Differential effects of COVID‐related lockdown on sleep–wake rhythms in adults with autism spectrum disorder compared to the general population

Abstract

COVID-related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. The study is a French nation-wide online survey assessing sleep-wake rhythms and behaviors known to affect sleep (daily screen time, daylight exposure, and physical activity), before and during COVID-related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Before lockdown, the adults with autism displayed on average later bedtime and waking hours, lower sleep quality, more evening screen time, less exposure to daylight, and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups: poorer self-rated sleep quality as well as a less regular and delayed sleep-wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favorable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviors was similar in both groups, the results highlight that the preexisting shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown. Lay abstract: COVID-related lockdown led to a radical modification of daily activities and routines known to affect sleep. In a sample of 1800 adults, we observed that, before lockdown, participants with autism displayed significantly higher levels of sleep disturbances and less favorable daily routines known to regulate sleep, compared to the general population. While the deleterious effect of lockdown on sleep was similar in both groups, pre-existing difficulties in adults with autism reached worrying levels during lockdown. K E Y W O R D S autism spectrum disorder, circadian rhythm, insomnia, sleep, sleep hygiene Eve Reynaud and Julien Pottelette are co-first authors. Romain Coutelle and Carmen M. Schröder are co-last authors.

Screen Time and Autism Spectrum Disorder

“…The initial systematic literature search yielded 4682 records (Figure 1). The first filtering step resulted in 145 studies, and the second filtering step resulted in a final collection of 46 studies that examined the association between screen time and ASD (Figure 1 and Table 1).…”

“…Thirteen studies reported on data collected since the COVID-19 pandemic (Table 1). Notably, the research design of all 46 studies was observational: 41 were cross-sectional and 5 were longitudinal . Accordingly, the overall research quality of these studies was determined to be relatively low (according to the GRADE approach) …”

“…The initial systematic literature search yielded 4682 records ( Figure 1 ). The first filtering step resulted in 145 studies, and the second filtering step resulted in a final collection of 46 studies 9 , 10 , 11 , 12 , 13 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 that examined the association between screen time and ASD ( Figure 1 and Table 1 ).…”

Caregiver Perspective on the Impact of COVID-19 on the Psychosocial and Behavioral Health of Children with ASD in the United States: A Questionnaire-Based Survey

“…As the pandemic has progressed, the reported impact of COVID-19 on individuals with ASD and their families has been significant [8,[16][17][18]. Specifically, children with ASD have experienced increased mental health issues [1,12,19], a decline in positive social behaviors and other conduct [19], and an increase in sleep disturbances [20,21]. A number of factors may exacerbate these effects [15,22], including the presence of behavioral issues prior to the pandemic [23] and parental stress levels [24,25].…”

Sleep Problems, Circadian Rhythms, and Their Relation to Behavioral Difficulties in Children and Adolescents with Autism Spectrum Disorder

“…Lockdown is reported to have significantly changed bedtime for nearly 58% of children with ASD and rise time for 69% (Bruni et al, 2022 ). Various researchers have reported reduced sleep duration, difficulties in falling sleep, night waking, sleep terrors and daytime sleepiness in autistic populations (Bruni et al, 2021 , 2022 ; Reynaud et al, 2022 ; Türkoğlu et al, 2020 ); in addition, adults with autism displayed higher levels of sleep and circadian rhythm disturbances, with less favorable daily routines (Reynaud et al, 2022 ) and children with ASD reported higher presence of the ‘eveningness’ chronotype and higher autism symptom scores during the period of home confinement (Türkoğlu et al, 2020 ).…”