The majority of children with autism spectrum disorders have sleeping problems and many take medications for sleep, but those taking medications have worse daytime behaviors and poorer quality of life, according to a study published in the February issue of Pediatrics.

“These findings underscore the need for both longitudinal and interventional studies to determine whether improvement of sleep disturbance with medications also improves daytime behaviors and quality of life,” reported Dr. Beth A. Malow of Vanderbilt University in Nashville, and her associates ( Pediatrics. 2016;137[S2]:e20152851H ).

The researchers analyzed data from parent questionnaires and clinical forms filled out between April 2009 and December 2013 for 1,518 children, aged 4-10 years, in the Autism Speaks Autism Treatment Network Registry. Most of the children were white boys; only 16% were girls and 20% were nonwhite.

Although only 30% of children (P less than .0001) had sleep diagnoses in clinical reports, parents reported that 71% of the children had significant sleep problems, indicated by a score of at least 41 on the Children’s Sleep Habits Questionnaire. The most common sleep diagnosis was sleep disturbance not otherwise specified, followed by inadequate sleep hygiene, behavioral insomnia of childhood, other sleep disorder, and organic insomnia unspecified.

One reason for the discrepancy between diagnoses and parent-reported difficulties, the researchers suggested, was that “sleep concerns may be eclipsed by other needs [of children with ASD], especially in the limited time available at a clinician visit.” At the same time, however, they note that 41 may be too low a scale cutoff for autistic children.

Among those with a sleep diagnosis, 46% were taking any medication for sleep. Just over a third (36%) of those with a sleep diagnosis took melatonin, and 14% took alpha-agonists. Only 2% of those without a sleep diagnosis took alpha-agonists, but 13% took melatonin and 15% took any medication. Other medications children took for sleep included antidepressants, antihistamines, atypical antipsychotics, benzodiazepines, beta-blockers, sedatives, iron supplements, and vitamins/dietary supplements.

The children taking medications for sleep had more insomnia, significantly lower scores for quality of life, and significantly higher scores for irritability and for internalizing and externalizing behaviors.

“It is possible that sleep disturbance itself is driving this relationship,” Dr. Malow and her associates said. “It is also possible that a clinician would be more likely to use a medication for sleep in a child with more difficult daytime behaviors” or that sleep medications influence behaviors and quality of life.

The research was supported by the Autism Speaks Autism Treatment Network, the U.S. Department of Health & Human Services, and the Maternal and Child Health Research Program to the Massachusetts General Hospital. Dr. Malow has received grant funding from Neurim Pharmaceuticals for a study of prolonged release melatonin (Circadin), and Dr. Reynolds has received grant funding from Mead Johnson.


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