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

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%; chi(2)=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.