Background: Several studies have reported disturbed sleep patterns (e.g. frequent nocturnal awakenings, morning wakefulness, and overall shorter sleep times) in children with autism spectrum disorders (ASD). Since almost all these sleep disturbances are reported by parents, it is logical to assume that the parents' sleep patterns are also disturbed, resulting in poorer sleep quality and quality of life. No study so far has included a validated self-assessment measure of sleep quality in parents of children with ASD.

Objectives: The purpose of this exploratory study is to examine sleep quality and sleep-wake patterns in parents of children with ASD in comparison with parents of typically developing children matched for age and gender.

Methods: Parents of 29 children and adolescents with autism (21 males; 8 females; age range: 4-17; mean age 10.9 years) were involved in the study. Twenty-three out of 29 subjects with autism had level 3 severity according to DSM V. Principal caregivers who took part in the study were 13 fathers and 16 mothers (age range 30-52 years). They were asked to fill out the Pittsburgh Sleep Quality Index questionnaire -validated Italian version- consisting of 19 questions and 7 dominions (subjective evaluation, latency, duration, efficacy, disturbances, hypnotic use, daily dysfunction).
The control group was represented by parents (9 males and 14 females- age range 29-58 years) of 23 typically developing (TD) kids (13 males; 10 females; age range 3-15 years mean age 9.8 years.
To graphically show the most important connections among the variables a fourth-generation artificial neural network called Auto-CM coupled with a minimum spanning tree filter developed a semantic connectivity map of the variables in the study (Figure).

Results: The map developed by the Auto-CM system clearly shows a separation between the two groups' sleep qualities. The node of parents of the ASD group was directly connected with short sleep duration, linked to scarce sleep efficacy and in sequence high sleep latency, subjective evaluation of sleep poor high sleep disturbances, and dysfunction during the day (figure). The low scores of seven dominions were connected to parents of the Control group starting with normal sleep duration.

Conclusions: Our study confirms that parents of children with ASD have poorer sleep quality and more disturbed sleep patterns than parents of TD children.

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Autism Research Unit, Villa Santa Maria SCS, Tavernerio, Como, Italy