Sleep problems in autism: Sex differences in the school-age population

Area of Science:

• Neurodevelopmental disorders
• Sleep medicine
• Pediatric health

Background:

• Sleep problems are prevalent in school-aged autistic children, impacting cognition, behavior, and health.
• Sex differences in sleep disturbances within the autistic population are not well understood.
• Existing research lacks comprehensive data on sleep issues across sexes in school-aged autistic individuals.

Purpose of the Study:

• To investigate sex-based differences in the prevalence and nature of sleep problems among school-aged autistic children.
• To compare sleep patterns in autistic children with typically developing peers, analyzing sex-specific variations.
• To explore the relationship between intellectual ability, anxiety, and sleep problems in autistic children.

Main Methods:

• Utilized parent-reported data from the Children's Sleep Habits Questionnaire for 250 autistic and 114 typically developing (TD) children aged 6-12.
• Conducted direct assessments to confirm autism diagnosis and evaluate intellectual ability.
• Analyzed sleep problem prevalence, types, sleep duration, and anxiety correlations across groups.

Main Results:

• Autistic females (85%) showed significantly higher rates of sleep problems than autistic males (65.8%), TD females (44.8%), and TD males (42.4%).
• Autistic females reported more bedtime resistance, sleep anxiety, and sleepiness, with shorter sleep duration compared to autistic males.
• No significant sex differences were found in sleep onset delay, night wakings, parasomnias, or disordered breathing; intellectual ability was unrelated to sleep problems.

Conclusions:

• Autistic females exhibit a higher burden of sleep problems compared to autistic males and typically developing children.
• Sleep difficulties in autistic females manifest as increased resistance, anxiety, and daytime sleepiness.
• Clinical practices should address sleep issues in autistic females and anxiety in autistic males for improved outcomes.