29409
Links between Autism Spectrum Disorder and Sleep Difficulties

Poster Presentation
Friday, May 3, 2019: 5:30 PM-7:00 PM
Room: 710 (Palais des congres de Montreal)
D. Crocetti1, C. Holingue2,3, A. Spira3,4,5, S. H. Mostofsky1,6 and H. E. Volk2,3,7, (1)Center for Neurodevelopmental and Imaging Research, Kennedy Krieger Institute, Baltimore, MD, (2)Wendy Klag Center for Autism and Developmental Disabilities, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (3)Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (4)Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, (5)Johns Hopkins Center on Aging and Health, Johns Hopkins University, Baltimore, MD, (6)Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, (7)Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
Background:

Disturbed sleep is very common among children with ASD and can be conceptualized as a consequence of ASD. However, poor sleep may also influence behavioral or cognitive traits among individual with ASD.

Objectives:

To compare sleep of children with autism spectrum disorder (ASD) with that of typically developing (TD) children and to assess associations of sleep with quantitative measures of ASD-related traits and with intellectual disability.

Methods:

Participants included 151 children with high-functioning ASD and 294 TD children (ages 8-12 years) whose parents completed the Children’s Sleep Habits Questionnaire (CSHQ). Multivariable linear regression models were used to: 1) Examine associations between ASD and CSHQ subscales and total CSHQ score, and 2) Examine associations of CSHQ total score with social responsive scale (SRS) total score and the WISC-5 full scale IQ, within both ASD and TD groups. All models were adjusted for age, sex, race, ethnicity, and family socioeconomic status.

Results:

Among children with ASD, 64% reached the CSHQ threshold for a pediatric sleep disorder (score >41) compared to 27% in the TD group (χ2=56, p<0.00001). After adjusting for potential confounders, ASD was significantly associated with all CSHQ subscales and the total score. Specifically, compared to children with TD, those with ASD exhibited greater bedtime resistance (Beta=1.1), greater delays in sleep onset (Beta=0.5), shorter sleep duration (Beta=0.8), higher sleep anxiety (Beta=1.2), more night wakings (Beta=0.6) and parasomnias (Beta=0.8), greater daytime sleepiness (Beta=2.2), and a higher total score for sleep problems (Beta=6.7) (all p<0.00001). Children with ASD also had 5 times the odds of meeting the clinical threshold for a pediatric sleep disorder (OR = 5.0, p<0.00001). The only sleep item not significantly associated with ASD status was sleep-disordered breathing (Beta=0.1, p=0.4). In both the ASD and TD groups, CSHQ total score was significantly associated with SRS total score (ASD Beta=0.2, p<0.05; TD Beta=0.3, p=0.003). In both the ASD and TD groups, there was no significant association between IQ (WISC-V full scale) and CSHQ total score.

Conclusions:

Compared with TD peers, children with ASD show significantly worse parent-reported sleep problems, including: bedtime resistance, shorter sleep, greater delays in sleep onset, more sleep anxiety and wakings, as well as greater daytime sleepiness. Reports of sleep-disordered breathing did not differ between children with ASD and TD, consistent with previous literature showing low endorsement of sleep-disordered breathing items in ASD samples. We also found significant associations between total CSHQ score and total SRS score within both the ASD and TD groups, suggesting a relationship between sleep health and social-communicative behavior that is not specific to ASD. We did not find any evidence of an association between total CSHQ and IQ in either the ASD or TD group. Further research is needed to examine the role of sleep problems in ASD behaviors, comorbid psychopathology, and medical conditions.

See more of: Medical and Psychiatric Comorbidity
See more of: Medical and Psychiatric Comorbidity