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

Introduction: Patients with autism spectrum disorder (ASD) frequently complain symptoms of insomnia. However, the available literature is fragmented and the degree of agreement between objective and subjective measures has been poorly explored. The aim of this study was to compare ASD children and healthy children to observe possible variations in sleep patterns using objective and subjective measures. Methods: 11 ASD children (11 males; 7.82 ± 1.50 years) were recruited from the Bambino Gesù Hospital in Rome and 10 healthy children (4 males; 10.90 ± 0.98 years) voluntarily participated in the study. Caregivers were administered the questionnaires Sleep Disturbance Scale for Children (SDSC) and the Child Behavior Checklist (CBCL) to assess sleep and behavioral problems respectively. All participants were under 18 years of age. The controls were free of psychopathological or medical diagnoses, sleep disorders (SDSC < 70) and behavioral problems (CBCL < 60). Participants wore the actigraph for one week. Every morning within 15 min of waking up, the parents were asked to complete a sleep diary about the previous night. Comparison analyses (t-tests) were conducted between the two groups to compare demographic (χ2-test for gender distribution), clinical and sleep variables 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, ASD children showed higher scores on both the SDSC (p < 0.001) and the CBCL (p < 0.001). Comparison of sleep diaries showed greater daytime fatigue (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 also showed a higher average awakening time (p = 0.028) as measured by actigraphs. Conclusions: These findings suggest a worse sleep quality in ASD children detected by both diaries and actigraphs and are consistent with the available literature. This underlines the need to investigate sleep characteristics in these patients using both subjective and objective measures in order to develop more effective treatments.