Sleeping Disorders in Children with Autism Spectrum Disorders and Other Developmental Disabilities

Background:  Children with developmental disabilities(DD) experience sleep disorders at a higher rate than typically developing children.  There has been a growing interest in characterizing sleep problems in children with special needs since interventions can improve sleep and may result in better daytime functioning and quality of life. Sleep problems are commonly reported by parents of children with Autism Spectrum Disorders (ASD) but information on sleep disorders in ethnically diverse populations is sparse and there are few comparisons with children with other developmental disabilities.

Objectives:  To compare reported sleeping difficulties in ethnically diverse children with ASD vs. those with other DDs and to assess the relationship of sleeping disorders with demographic factors.

Methods:  Cross sectional study with structured interview for 50 children with ASD and 50 children with other DD, matched by age/gender. DDs included intellectual disability/global delay and cerebral palsy.  Interview included the Child's Sleep Habits Questionnaire (Owens) and demographic factors. Sleeping disorder was defined as a score above 41 in the Total Sleep Disturbance Score. Statistical analysis included paired statistics, chi-square, t test, correlations and regression.

Results:  Mean age 8 3 yr; 15% White, 44% Hispanic and 24% African/American. Sleeping disorder was reported in 78% of the ASD group and 34% of the DD group (p<0.001) and the Total Sleep Disturbance Score was significantly higher in the ASD group (49±7 vs. 44±9 p=0.01). Families of children with ASD reported higher scores in the areas of bedtime resistance(9.8±2 vs. 8±2 p=0.002), sleep anxiety(6.5±2vs.5.2±1.6p=0.001) and night wakings(3.9±1 vs. 3.3±0.9p=0.003)  but there were no differences between the groups in the sleep duration, sleep onset delays, parasomnias, sleep disorder breathing or daytime sleepiness. Overall younger patients were more likely to present bedtime resistance (r-.26 p=0.008) and night waking (r-.22 p=0.027) but there was no other association between demographic characteristics and reported sleeping disorders within or across groups.  The association between sleeping disorders and ASD persisted after adjusting for demographic characteristics, including maternal education, ethnic groups and time since diagnosis (OR 7.1 95%CI= 2.2-22.2).

Conclusions:  In this ethnically diverse sample, parents of children with ASD reported more sleeping difficulties than children with other DDs, including bedtime resistance, sleep anxiety and night waking. There was no difference in sleep duration or parasomnias or daytime sleepiness between the groups. Therapy may be best targeted on these factors.