Sleep pattern consistency and autism spectrum disorder in U.S. children: Associations and identification of high-risk subgroups.

BACKGROUND

Sleep behavior is closely linked to autism spectrum disorder (ASD) and may influence behavioral and neurological development. This study examined the association between sleep pattern consistency (SPC) and ASD among children aged 6-17 years.

METHODS

This study used data from 63,866 children from the 2022-2023 National Survey of Children's Health (NSCH). ASD status was based on parent-reported provider diagnoses. SPC was constructed from sleep duration and bedtime regularity. Associations between SPC and ASD were examined using relative risks and multivariable logistic regression. Machine learning methods predicted individualized ASD profiles and identified high-risk subgroups. Model performance was evaluated using discrimination and calibration metrics.

RESULTS

The cohort showed 4.41 % ASD prevalence, mean age 11.9 years, 51.8 % male, 62.4 % healthy weight, 28.9 % poor sleep routines, 28.8 % lower income, 40.5 % co-occurring disorders, and 42.4 % with medication. Children with poor sleep routines (PSR) demonstrated a significantly higher likelihood of ASD (aOR: 1.92; 95 % CI: 1.64-2.25), whereas long sleep with regularity (LSR) was associated with a lower likelihood (aOR: 0.81; 95 % CI: 0.70-0.94). Other correlated factors included male sex (aOR: 3.83, p < 0.001), underweight (aOR: 1.28, p < 0.001), and overweight (aOR: 1.39, p < 0.001). Among female children from low-income households with co-occurring conditions, PSR patterns were associated with higher predicted ASD probability (∼12 %, p = 0.002), whereas healthy sleep routine (HSR) showed substantially lower predicted probabilities.

CONCLUSION

SPC was significantly associated with ASD. These findings highlight the potential relevance of sleep health in relation to developmental outcomes and ASD screening, particularly among higher-risk subgroups.