant associations were also found amongst PedsQL scores and CSHQ subscale scores in the expected direction, with a particularly strong relationship between sleep duration and HRQoL.

Conclusions: The associations found amongst sleep and HRQoL variables indicate that children’s quality of life is adversely impacted by the experience of sleep problems, especially those related to sleep duration.  Additionally, these results suggest that treatments that are effective in treating sleep disturbances may improve children’s quality of life.