Asiye Arici Gürbüz, Semiha Cömertoğlu Arslan, Seda Bozduman Çelebi, Hülya Binokay, Hatice Altun
Sleep disturbances in children with ASD were associated with greater behavioral difficulties, lower HRQoL, and poorer maternal mental health. Sleep quality also mediated the associations between child behavioral difficulties, maternal psychological well-being, and HRQoL. These findings highlight the importance of assessing sleep as part of comprehensive, family-centered care for children with ASD.
BACKGROUND: Sleep disturbances affect 40-80% of children with autism spectrum disorder (ASD), yet their concurrent associations with neurobehavioral functioning, health-related quality of life (HRQoL), and primary caregiver mental health remain insufficiently characterized within an integrated multivariate framework that includes typically developing controls. This limits clinicians' ability to position sleep disturbance within the broader family burden associated with ASD.
METHODS: This cross-sectional case-control study included 101 children aged 6-12 years with DSM-5-confirmed ASD and 81 typically developing controls, together with their primary caregiving mothers. Sleep was assessed using the Children's Sleep Habits Questionnaire (CSHQ), child behavior using the Strengths and Difficulties Questionnaire (SDQ), HRQoL using the KINDL, and maternal psychiatric morbidity using the Beck Depression Inventory (BDI) and Maslach Burnout Inventory (MBI). Multiple linear regression and bootstrap mediation analyses were performed.
RESULTS: Despite significantly longer total daily sleep duration, children with ASD had poorer scores across most CSHQ subscales, including bedtime resistance, night wakings, and parasomnias (p < 0.05), whereas daytime sleepiness was not significantly different (p = 0.075). Maternal depression and burnout were substantially higher in the ASD group (p < 0.001). In multivariable analysis, ASD diagnosis (B = -6.124, p = 0.001), SDQ total difficulties (B = -0.533, p < 0.001), sleep disturbance severity (B = -0.523, p < 0.001), and maternal burnout (B = -0.146, p = 0.016) independently predicted lower HRQoL. Sleep quality significantly mediated the associations of child behavioral difficulties (23.1%, p = 0.016), maternal depression (51.4%, p = 0.002), and maternal burnout (36.6%, p = 0.027) with HRQoL.
CONCLUSION: Sleep disturbances in children with ASD were associated with greater behavioral difficulties, lower HRQoL, and poorer maternal mental health. Sleep quality also mediated the associations between child behavioral difficulties, maternal psychological well-being, and HRQoL. These findings highlight the importance of assessing sleep as part of comprehensive, family-centered care for children with ASD.