Abstract
BackgroundHigh prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels.MethodsUsing a cross-sectional design, we included 2 to 7-year-old children from 13 cities in China: 1310 with ASD and 1158 with typically-developing (TD) children. The neurodevelopmental level was evaluated with the revised Children Neuropsychological and Behavior Scale (CNBS-R2016). ASD were diagnosed with DSM-5 and Child Autism Rating Scale (CARS). the Social Responsiveness Scale (SRS), the Autism Behavior Checklist (ABC) and the communication warning behavior sub-scale in CNBS-R2016 valued autism behaviors. The children’ s sleep habits questionnaire (CSHQ) assessed sleep conditions.ResultsThe prevalence of sleep disorders in ASD children was significantly higher than that in TD (67.4% vs. 51%, p < 0.01), and among them the four dimensions with the highest prevalence of sleep problems were bedtime resistance (25.6%), sleep anxiety (22.7%), sleep onset delay (17.9%) and daytime sleepiness (14.7%). ASD children with sleep onset delay or sleep anxiety had higher ABC, SRS scores and higher scores on communication warning behavior with sleep anxiety, with daytime sleepiness had higher ABC, SRS and CARS scores, and with bedtime resistance had higher SRS total scores. Differences in the neurodevelopmental level were not significant.ConclusionChildren with ASD have a higher prevalence of sleep problems. Bedtime resistance, anxiety, sleep onset delay and daytime sleepiness may be related to the core symptoms, but not be related to the developmental level in ASD children. In the clinic, sleep assessment should be included in the routine of ASD visits, and during the intervention, sleep hygiene education is as important as the treatment of biological factors.Trial registrationThe study was approved by the ethics committee of the Children’s Hospital of Chongqing Medical University, Approval Number: (2018) IRB (STUDY) NO. 121, and registered in the Chinese Clinical Trial Registry (Registration number: ChiCTR2000031194).
Highlights
High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD)
A total of 2726 children aged 2–7 years were enrolled in the study, and 2468 children were included eventually after excluding 258 children who had a sleep questionnaire loss (Fig. 1)
Model II included adjusted factors such as gender, age, region, residence, parents’ educational level and annual family income as independent variables, and the results showed that the differences in sleep problems between the two groups remained (OR = 1.873, p < 0.001) (Additional file 1)
Summary
High prevalence of sleep problems have been reported in children with Autism Spectrum Disorder (ASD). This study aims to investigate the sleep conditions of ASD children in China, and explore the relationship between the common sleep problems and core symptoms and developmental levels. In China, the prevalence has risen from 0.35% in 2018 [3] to 0.7% in 2020 [4]. It is one of the fastest-growing pediatric diseases and has attracted worldwide attention. Less than 50% [5,6,7,8] of typically developing children experience sleep disorders, but 50–80% [9,10,11,12] of ASD children. Other researchers have found high rates of bedtime resistance and daytime sleepiness [16]
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