Maternal Poor Sleep of Children with ASD in Saudia Arabia and UK

Background: Sleep problems in children are common, with around one third of children experiencing some kind of sleep disturbance during their development. Many children with ASD are reported to have severe sleep problems including long night time wakings and sleep onset delay. This is particularly important as sleep plays an active role in children’s memory consolidation and impacts daytime functioning.

Objectives: To date, most research has primarily focused on sleep characteristics of children with ASD in western countries. Very little research used objective assessments of sleep parameters and mental health of mothers who have school-age children with ASD. The current study was twofold: 1) examine maternal sleep and mental health (depression and anxiety) and 2) examine if there are ethnic differences in sleep by comparison two groups: UK and Saudi Arabia.

Saudi Arabia is a country with very little research carried out on children with ASD and their families. Yet, numbers of diagnosis are on increase as well as awareness. Hence gaining understanding of common sleep issues and maternal mental health status is of great importance.

Methods: Participants included 90 mothers of children with ASD (50% from UK) and 90 mothers in control group (no ASD, 50% from UK). Inclusion criteria were that all children had to be of school age and have current diagnosis of ASD. Maternal sleep was measured using actigraphy for 7 days and further assessed using a large battery of Sleep Questionnaires such as The Pittsburgh Sleep Quality Index and sleep diary. Maternal mental status was measured using Becks Inventory and Parenting Stress Index. Each mother filled in Childhood Sleep and Habits Questionnaire about their child’s sleep patterns.

Results: As expected children with ASD had significantly higher sleep onset delay and decreased sleep, large number of night-time wakings in comparison to the control group. Mothers in both groups suffered from sleep onset delay, frequent night wakings and shorter sleep. In sum their sleep quality and quantity significantly differed from the control group. Interestingly, sleep parameters of mothers in Saudi Arabia were significantly worse than both groups. On the depression and stress index mothers from the UK group had higher scores than the Saudi group. Regression models showed that depression and poor sleep were strongly associated with the child’s sleep.

Conclusions: The findings confirm previous studies that children with ASD suffer from sleep problems. New findings using objective sleep measures show that maternal sleep is linked to their child' sleep patterns. The association of sleep to depression and anxiety scores ought to be examined further and treatments should be offered to manage sleep issues of mothers and their children as a unit. More proactive work needs to be put towards the ASD awareness in the Middle East countries.