Trajectory of sleep patterns across adolescence in autistic and neurotypical youth

Study objectives

Changes in sleep-wake patterns are synonymous with the developmental transition to adolescence. To examine the trajectory of sleep-wake patterns in adolescents with autism spectrum disorder (ASD) compared to typically developing (TD) adolescents.

Methods

The total sample consisted of 244 participants, 140 with ASD and 104 who were TD. Sleep data were collected annually in a 4-year longitudinal study on pubertal development, at four time points (10–13 years, 11–14 years, 12–15 years, and 13–16 years). Changes in self-reported weekday and weekend bedtime and waketime across pubertal status were compared between TD and ASD participants, using mixed effects models adjusted for sex, reported night wakings, melatonin use and a diagnosis by puberty interaction. A repeated measures adjusted proportional odds model was used to model reported daytime sleepiness using the same independent variables.

Results

The ASD and TD groups differed in the change in bedtime across pubertal stages (diagnosis by puberty interaction, X² = 24.27, df = 3, p < 0.001). At time 1 (ages 10–13 years), bedtime was comparable in the autism and TD groups for both weekdays and weekends. As Tanner stage progressed, the TD group had later bedtimes compared to those with ASD. Moreover, there was a significant diagnosis by puberty interaction in daytime sleepiness (X² = 20.71, df = 3, p = 0.001) characterized by TD youth endorsing greater daytime sleepiness at later pubertal stages than ASD youth.

Conclusions

Autistic and TD adolescents exhibit differences in bedtime and daytime sleepiness with pubertal development. These differences may be related to hormonal differences or behavioral factors in these populations and warrant further study.