Abstract: Objective To investigate the distribution of sleep and eating behavior problems in children with autism spectrum disorder (ASD), and to analyze their correlations with clinical characteristics,in order to provide basis for fwture mechanism research and clinical intervention. Methods A total of 211 ASD children aged 2 - 7 were enrolled into this study from outpatient department from January to June 2023, and 91 typically developed children matched with age and sex were enrolled into control group.Autism Behavior Checklist (ABC), Children's Sleep Habits Questionnaire (CSHQ) and a self-made questionnaire were used to assess children's autistic behavior, sleep problems and eating behaviors. Chi-square test, t test, non-parametric test and multinomial Logistic regression analysis were performed to analyze the relationship between sleep problems and eating behaviors in children with ASD. Results The prevalence rates of sleep problems and food selectivity were significantly higher in children with ASD than those in control group (χ²=6.876、17.299,P<0.05).The total score of CSHQ of ASD children (48.55±6.07) was significantly higher than that of control group (45.24±5.33)(t=4.494,P<0.05).ASD children were more likely to report bedtime resistance, sleep onset delay, sleep duration, night waking, parasomnias and sleep disordered breathing than control group (P<0.05).The total score of CSHQ was significantly higher in ASD children with aberrant eating behaviors, and the difference was statistically significant in food selectivity (type selectivity, texture selectivity and pica) (Z=2.803, P<0.05).Multinomial Logistic regression indicated that the occurrence of sleep onset delay was positively affected by body and object use (OR=1.063), and negatively affected without food texture selectivity (OR=0.524) and pica (OR=0.343). Conclusions ASD children have a higher risk of sleep problems and aberrant eating behaviors than the typically developed children.Moreover,ASD children with aberrant eating behaviors have more severe sleep problems.The influencing factors of sleep onset delay include body and object use, food texture selectivity and pica.

Key words: autism spectrum disorder, sleep problems, eating behaviors, children

摘要： 目的 探讨孤独症谱系障碍(ASD)儿童的睡眠和饮食行为问题的分布情况及其临床特征之间的关系,为今后的机制研究与临床干预奠定基础。方法 选取2023年1—6月在南京医科大学附属脑科医院儿童心理卫生研究中心门诊就诊的211名2~7岁ASD患儿和年龄、性别相匹配的91名正常儿童为ASD组和对照组。采用孤独症行为检查表(ABC)评估ASD儿童的行为,采用儿童睡眠习惯问卷(CSHQ)和自编问卷分别评估两组被试的睡眠问题和饮食行为。使用χ²检验、t检验、非参数检验和多元Logistic回归分析ASD儿童睡眠问题和饮食行为问题之间的关系。结果 ASD组睡眠问题和食物选择性问题的发生率高于对照组,差异有统计学意义(χ²=6.876、17.299,P＜0.05)。ASD组患儿CSHQ总分[(48.55±6.07)分]高于对照组[(45.24±5.33)分],差异有统计学意义(t=4.494,P<0.05)。ASD儿童更有可能出现就寝习惯、入睡潜伏期、睡眠持续时间、夜醒、异态睡眠、睡眠呼吸暂停等睡眠问题(P<0.05)。在ASD儿童中,有饮食行为的儿童CSHQ总分增高,且在食物选择性(种类选择性、质地选择性和异食癖)方面差异有统计学意义(Z＝2.803,P＜0.05)。多元有序Logistic回归分析显示入睡潜伏期延长受到ABC量表躯体运动分量表得分(OR=1.063)的正向影响,无食物质地选择性(OR=0.524)和无异食癖(OR=0.343)的负向影响。结论 ASD儿童常伴随更严重的睡眠问题和饮食行为问题。有饮食行为问题的ASD儿童睡眠问题更严重。ASD儿童入睡潜伏期延长受到躯体运动、食物质地选择性和异食癖的影响。

关键词: 孤独症谱系障碍, 睡眠问题, 饮食行为, 儿童