Differential effects of COVID-related lockdown on sleep-wake rhythms in adults with autism spectrum disorder compared to the general population

ABSTRACT

Introduction: COVID-related lockdown led to a radical modification of daily activities and routines which are known to affect sleep. Compared to the general population, participants with autism may be particularly vulnerable to the repercussions of lockdown on sleep, given their intrinsic inflexible adherence to routines and the high overall prevalence of sleep disturbances in this population. Method(s) The study is a French nation-wide online survey assessing sleep-wake rhythms and behaviours known to affect sleep (daily screen time, daylight exposure, physical activity), before and during COVID-related lockdown. Respondents were 207 adults with autism (56% female) and 1652 adults of the general population (77% female), with a mean age 35.3 years (SD 11.3). Between group comparison (before, during and difference between before and during lockdown) were conducted using logistic regressions adjusted on age and sex. Within group comparison (comparing before and during lockdown) were conducted using paired analyses (Mantel-Haenszel or Wilcoxon rank test accordingly). Result(s) Before lockdown, the adults with autism displayed on average later chronotype, lower sleep quality, more evening screen time, less exposure to daylight and less exercise (all p < 0.01). Lockdown affected all studied measures of sleep and related exposures in a similar way in both groups Poorer self-rated sleep quality as well as a less regular and delayed sleep-wake rhythm, longer screen time in the evening and less exposure to daylight (all p < 0.001). However, modification in sleep duration was not linear, with an increase of extremes (less than 6 h and more than 10 h) in both groups. Conclusion(s) Adults with autism displayed significantly higher levels of sleep and circadian rhythm disturbances and less favourable daily routines known to regulate sleep. While the effect of confinement on sleep and sleep related behaviours was similar in both groups, the results highlight that the pre-existing shift in circadian rhythms and lifestyles in adults with ASD further deteriorated during lockdown.