Sleep and Awake Bruxism in Children With Autism Spectrum Disorder: Associations With Sleep Indicators and Caregiver...

Bruxism, a centrally mediated masticatory muscle activity, is highly prevalent in children with autism spectrum disorder (ASD), a population where research remains limited despite the condition's impact on sleep and quality of life. This study aimed to investigate the frequency of sleep and awake bruxism in children with ASD and analyze their associations with sleep indicators and caregiver mental health. This cross-sectional study included 146 participants (4-18 years old) divided into two groups: 73 with an ASD diagnosis and 73 without ASD. Data were collected from questionnaires administered to caregivers (sociodemographic data, Sleep Disturbance Scale for Children [SDSC], and Depression, Anxiety, Stress Scale [DASS-21]) and from children's clinical oral examinations. Clinically based sleep bruxism was more frequent in children with ASD, while awake bruxism predominated in the neurotypical group. Caregivers, mostly women, reported significantly higher levels of anxiety and depression in the ASD group (p < 0.05). In the ASD group, higher frequencies of sleep bruxism were observed among children with sleep-onset and maintenance difficulties and among those whose caregivers did not report depressive symptoms; however, these associations did not remain statistically significant after Bonferroni correction for multiple comparisons. The findings suggest that children with ASD have a higher frequency of sleep disturbances and medication use. The association between sleep bruxism and sleep difficulties in the ASD group suggests the preponderance of neurophysiological/sleep regulation mechanisms. Moreover, caregivers face significant socioeconomic impact and psychological distress.