Short Report: Divergent Sleep-Wake Regularity in U.S. Children With Autism Spectrum Disorder: Bedtime vs Wake-up...

Sleep-wake regularity is an emerging dimension of sleep health, yet its association with autism spectrum disorder (ASD) remains understudied in nationally representative samples, particularly across distinct components of sleep timing. Using parent-reported data from 11,462 U.S. children aged 5-17 years in the 2022 and 2024 National Health Interview Survey, this study examined associations between ASD diagnosis and irregular bedtime and wake-up timing, including differences by age group. Multivariable logistic regression models were adjusted for sociodemographic characteristics, family context, daytime fatigue, and mental health indicators, with survey weights applied to account for the complex sampling design. In pooled analyses, ASD was associated with lower odds of irregular bedtime (adjusted odds ratio [aOR] = 0.64, 95% CI: 0.43-0.95) but higher odds of irregular wake-up times (aOR = 1.60, 95% CI: 1.01-2.56). Age-stratified analyses showed that the association with irregular wake-up timing remained in children (aOR = 2.27, 95% CI: 1.14-4.51) but not in adolescents, while no association was observed for bedtime in either age group. As one of the first nationally representative analyses distinguishing bedtime and wake-up regularity in ASD, these findings suggest that associations differ by timing component and age group, with wake-up timing representing a potential intervention target.Lay abstractMany children do not go to bed or wake up at the same time every day, which can affect their health and daily functioning. Sleep problems are especially common among autistic children, but most research has focused on how long they sleep or how well they sleep, rather than whether their sleep schedules are consistent. In this study, we used national survey data from the United States to examine whether autistic children differ from other children in how regularly they go to bed and wake up. Using data from the 2022 and 2024 National Health Interview Survey, we analyzed parent-reported information from over 11,000 children aged 5 to 17 years. Our results showed that autistic children were more likely to have consistent bedtimes but also more likely to have irregular wake-up times than children who were not autistic. This pattern remained after accounting for factors such as daytime tiredness and emotional well-being. These findings suggest that sleep challenges in autistic children may vary by time of day and developmental stage. In particular, maintaining consistent wake-up times may be more difficult for younger autistic children. Focusing on wake-up timing may therefore be a useful target for supporting sleep health in this group. Further research is needed to understand the reasons behind these differences and to identify effective ways to promote consistent sleep schedules.