Sleep disturbances in children and adolescents are important to identify as they affect daytime function, and, although extremely common, can be especially hard to diagnose in those with autism. For this reason, the description of the type and frequency of sleep diagnoses in the pediatric autism population has been elusive to researchers, clinicians, and caregivers.
We filtered a large pediatric clinical encounter data set for participants ages 3-17 and autism diagnosis. We then developed a comprehensive list of sleep diagnoses based on the ICD-10 code and counted each diagnosis code as a one-time event for each participant. Later, during post-hoc analysis, we used the same methodology for weight-related diagnoses.
Our study utilized the Nationwide Children’s Hospital (NCH) DataBank of over 5.6 million clinical observations of 3673 unique patients seeking clinical sleep evaluation between 2017 and 2019.
The most common categories of sleep problems diagnosed among both autistic and non-autistic participants (median age 10.5) were apnea, snoring, unspecified sleep disorders (including restless sleep), circadian rhythm disorder (CRD), and insomnia. Of these categories, restless sleep, CRD, and insomnia were more common in those with autism. Exploration of sleep co-morbidities revealed the non-autism group had a higher percentage of obesity (54% vs. 47%). In comparison, the autism group was more frequently diagnosed with failure to thrive, abnormal weight gain, prematurity, low birth weight, and small for gestational age.
Evidence for the frequency of sleep disorders gleaned from real-world clinical encounters sheds light on the burden of sleep disturbance for pediatric patients and their families. Identification of the increased incidence of restless sleep, circadian rhythm disorder, and insomnia in the pediatric autism population, and co-existing weight-related diagnoses provides diagnostic clues to help guide those overseeing the care of these individuals.
Smith AM, Johnson AH, Bashore L. Exploration of sleep disturbances in children and adolescents with and without autism in a paediatric sample referred for polysomnography. J Paediatr Child Health. 2023; https://doi.org/10.1111/jpc.16421 (forthcoming).
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Link to paper: https://doi.org/10.1111/jpc.16421
Guest Blogger: Dr. Andrea M Smith
Paper Authors: Dr. Andrea M Smith, Dr. Ann H Johnson, Dr. Lisa Bashore