OBJECTIVE: This longitudinal study examined the impact of tic disorders on autonomic nervous system function using heart rate variability (HRV) as a biomarker and assessed its association with quality of life over a 1-year period. METHODS: The patient group comprised 39 individuals, of whom 19 were followed up after 1 year, whereas the control group included 30 individuals. Tic severity and quality of life were assessed using the Yale Global Tic Severity Scale and KIDSCREEN-27 questionnaire, respectively. HRV parameters were used to measure autonomic function during this period. RESULTS: At baseline, patients with tic disorders demonstrated lower HRV, particularly in low-frequency (LF) power, and a higher standard deviation of the average normal-to-normal intervals, indicating significant autonomic dysregulation compared to control participants. Over the 1-year follow-up period, these patients demonstrated a decline in HRV indices, particularly LF power. HRV metrics and quality of life scores exhibited significant correlations at baseline, indicating that a better autonomic balance status was associated with perceived better quality of life. During follow-up, the correlations between HRV measures and psychological/behavioral scales observed at baseline were altered and no longer significant, potentially reflecting the effects of treatment and homeostatic adaptation over time. CONCLUSION: Tic disorders are associated with persistent autonomic dysfunction, which progressively impair physiological regulation and quality of life. The findings of this study elucidate the significance of incorporating strategies for autonomic modulation into treatment plans for patients with tic disorders.