Sleep patterns in autism spectrum disorder: A study using objective and subjective measures of sleep

Introduction: Patients with autism spectrum disorder (ASD) frequentlycomplain symptoms of insomnia. However, the availableliterature is fragmented and the degree of agreement betweenobjective and subjective measures has been poorly explored. Theaim of this study was to compare ASD children and healthy childrento observe possible variations in sleep patterns using objectiveand subjective measures.Methods: 11 ASD children (11 males; 7.82 ± 1.50 years) wererecruited from the Bambino Gesù Hospital in Rome and 10 healthychildren (4 males; 10.90 ± 0.98 years) voluntarily participated in thestudy. Caregivers were administered the questionnaires Sleep DisturbanceScale for Children (SDSC) and the Child Behavior Checklist (CBCL)to assess sleep and behavioral problems respectively. All participantswere under 18 years of age. The controls were free of psychopathologicalor medical diagnoses, sleep disorders (SDSC < 70) and behavioralproblems (CBCL < 60). Participants wore the actigraph for oneweek. Every morning within 15 min of waking up, the parents wereasked to complete a sleep diary about the previous night. Comparisonanalyses (t-tests) were conducted between the two groups to comparedemographic (χ2-test for gender distribution), clinical and sleepvariables derived from the diaries and actigraphs.Results: The two groups differed in gender distribution (p = 0.004)but not in age (p = 0.109). With respect to clinical variables, ASDchildren showed higher scores on both the SDSC (p < 0.001) and theCBCL (p < 0.001). Comparison of sleep diaries showed greater daytimefatigue (p = 0.025), more nocturnal awakenings (p = 0.005),more intra-sleep wakefulness (p = 0.021) and lower sleep efficiency(p = 0.039) in ASD participants compared to controls. Patients alsoshowed a higher average awakening time (p = 0.028) as measured byactigraphs.Conclusions: These findings suggest a worse sleep quality in ASD childrendetected by both diaries and actigraphs and are consistent withthe available literature. This underlines the need to investigate sleepcharacteristics in these patients using both subjective and objectivemeasures in order to develop more effective treatments.