Burden of insomnia on healthcare utilization in children with autism spectrum disorder

Insomnia is frequently reported in children with autism spectrum disorder (ASD) and is associated with the severity of hyperactivity, irritability, sensory sensitivities, and related symptoms. The aim of this study was to examine the extent of healthcare utilization associated with insomnia in children with ASD. We conducted a retrospective, cross-sectional study of 541 children with ASD registered at the National Autism Database of Israel (NADI). Parents of all children completed the Children's Sleep Habits Questionnaire (CSHQ) and insomnia was defined as a total CSHQ score [≥]48. We compared sociodemographic characteristics, ASD diagnostic measures, chronic comorbidities, medication usage, hospitalizations, visits to the emergency room (ER), and visits to specialists between ASD children with and without insomnia. Finally, we assessed the independent association of insomnia with clinical characteristics and healthcare utilization using multivariate logistic regression models. Of the 541 children with ASD, 257 (47.5%) had insomnia. Children with insomnia compared to children without insomnia exhibited higher rates of comorbidities within the symptoms, signs, and ill-defined conditions (ICD 9[780:789]) category (aOR=1.70; 95%CI=1.04 - 2.77; p=0.033) and were prescribed more medications for chronic comorbidities (aOR=1.47; 95%CI=1.01 - 2.15; p=0.046). Finally, ASD children with insomnia were 1.75 and 2.82 times more likely to visit the ER and be hospitalized than their counterparts (aOR=1.75; 95%CI=1.17 - 2.62; p=0.007 and aOR=2.82; 95%CI=1.43 - 5.56; p=0.003, respectively). Our findings demonstrate that insomnia is associated with greater healthcare utilization among children with ASD. Thus, treating insomnia in children with ASD may have a broad clinical impact beyond specific improvements in sleep disturbances.