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Sleep Problems in Children with Autism Spectrum Disorder in Bangladesh: A Case-Control Study

Naznin Sultana^1,2, Md Asaduzzaman³, Firoj Al Mamun^1,4

¹CHINTA Research Bangladesh (Centre for Health Innovation, Networking, Training, Action and Research - Bangladesh), Savar, Dhaka, Bangladesh.

Nature and Science of Sleep

|June 3, 2021

Insights

Sleep problems are highly prevalent in children with Autism Spectrum Disorder (ASD) in Bangladesh, affecting 94% of those with ASD compared to 87.5% of typically developing children (TDC). These sleep disturbances in ASD children require immediate parental education and support programs.

Area of Science:

Child Psychology
Neurodevelopmental Disorders
Sleep Medicine

Background:

Sleep disturbances are common in children with Autism Spectrum Disorder (ASD).
Limited research exists on ASD sleep issues in low- and middle-income countries (LMICs).
This study focuses on Bangladesh, comparing ASD children with typically developing children (TDC).

Purpose of the Study:

To investigate the prevalence of sleep disturbances in Bangladeshi children with ASD.
To identify socio-demographic determinants of sleep problems in ASD.
To compare sleep patterns between children with ASD and TDC.

Main Methods:

A cross-sectional interview study was conducted with 446 Bangladeshi mothers.
Participants included 151 children with ASD and 295 TDC, with a mean age of 8.1 years.
The Child Sleep Habit Questionnaire (CSHQ) was used, with a cut-off score of 41 indicating sleep problems.

Main Results:

Nearly 90% of children experienced sleep problems, with higher rates in ASD (94%) versus TDC (87.5%).
ASD children had significantly higher overall CSHQ scores and specific issues in sleep duration, anxiety, night waking, parasomnias, and sleep-disordered breathing.
Medication use for sleep issues was markedly higher in ASD (28.5%) compared to TDC (0.3%).

Conclusions:

Children with ASD in Bangladesh exhibit a high likelihood of sleep disturbances.
Urgent implementation of parental educational and support programs is necessary.
Mitigating sleep problems is crucial for ASD families in this region.

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Abstract

Background:

Sleep problems in children with Autism Spectrum Disorder (ASD) are highly prevalent, but little information is available on this issue in low- to middle-income countries (LMIC) such as Bangladesh. Therefore, the present study investigated the prevalence and socio-demographic determinants of ASD sleep disturbances in a comparison with typically developing children (TDC).

Methods:

A cross-sectional interview study was carried out within a total of 446 Bangladeshi mothers, whose children's mean age was 8.1±2.9 years (151 ASD [8.5±2.7 years] and 295 TDC [7.9±2.9 years]); in addition to socio-demographics, the Child Sleep Habit Questionnaire (CSHQ) was used, and a cut-off score of 41 out of 93 points considered as reflecting sleep problems.

Results:

About 89.7% of the children reported having problems in sleep, with ASD reporting higher frequency vs TDC (94.00% vs 87.50%; χ²=4.678, p=0.031). The overall mean CSHQ score was 48.7±7.6 in total sample, whereas ASD children reported higher scores compared to TDCs (50.9±8.1 vs 47.5±7.0, p<0.001). Similarly, subscales of CSHQ such as sleep duration (4.23±1.56 vs 3.90±1.31, p=0.017), sleep anxiety (7.23±2.05 vs 6.45±1.92, p<0.001), night waking (3.82±1.07 vs 3.17±1.89, p<0.001), parasomnias (8.86±2.06 vs 7.85±2.27, p<0.001), and sleep disordered breathing (4.02±2.92 vs 3.43±2.07, p=0.014) were more problematic among ASD compared to TDC. Lastly, 28.5% of ASD reported taking sleep-related medications vs 0.3% for TDC (n=1).

Conclusion:

Bangladeshi ASD children are highly likely to manifest sleep disturbances, which warrant urgent implementation of parental educational and support programs to mitigate the impact of sleep problems in ASD families.

Keywords:

ASD Bangladesh autism spectrum disorder child sleep habit questionnaire insomnia sleep problems

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