Assessing a hyperarousal hypothesis of insomnia in adults with autism spectrum disorder
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This study aimed to investigate the relationship between sleep, psychopathology (anxiety, depression and presleep arousal) symptoms, and cortisol in adults with autism spectrum disorder (ASD). The sample composed of 29 adults with ASD (51.7% males) and 29 control adults (51.7% males) aged 21–44 years. Thirteen adults with ASD were medicated for a comorbid diagnosis of anxiety and/or depression (ASD‐Med), while the remaining 16 adults with ASD were not medicated for such diagnoses (ASD‐Only). Participants completed a questionnaire battery, 14‐day sleep/wake diary and 14‐day actigraphy assessment. On one day during the data collection period, participants collected five saliva samples, hourly, prior to sleep and two morning samples; immediately upon waking and 30 min thereafter for the analysis of cortisol. Cortisol 1 hr prior to habitual sleep onset time was associated with poorer sleep efficiency in both ASD groups and increased wake after sleep onset duration (ASD‐Only). Higher subjective somatic arousal was also associated with increased sleep onset latency, regardless of group, and poorer sleep efficiency in the ASD‐Only group. ASD‐Only participants had significantly greater reductions in evening cortisol concentrations compared to both ASD‐Med and control participants. No significant group differences were found for the cortisol awakening response. Findings suggest a hyperarousal hypothesis of insomnia in adults with ASD. Moreover, the low cortisol levels observed in ASD‐Only adults suggest dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis. Longitudinal studies exploring the interplay between insomnia, anxiety and HPA axis regulation across the lifespan in those with ASD are warranted. Autism Res 2019, 12: 897–910. © 2019 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary: Both objective (cortisol) and subjective (somatic) physiological arousal were associated with poor sleep quality in adults on the autism spectrum. Adults with autism spectrum disorder (ASD) who were not medicated for a comorbid diagnosis of anxiety and/or depression also had dampened cortisol secretion, suggesting a dysregulation of the hypothalamic pituitary axis. Longitudinal studies investigating the relationship between sleep, psychopathology symptoms and physiological arousal in autistic individuals are warranted. Autism Res 2019. © 2019 International Society for Autism Research, Wiley Periodicals, Inc.
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Poor sleep is associated with symptoms of depression and anxiety.
“poor sleep is associated with symptoms of depression and anxiety (1–12)”
From Sleep disturbances and psychological well-being among military medical doctors of the Swiss Armed Forces: study protocol, rationale and development of a cross-sectional and longitudinal interventional study (2024) · cites this paper as [3]
The Introduction (page unavailable) states that poor sleep in people with ASD has been associated with anxiety. The Wake After Sleep Onset results (page unavailable) find an association with depression symptoms only in the medicated ASD group, not the other groups. The source therefore supports parts of the claim, but not its unqualified implication that poor sleep is associated with both symptom types generally. (LLM, conf=0.88)
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Martínez‐Cayuelas, E., García‐Muñoz, A. M., de Ocaña‐Moreno, M. L. S., Richdale, A. L., Gisbert, L., Lugo‐Marín, J., Rodríguez-Morilla, B., Peiró, A. M., Victoria‐Montesinos, D., López‐Anguas, C., et al. (2025) · Autism Research · doi:10.1002/aur.70058 · Cited by 2 · see citing works
Self-citationA scientometric analysis investigating melatonin and cortisol in the context of sleep in autism
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Aperiodic and periodic neural activity during sleep in autism spectrum disorders
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Self-citationSleep in Children with Neurodevelopmental Disorders
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Self-citationCognitive Factors in Sleep in Children with Autism Spectrum Disorder
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“I Need Sleep Now”: A Qualitative Study of Sleep and Mothers of Autistic Individuals
Knutson, L. M., & Badahdah, A. M. (2026) · Family Relations · doi:10.1111/fare.70401
- Authors
- Baker, E. K., Richdale, A. L., Hazi, A., & Prendergast, L. A.
- Affiliations
- The University of Melbourne (AU)
- La Trobe University (AU)
- Corresponding author
- Baker, Emma K.
- Venue
- Autism Research
- Publisher
- Wiley
- Published
- 2019-03-21
- Volume
- 12
- Issue
- 6
- Pages
- 897-910
- ISSN
- 1939-3792 (ISSN-L)
- 1939-3806
- OpenAlex
- W2922944062
- Cited by
- 42
- References
- 66
- Citations by year
- 2026: 6 · 2025: 3 · 2024: 5 · 2023: 4 · 2022: 8 · 2021: 5 · 2020: 8 · 2019: 3
- FWCI
- 7.08
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Autism Research (publishedVersion)
- PubMed (publishedVersion)
- Minerva Access (University of Melbourne) (submittedVersion)
- Topics
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Life Sciences › Neuroscience › Cognitive Neuroscience › Sleep and Wakefulness Research
- Keywords
- autism spectrum disorder, insomnia, cortisol, HPA axis dysregulation, sleep efficiency, wake after sleep onset, sleep latency, somatic arousal, anxiety, depression, autistic adults, cortisol awakening response
- MeSH terms
- Autism Spectrum Disorder, Adult, Anxiety Disorders, Arousal, Depressive Disorder, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Sleep Initiation and Maintenance Disorders, Longitudinal Studies, Male, Pituitary-Adrenal System, Surveys and Questionnaires, Saliva, Comorbidity, Young Adult
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