Association Between Sleep Deficiencies with Behavioral Problems in Autism Spectrum Disorder: Subtle Sex Differences

Sleep problems are prevalent in people with autism spectrum disorder (ASD). Several studies have shown an association between sleep problems and severity of ASD-related behaviors. Most of these studies have not addressed potential sex differences either in the prevalence of the sleep problems or in their association with the manifestation of other behavioral issues in ASD. Given the strong prevalence of ASD in males, we thought it important to address whether sex differences exist in this realm. We examined the association of sleep problems with the severity of ASD-behavioral measures in a large data set collected from an online phenotyping project: Simons Foundation Powering Autism Research for Knowledge. We confirmed a high prevalence of sleep problems in ASD and a strong association between sleep problems and severity of other ASD-related behaviors. Furthermore, we were able to detect sex differences in these associations. In children with ASD, there was a slightly stronger association between repetitive behaviors and diagnosed sleep problems in females compared to males. In children without diagnosed ASD (undiagnosed siblings), there was a stronger association between sleep problems and impairments in social communication in males compared to females. These data highlight potential sex differences in the association of sleep problems and behavioral problems in ASD. LAY SUMMARY: We tested for sex differences in the association between sleep deficiencies and behavior in autism spectrum disorder (ASD). In children with ASD, we found the association between sleep problems and repetitive behaviors was slightly stronger in females. In siblings without diagnosed ASD, the association between sleep problems and social communication scores was stronger in males. These data suggest that sex might play a role in an association between sleep deficiencies and behavioral impairments.