A Comprehensive Look at Risk Factors for Poor Quality Sleep in Adults with Autism

Rebecca Charlton, PhD

Sleep quality has profound impacts on an individual's physical and psychological well-being and research has progressed the understanding of how some mechanisms of sleep function. While there are already many factors that contribute to these functions when looking at sleep on its own, the variability expands even further when considering specific diagnoses.

In this evaluation, Rebecca Charlton, PhD, Department of Psychology, Goldsmiths University of London, and a team of investigations, focused on the sleep quality of adults with autism through a biopsychosocial lens in order to investigate a comprehensive range of predictors in this population. The biopsychosocial was utilized for its relevance to the target population, according to the study.

Issues with sleep have been studied in children with autism because they commonly experience them. Less is known about the effects of sleep quality across the autistic adult lifespan.

"Biopsychosocial models for sleep problems propose that biological and genetic predisposition for sleep problems, are reinforced by experience, environmental factors, and maladaptive coping," investigators wrote.

Details Determine Sleep Health

A total of 730 adults with autism between the ages of 18-78 years participated in the study after being recruited through Simons Powering Autism Research for Knowledge Research Match. They completed surveys online to report information on demographics, health problems, social support, symptoms of anxiety and depression, and sleep quality.

Investigators gathered detailed information in each category included in the surveys to be able to get a comprehensive profile and determine associations that may be relevant to the quality of sleep. In addition to detailed demographic information, the participating adults shared use of pyschotropic medication and existing health conditions, such as hypertension, history of cancer, arthritis, and more, as well as the number of health conditions currently, or historically, present.

Conditions related to sleep were not included in the physical health condition reporting for the regression analyses. In the sleep analyses, data were obtained from participants based on the Pittsburgh Sleep Quality Index (PSQI) which assessed overall sleep quality, and more specific sub-components like latency, duration, and disturbance among others.

Based on the aspect of sleep, responses were delivered in the format of a point scale or open-field text depending on what was appropriate. After compiling the data related to specific, and overall, aspects of participant sleep quality, investigators calculated a single overall sleep quality score, plus 7 sub-components of sleep:

1. Subjective sleep quality
2. Sleep latency
3. Sleep duration
4. Sleep efficiency
5. Sleep disturbance
6. Sleep medication use
7. Daytime dysfunction

Poor sleep quality was represented by a total overall sleep quality score higher than 5. This score indicated severe difficulties in at least 2 areas, or moderate difficulties in at least 3 areas.

Autism and Sleep Quality Predictors

Results showed that those who were assigned female at birth, had worse physical health, and self-reported symptoms of anxiety were vulnerable to poor sleep quality in all aspects. Daytime dysfunction, as well as overall, and subjective, sleep quality was influenced by perceived stress of the participant.

Depression symptoms did not show significant contributions to any of the models of sleep quality. Though, investigators assessed participants' utilization of government support in the surveys, which presented in the findings.

"Utilizing government support mechanisms (such as social security) contributed to the model of sleep efficiency," they wrote. "Age contributed little to models of sleep quality, whereas perceived stress and psychotropic medication use contributed to some but not all aspects of sleep."

Because of the insight gathered by these data showing the impacts that poor sleep can have not only on health, but also, cognition and quality of life, the team urged for more investigation, and attention to the possible everyday effects for individuals with autism of all ages.

The study, "Predictors of sleep quality for autistic people across adulthood" was published in Autism Research.