The relationship between autism spectrum and sleep–wake traits

Abstract

Autistic children and adults often have sleep disturbances, which may affect their and their family's quality of life. Yet, the relationship between sleep-wake patterns and autism spectrum traits is understudied. Identifying such relationships could lead to future research elucidating common mechanistic underpinnings. Thus, we aimed to determine whether sleep-wake patterns, specifically related to sleep, physical activity, and the daily sleep-wake rhythm (i.e., circadian rhythm), are associated with autism spectrum-related traits. Accelerometer-derived sleepwake parameters were estimated in individuals with autistic spectrum traits and their family members (N = 267). We evaluated autism spectrum traits using the Social Responsiveness Scale (SRS) to assess the presence and severity of social impairment and the Behavior Rating Inventory of Executive Function (BRIEF) to assess executive function. The linear multivariate regression analysis (using SOLAR-Eclipse) showed that in adults, increased core autism spectrum traits and executive dysfunction were associated with disruption of several sleep-wake parameters, particularly related to the daily sleep-wake rhythm, and that executive dysfunction was associated with disrupted sleep quality and level of physical activity. We highlight the interplay between daytime function and disrupted sleep-wake patterns, specifically related to the daily sleep-wake rhythm, that could guide future research into common mechanisms. Lay SummaryAutistic children and adults often report sleep disturbances. To dissect the relationship between a range of autism spectrum traits and sleep-wake patterns, we assessed social interaction and executive function in participants who also wore actimetry watches on their wrists to assess their sleep-wake patterns. We found that increased impairments in social and executive function occurred with Stacey D. Elkhatib Smidt and Arpita Ghorai should be considered joint first authors.

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

“…In this study, we also report that a lower percentage of hours of nighttime sleep and lower stability of motor activity, sleep, and light exposure are associated with restrictive behavior, self-injurious behavior, somatic complaints, and withdrawal. Though no causal relationships can be drawn from our data, these results are in agreement with previous studies that found higher variability and a decreased strength of the circadian rhythm in those with more pronounced core autism spectrum traits (Elkhatib Smidt et al, 2021 ; Yavuz-Kodat et al, 2020 ).…”

“…Though most earlier research has relied on subjective data to measure sleep functioning, use of objective data has increased in recent years, with a number of papers including polysomnography or actigraphy to analyze the relationship between sleep and behavior difficulties in ASD (Aathira et al, 2017 ; Allik et al, 2006a ; Elia et al, 2000 ; Elkhatib Smidt et al, 2021 ; Fletcher et al, 2017 ; Gagnon et al, 2021 ; Goldman et al, 2009 ; Leader et al, 2022 ; Malow et al, 2006 ; Richdale et al, 2014 ; Yavuz-Kodat et al, 2020 ). New generation actigraphs such as Ambulatory Circadian Monitoring (ACM) devices offer valuable information about light, temperature and movement, allowing both sleep parameters and other circadian data to be collected in studies in autistic populations (Ballester et al, 2019 ).…”

“…New generation actigraphs such as Ambulatory Circadian Monitoring (ACM) devices offer valuable information about light, temperature and movement, allowing both sleep parameters and other circadian data to be collected in studies in autistic populations (Ballester et al, 2019 ). Despite the existence of these new devices, data on circadian rhythm for this population remain scarce (Bangerter et al, 2020 ; Elkhatib Smidt et al, 2021 ; Yavuz-Kodat et al, 2020 ). Therefore, it would be recommended that studies including objective sleep parameters would expand their analysis with circadian data, enhancing in such a way, the knowledge about autism and the circadian system.…”

Copy number variation at the 22q11.2 locus influences prevalence, severity, and psychiatric impact of sleep disturbance

“…To study the relationship between sleep and clinical symptoms and neurobehavioral traits, we selected assessments measuring traits and behaviors associated with sleep in other clinical populations including ASD and clinical high-risk for psychosis populations [ 13 , 14 , 44 – 46 ]. We tested if there was an effect of sleep on positive psychosis-risk symptoms, Autism-related behaviors, real-world executive function, and emotional or behavioral problems.…”

“…In a study of boys with ASD, sleep disturbance was found to moderate the relationship between ASD symptom severity and problem behaviors [ 13 ]. Sleep has also been shown to play a role in the executive functioning difficulties often observed in developmental psychiatric disorders [ 14 , 15 ]. For example, a recent cross-sectional study found sleep mediated the relationships between real-world executive function and both overall autistic traits and restrictive and repetitive behaviors [ 15 ].…”