How Often Do Physicians at a Multidisciplinary Autism Center Address Sleep Problems In Children with Autism Spectrum Disorders?

Background:

Sleep problems are highly prevalent among children with Autism Spectrum Disorders (ASDs), particularly difficulty initiating and maintaining sleep. This can lead to disrupted sleep for families as well. Pediatric sleep problems are often overlooked by primary care providers, but it is unknown how they are addressed in children with ASDs.

Objectives:

To quantify how often children with an ASD and parentally-identified sleep problems had their sleep related concerns addressed by their medical provider.

To test for differences between children whose sleep problems were addressed versus not addressed. It was hypothesized that children with observed apnea would be more likely to be referred for evaluations by sleep specialists and that those with difficulty initiating and maintaining sleep would not consistently receive guidance about sleep problems.

Methods:

This retrospective cross-sectional cohort consisted of 122 subjects with ASDs from a single center, ages 2-17.5 years, 85% male and 79% white, seen for initial medical evaluation. Parents were assessed using the Children’s Sleep Habits Questionnaire (CSHQ), which queries parentally-reported symptoms of common pediatric sleep disorders. Problem sleep was defined by a parent questionnaire item that asked the extent to which sleep disturbance has been a problem within the past month, with choices of “no problem”, mild, moderate, or severe used to dichotomize children into good or poor sleepers (good sleepers had no or mild sleep problems). Whether discussion occurred was based on clinician response to an item documenting whether sleep problems had been discussed. Whether referral to subspecialty clinic occurred was based on clinician response to an item documenting a sleep-related referral. Logistic regression models were performed to examine the association between sleep symptoms (sleep disordered breathing and insomnia) and discussion/referral of sleep problems.

Results:

Twenty-six (21%) of subjects were categorized as problem sleepers. Twelve (46%) of these problem sleepers had discussion (8), referral (3), or both (1). CSHQ Sleep Disordered Breathing Subscale score was not associated with increased problem sleep (p=0.1), but was associated with increased odds ratio (OR) for discussion or subspecialty referral (OR=1.7, confidence interval [CI]=1.1-2.8, P=0.03). Sleeping too little and waking during the night were associated with problem sleep (P<0.001), and also with increased OR for discussion and referral (sleeping too little: OR=3.5, CI=1.6-7.6, P=0.001; waking: OR=2.2, CI=1.1-4.4, P=0.03). Sleeping in a parent’s bed or taking more than 20 minutes to fall asleep were not associated with problem sleep being discussed or referred.

Conclusions:

Sleep issues in children with autism may not be consistently addressed, even by experienced autism clinicians. In larger multicenter studies, factors which affect whether children with ASDs have their sleep problems addressed should be further explored.