Improving Sleep Quality Among Autistic Adults May Reduce CVD Risk

Lauren Bishop, PhD

New research published in Autism Research outlines how self-reported cardiovascular disease (CVD) risk factors were highly prevalent in autistic adults, with older age and male sex assigned at birth associated with greater numbers.

The findings indicates poorer sleep quality was associated with an increased number of CVD risk factors and with an increased likelihood of overweight or obesity, while using antipsychotic medications was associated with an increased likelihood of diabetes.

“Findings are highly suggestive that CVD risk factors represent a major risk factor for premature mortality among autistic adults and deserve increased attention in both clinical work and research,” wrote study author Lauren Bishop, PhD, Waisman Center, University of Wisconsin-Madison.

Approximately 40% of American adults are affected by CVD and its risk factors (high blood pressure, high cholesterol, diabetes, and overweight or obesity) and autistic adults may be disproportionately affected. Despite the growing knowledge on elevated risk factors in autistic people, there is limited research focusing specifically on the underlying mechanisms behind the high CVD prevalence.

The mechanisms in non-autistic adults suggest that both poorer sleep quality and higher levels of perceived stress are associated with increased CVD risk, with both known to be elevated in autistic relative to non-autistic adults. Antipsychotic medications also directly and indirectly increase risk for developing CVD risk factors and are often used to treat irritability and emotion dysregulation in autistic people.

The study recruited a sample of 545 autistic adults without intellectual disability aged 18 years or older through the Simons Foundation Powering Austic Research, Research Match service. Most were assigned female sex at birth (n = 350, 64.2%), were White (n = 437, 80.2%), and ranged in age from 18 to 77 years (mean, 41.0 years; SD = 13.45).

Investigators used multiple linear regression models to examine the association between key independent variables (self-reported perceived stress, sleep quality, and antipsychotic medication use) and CVS risk factors, controlling for demographic variables (age, sex assigned at birth, race, low-income status, and autistic traits).

Nearly 73.2% of autistic adults in the sample had high cholesterol, 45.3% had high cholesterol, 39.4% had high blood pressure, and 10.3% had diabetes.

Regarding the number of CVD risk factors, only about one-eighth of autistic adults (n = 69, 12.7%) had no CVD risk factors, while 33.4% (n = 182) of autistic adults had one CVD risk factor, 31.4% (n = 171) had two CVD risk factors, 18.2% (n = 99) had three CVD risk factors, and 4.4% (n = 24) had all four CVD risk factors.

The multiple linear regression analysis reported a significant, positive association between sleep quality and number of CVD risk factors, when controlling for traits such as age, sex, race, low-income status, autistic traits, perceived stress, and antipsychotic medication use. The findings indicated that better sleep quality was associated with fewer CVD risk factors.

Older age, male sex assigned at birth, and poorer sleep quality were associated with a higher number of CVD risk factors. Meanwhile, race, low-income status, autistic traits, perceived stress, and antipsychotic medication use were not significantly associated with a number of CVD risk factors.

The data suggest the use of antipsychotic medications led to a 106.5% increased likelihood of having diabetes, with the likelihood of having diabetes was increased by 3.6% for each additional year of age. Additionally, race, sex, autistic traits, perceived stress, and sleep quality were not significantly associated with diabetes.

Moreover, each additional unit of poorer sleep quality was reported to have a 6.5% increase in the likelihood that an autistic adult's BMI was in the range of overweight or obesity.

The research article, “Cardiovascular disease risk factors in autistic adults: The impact of sleep quality and antipsychotic medication use,” was published in Autism Research.