Exploring sleep in children and adolescents with autism spectrum disorder using objective and subjective sleep measures

Introduction: Insomnia is common in children with autism spectrum disorder (ASD), however, few studies used subjective and objective sleep measures. This study compared subjective and objective sleep patterns in children with and without ASD and explored associations with demographic and clinical characteristics. Methods: Thirty-six children with ASD (7F; 8.31±0.60 years) and 24 healthy controls (10F; 10.08±0.75 years) were recruited. Caregivers completed questionnaires on sleep and behavioral problems. Participants wore wrist actigraphs for one week, while caregivers completed daily sleep diaries. Group comparisons were performed on demographic, clinical, and sleep variables (t test/Mann-Whitney-U, χ²-test). Within the ASD group, sleep differences between children with IQ ≥85 (t-test/Mann-Whitney-U) and correlations among demographic, clinical, and sleep variables were examined (r/rho). Results: Participants with ASD showed higher sleep and behavioral problems. Comparisons on sleep diaries revealed more insomnia-related symptoms in the ASD group. Children with ASD and IQ<85 exhibited poorer subjective sleep quality and greater actigraphic sleep fragmentation. Poorer sleep quality correlated with younger age and lower IQ (all p<0.05). Conclusion: Children with ASD, particularly those with lower IQ, may experience greater sleep difficulties. Given the differing tool sensitivities, these findings highlight the need to integrate subjective and objective sleep measures.