Association Between Age-Specific Sleep Sufficiency and Autism Spectrum Disorder in U.S. Children

This study aimed to examine the association between age-specific sleep sufficiency (ASSS) and autism spectrum disorders (ASD) among U.S. children aged 6-17 years.

Data were gathered from the 2022-2023 National Survey of Children's Health (NSCH), including 63,866 children. ASSS was defined based on age-specific sleep hours guidelines from the American Academy of Sleep Medicine. Descriptive statistics, incidence risk, and adjusted regression models were used to assess associations, whereas stratified models were conducted to explore effect modification. Additionally, a machine learning model was developed to predict conditional probability with ROC curve and calibration were used for model evaluation.

Children who did not meet ASSS recommendations had a significantly higher prevalence of ASD (5.16%) compared to those with ASSS (4.05%) (p < 0.001). In adjusted regression models, meeting ASSS criteria was associated with a markedly lower likelihood of ASD (OR = 0.78; 95% CI: 0.72-0.85; p < 0.001). Sex-stratified analyses demonstrated that this association persisted in both males (OR = 0.78; 95% CI: 0.71-0.86) and females (OR = 0.80; 95% CI: 0.68-0.93), though it was slightly stronger among males. Complementary machine learning analyses further supported these findings, revealing that females with sufficient sleep and aged below 14 years had the lowest predicted probability of ASD, whereas males aged 8-14 years without ASSS exhibited the highest likelihood of ASD.

ASSS was significantly associated with a lower likelihood of ASD, particularly among males, highlighting its role as an important behavioral factor and a potential focus for targeted psychological health interventions.