Chronic Sleep Reduction and Psychopathology Symptoms in Adults with High-Functioning Autism Spectrum Disorder

Background:  Insomnias are common co-morbidities reported by individuals with ASD, with resultant reduced total sleep time. Individuals with ASD are also reported to have a higher prevalence of anxiety and depressive disorders. However, the relationship between sleep, chronic sleep reduction, and psychopathology in adults with ASD has not yet been investigated. 

Objectives:  To investigate the relationships between sleep, chronic sleep reduction and psychopathology symptoms in adults with a diagnosis of autism spectrum disorder (ASD) and no comorbid intellectual impairment compared to age-, sex-, and IQ-matched neuro-typical (NT) adults.

Methods:  Participants completed a questionnaire battery including the Chronic Sleep Reduction Questionnaire (CSRQ), the Patient Health Questionnaire, the State Trait Anxiety Inventory, and the Sleep Anticipatory Anxiety Questionnaire. Participants also completed a 14 day sleep/wake diary and 14-day actigraphy.

Results:  Thirty-six adults with ASD and no comorbid intellectual impairment and 57 NT adults completed the study. Currently data from 28 ASD and 28 NT participants has been analysed. These preliminary results showed that adults with ASD had significantly higher scores on all psychopathology measures; effect sizes were moderate to large. Adults with ASD also had significantly higher total scores on the CSRQ as well as on the shortness of sleep, irritability, and loss of energy sub-scales; effect sizes were also moderate to large. CSRQ scores were significantly and strongly correlated with all psychopathology variables in both groups. In assessing, psychopathology variables with sleep diary and actigraphy variables in the NT group, state anxiety was significantly correlated with total sleep time (TST; r = -.397) measured by both the diary and actigraphy. In addition, wake after sleep onset (WASO) duration measured by the diary was significantly associated with physiological sleep anxiety (r = .327), cognitive sleep anxiety (r = .363), and depression (r = .372). While in the ASD group only actigraphy variables were correlated with psychopathology measures. Specifically, state anxiety was significantly correlated with sleep onset latency (SoL; r = .356), WASO duration (r = .396), and sleep efficiency (r = -.433). Physiological sleep anxiety was associated with SoL (r = .340), and sleep efficiency (r = -.345), and depression was associated with WASO duration (r = .382), and sleep efficiency (r = -.346).

Conclusions:  The CSRQ measures symptoms of chronic sleep reduction and thus the impact of sleep debt. The strong correlations between chronic sleep reduction and psychopathology variables confirms the impact poor sleep can have on general wellbeing in both groups; however the relationship between psychopathology symptoms and sleep appears to differ between the two groups. Subjective feelings of poor sleep are associated with increased symptoms of psychopathology in NT adults; however objective poor sleep is related to increased symptoms of psychopathology in ASD adults. It may be that NT adults are more inclined to under-report their sleep while ASD adults with increased psychopathology symptoms may not perceive their sleep to be as problematic. Data for the full sample of participants will be available at the time of presentation.