This study investigated sleep of children with autism and developmental regression and the possible relationship with epilepsy and epileptiform abnormalities. Participants were 104 children with autism (70 non-regressed, 34 regressed) and 162 typically developing children (TD). Results suggested that the regressed group had higher incidence of circadian rhythm disorders than non-regressed children. The regressed group showed higher Children's Sleep Habits Questionnaire Bedtime Resistance, Sleep Onset Delay, Sleep Duration and Night-Wakings scores. Epilepsy and frequent epileptiform EEG abnormalities were more frequent in regressed children. Past sleep disorders and a history of developmental regression were significantly associated with sleep disorders. This study is an initial step in better understanding sleep problems in regressed children with autism, further studies are necessary to better investigate these aspects.

Summary The purpose of the present investigation was to characterize and compare traditional sleep architecture and non‐rapid eye movement (NREM) sleep microstructure in a well‐defined cohort of children with regressive and non‐regressive autism, and in typically developing children (TD). We hypothesized that children with regressive autism would demonstrate a greater degree of sleep disruption either at a macrostructural or microstructural level and a more problematic sleep as reported by parents. Twenty‐two children with non‐regressive autism, 18 with regressive autism without comorbid pathologies and 12 with TD, aged 5–10 years, underwent standard overnight multi‐channel polysomnographic evaluation. Parents completed a structured questionnaire (Childrens’ Sleep Habits Questionnaire—CSHQ). The initial hypothesis, that regressed children have more disrupted sleep, was supported by our findings that they scored significantly higher on CSHQ, particularly on bedtime resistance, sleep onset delay, sleep duration and night wakings CSHQ subdomains than non‐regressed peers, and both scored more than typically developing controls. Regressive subjects had significantly less efficient sleep, less total sleep time, prolonged sleep latency, prolonged REM latency and more time awake after sleep onset than non‐regressive children and the TD group. Regressive children showed lower cyclic alternating pattern (CAP) rates and A1 index in light sleep than non‐regressive and TD children. Our findings suggest that, even though no particular differences in sleep architecture were found between the two groups of children with autism, those who experienced regression showed more sleep disorders and a disruption of sleep either from a macro‐ or from a microstructural viewpoint.

The prevalence and predictors of cosleeping were investigated in 901 healthy school-aged children. Parent reports on the Children's Sleep Habits Questionnaire and Child Behavior Checklist were used to assess children's sleep and behavioral problems. Regular, long-lasting cosleeping was present in 5% of our sample. Cosleepers rated higher on the Children's Sleep Habits Questionnaire total score and Bedtime Resistance, Sleep Anxiety, Nightwakings, and Parasomnias subscales than solitary sleepers. No significant behavioral problems were found in cosleepers. Regression results showed that low socioeconomic status, one parent who is a shiftworker, one-parent families, one parent who coslept as a child, prolonged breastfeeding, and previous and current sleep problems significantly predicted cosleeping. The high incidence of parents reporting having coslept as a child also suggested a lifestyle choice. Thus, cosleeping seems to reflect a parent's way to cope with sleep problems, and the long persistence of this practice may be related to the lifestyle of families.

This study investigated sleep, behavioral and emotional problems, and parental relationships and psychological distress in a group of school-aged children with bedtime problems and persistent cosleeping, compared to solitary sleepers and controls. Participants were 148 school-aged children with bedtime problems (44 cosleepers, 104 solitary sleepers) and 228 healthy peers. Results suggested that cosleepers have a significantly later bedtime, shorter nighttime sleep duration, higher Children's Sleep Habits Questionnaire (CSHQ) bedtime resistance and sleep anxiety scores, and more behavioral and emotional problems compared to other groups. Parents of cosleepers have a significantly higher level of psychological and couple distress. A past history of sleep problems, couple and maternal distress, CSHQ bedtime resistance, sleep anxiety, and night wakings subscale scores, and nighttime fears were significantly predictive of cosleeping. Thus, when cosleeping is present, the child's emotional adjustment, family relationships, and parental psychological problems should be investigated.

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Sleep characteristics in children vary not only with age but also with ethnic and socio-cultural influences. Lifestyle issues as well as cultural beliefs and family values might influence sleep too. This review points out a high incidence of parental involvement at bedtime associated with longer sleep latency, a higher incidence of night wakings and a reduction of night-time sleep in preschoolers. We found also in school-aged children a high incidence of bedtime resistance, parental presence at bedtime, all-night cosleeping and TV use as a sleep aid in 30% of them. An irregular sleep schedule was found in 19% of adolescents; however, we found that Italian adolescents reported much better sleep hygiene than US teens. In Italy subjective, parental, and medical knowledge on sleep patterns in childhood and adolescence are limited and sometimes distorted. The results of our studies were more or less in line with those reported by studies carried out in other countries. However, some interesting differences in sleeping habits, probably culturally determined, were reported too. To better understand such differences in the future it would be desiderable to plan international sleep studies which embrace many cultures and languages, conducted in the same period with identical measures and administration procedures. These studies for their cross-national nature might provide the added opportunity to adopt common strategies for prevention of sleep problems in children and adolescents in different cultures.

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