Sleep-Wake Cycle and Circadian Misalignment in People With Autism Across the Lifespan With an Emphasis on Living Conditions

Abstract

Sleep problems among individuals with autism spectrum disorder (ASD) are a persistent issue that spans from early childhood to adulthood. The present study aimed to objectively investigate sleep continuity and alignment using ambulatory circadian monitoring (ACM) in a group of autistic individuals, with and without intellectual disabilities. We studied 214 participants. Sleep continuity and alignment were assessed using a minimum of 3 days of ACM. Participants were divided into four groups: (1) age < 10 years (n = 40, 87.5% males, M = 6.78 ± 1.40 years), (2) age 10-17 years (n = 53, 90.6% males, M = 12.62 ± 2.04 years), (3) age 18-27 years (n = 59, 74.6% males, M = 23.50 ± 2.60 years), and (4) age 28-65 years (n = 62, 74.2% males, M = 39.04 ± 9.49 years). All groups had significantly impaired sleep outcomes, except for TST. Adults had longer SOL and WASO duration, than children and adolescents. However, those differences were attenuated if participants 'percentages of sleep parameters within normal range' were compared. When evaluating circadian misalignment, sleep M5 is delayed in children and adolescents (2:56 am and 3:00 am, respectively), and strongly advanced in the older adults (group 4). Sleep problems that manifest in autism during childhood can endure throughout adulthood. Furthermore, there is a necessity to investigate how living conditions, such as enforced schedules in residential facilities, can influence the timing of the sleep midpoint.