Sleep disturbances are associated with greater healthcare utilization in children with autism spectrum disorder

Abstract

Background: Sleep disturbances are frequently reported in children with autism spectrum disorder (ASD) and are associated with the severity of co-occurring symptoms. This study's aim was to examine the extent of healthcare utilization and clinical outcomes associated with sleep disturbances in children with ASD.

Study design: A retrospective, cross-sectional study of 541 children with ASD from the Azrieli National Center for Autism and Neurodevelopment Research (ANCAN) whose parents completed the Children's Sleep Habits Questionnaire (CSHQ). Children with a total CSHQ score ≥ 48 were defined as having sleep disturbances. Sociodemographic characteristics, ASD diagnostic measures, chronic co-occurring conditions, medication usage, hospitalizations, visits to the emergency room (ER), and visits to specialists were compared in ASD children with and without sleep disturbances. Multivariate logistic regression models were then used to assess the independent association of sleep disturbances with clinical characteristics and healthcare utilization.

Results: Of the 541 children with ASD, 257 (47.5%) had sleep disturbances. Children with sleep disturbances exhibited higher rates of multiple (≥ 3) co-occurring conditions (19.1% vs. 12.7%; p = 0.0414) and prescribed medications (45.5% vs. 32.7%; p = 0.0031) than other children. Finally, ASD children with sleep disturbances were 1.72 and 2.71 times more likely to visit the ER and be hospitalized than their counterparts (aOR = 1.72; 99%CI = 1.01-2.95; and aOR = 2.71; 99%CI = 1.10-6.67, respectively).

Conclusions: Our findings suggest that sleep disturbances are associated with greater healthcare utilization among children with ASD. Further studies could examine whether treating sleep disturbances in children with ASD yields additional clinical benefits beyond improvements in sleep.

Keywords: Autism; Autism spectrum disorder (ASD); Co-occurring conditions; Healthcare utilization; Medication use; Melatonin; Sleep; Sleep disturbances.

Fig. 1

Distribution of CSHQ scores in the study sample. A histogram of the frequency of CSHQ scores (X-axis) of children with ASD in the study sample. Overall, 257 children had CSHQ scores ≥ 48 and were defined as having insomnia. Abbreviations: Children’s Sleep Habits Questionnaire (CSHQ)

Fig. 2

Percentage of health services utilization during a period of one year before and after completion of the CSHQ. A. Number of hospitalizations. B. Days hospitalized. C. Number of visits to a specialist. D. Number of visits to a primary care physician. E. Number of visits to the ER. Note that percentages presented in panels A, C, and E sum to 13.6%, 42.4%, and 34.6% of ASD children with insomnia and 6.4%, 58.5%, and 25.3% of children without insomnia who were hospitalized, visited specialists, and visited the ER, respectively. P-values from Mann-Whitney U tests are for the differences between children with and without insomnia. Abbreviations: Children’s Sleep Habits Questionnaire (CSHQ), ER (ER)