Review of the possible relationship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias, and circadian rhythm disorders (original) (raw)
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Sleep patterns and the risk for ADHD: a review
Nature and Science of Sleep, 2012
Attention-deficit/hyperactivity disorder (ADHD) is often associated with comorbid sleep disturbances. Sleep disturbances may be a risk factor for development of the disorder, a symptom of the disorder, or a comorbid condition affected by a similar psychopathology. Various studies have examined the impact of sleep deprivation on the presence/exacerbation of ADHD symptomology, as well as longitudinal and concurrent associations between different sleep disturbances and ADHD, yet the notion of sleep disturbances as a predecessor to ADHD remains unclear. As such, this review examines the evidence for sleep disturbances as a risk factor for the development of ADHD, as well as the mechanisms underlying the association between sleep patterns and ADHD. Additionally, clinical implications regarding the comorbid nature of sleep disturbances and ADHD will be considered.
Sleep, 2005
There is continuing speculation about the relationship between attention-deficit/hyperactivity disorder (ADHD) and obstructive sleep apnea (OSA) or periodic limb movement disorder (PLMD)/restless legs syndrome. The objective was to determine if a significant portion of children with ADHD diagnosed using DSM-IV criteria have OSA or PLMD. Sleep disorders centers in a private practice setting and a hospital setting. Children aged 6 to 14 years with ADHD were enrolled. Patients with snoring were not excluded. Although patients with snoring plus either observed apneic episodes in sleep or excessive daytime sleepiness were to be excluded, as were patients with restless legs at night, only 1 subject actually had to be excluded because of these criteria. Forty children were evaluated with a polysomnogram. A respiratory disturbance index cut-off of more than 5 per hour of sleep was used to diagnose OSA, and a periodic limb movement (with arousal) index cut-off of 5 or more per hour of sleep ...
Sleep in attention-deficit/hyperactivity disorder in children and adults: Past, present, and future
Sleep Medicine Reviews, 2012
The understanding that sleep can give rise to, or exacerbate symptoms of attention-deficit/hyperactivity disorder (ADHD), and that good sleep hygiene improves attention and concentration tasks has sparked interest in the investigation of possible etiological relationships between sleep disorders and ADHD. Studies indicate that 30% of children and 60e80% of adults with ADHD have symptoms of sleep disorders such as daytime sleepiness, insomnia, delayed sleep phase syndrome, fractured sleep, restless legs syndrome, and sleep disordered breathing. The range and diversity of findings by different researchers have posed challenges in establishing whether sleep disturbances are intrinsic to ADHD or whether disturbances occur due to co-morbid sleep disorders. As a result, understanding of the nature of the relationship between sleep disturbances/disorders and ADHD remains unclear. In this review, we present a comprehensive and critical account of the research that has been carried out to investigate the association between sleep and ADHD, as well as discuss mechanisms that have been proposed to account for the elusive relationship between sleep disturbances, sleep disorders, and ADHD.
Sleep Disturbances in Children With Attention‐Deficit/Hyperactivity Disorder
Journal of The American Academy of Child and Adolescent Psychiatry, 1998
In this article, we advocate the need for better understanding and treatment of children exhibiting inattentive, hyperactive, impulsive behaviors, by in-depth questioning on sleepiness, sleepdisordered breathing or problematic behaviors at bedtime, during the night and upon awakening, as well as night-to-night sleep duration variability. The relationships between sleep and attentiondeficit/hyperactivity disorder (ADHD) are complex and are routinely overlooked by practitioners. Motricity and somnolence, the most consistent complaints and objectively measured sleep problems in children with ADHD, may develop as a consequence of multidirectional and multifactorial pathways. Therefore, subjectively perceived or reported restless sleep should be evaluated with specific attention to restless legs syndrome or periodic limb movement disorder, and awakenings should be queried with regard to parasomnias, dyssomnias and sleep-disordered breathing. Sleep hygiene logs detailing sleep onset and offset quantitatively, as well as qualitatively, are required. More studies in children with ADHD are needed to reveal the 24-h phenotype, or its sleep comorbidities.
Case Reports of Sleep Phenotypes of ADHD: From Hypothesis to Clinical Practice
Journal of Attention Disorders, 2013
Objective: Five sleep ADHD phenotypes have been hypothesized: (a) the hypo-arousal state of the "primary" form of ADHD, (b) the sleep phase advanced disorder, (c) sleep disordered breathing (SDB), (d) restless legs syndrome and/or periodic limb movements disorder (PLMD), and (e) epilepsy. Method: Five case reports are presented; each child but one underwent video-polysomnography. Results: The first case report is an example of ADHD and SDB, with improvement of hypersomnolence after resolution of sleep apnea. The second case shows the impact of delayed sleep onset latency in the pathogenesis of ADHD, and the efficacy of melatonin. The third case report describes the association with PLMD, with amelioration after iron supplementation. The other two cases are examples of ADHD and epilepsy, with clinical improvement after antiepileptic treatment was started. Conclusion: A diagnostic and therapeutic algorithm should be designed to find the best first-line treatment for ADHD and sleep problems/epilepsy. (J. of Att. Dis. 2013; 17
Frontiers in Psychology, 2017
Objective: To compare the occurrence of a spectrum of different self-reported sleep problems in adults with ADHD and a control group, and to study the impact of current ADHD medication use and clinical ADHD subtype. Method: Cross-sectional study of 268 clinically ascertained adult ADHD patients (DSM-IV criteria) and 202 randomly selected controls. Sleep problems were self-reported using validated questions, partly from Global Sleep Assessment Questionnaire. Results: ADHD patients reported more sleep problems than controls: Lifetime occurrence of sleep problems (82.6 vs. 36.5%), hypnotics use (61.4 vs. 20.2%), current sleep duration below 6 h (26.6 vs. 7.6%), and symptoms/signs during the past 4 weeks of excessive daytime sleepiness, cataplexy, loud snoring, breathing pauses during sleep, restless legs, and periodic limb movements in sleep (significant odds ratios ranged from 1.82 to 14.55). Current ADHD medication use was associated with less cataplexy compared with not using medication. Patients with inattentive subtype reported better sleep quality and less restless legs than patients with hyperactive/impulsive subtypes. Conclusions: Adults with ADHD reported a very high occurrence of many different self-reported sleep problems, underlining the importance of screening for sleep disorders. Among the ADHD patients, medication use was not associated with more sleep-related symptoms, but in fact less cataplexy. When comparing ADHD subtypes, the inattentive subtype was associated with less sleep problems.
Sleep Study Abnormalities in Children With Attention Deficit Hyperactivity Disorder
Pediatric Neurology, 2009
The study objective was to describe polysomnographic findings in children with attention deficit hyperactivity disorder (ADHD) with diverse sleep problems. Polysomnographic data were retrospectively analyzed for 33 children (age 3-16 years) with ADHD who had sleep studies performed for diverse sleep complaints. Eight patients (24%) had obstructive sleep apnea, 10 (30%) had periodic limb movements of sleep, 8 (24%) had upper airway resistance syndrome, and 5 (15%) had obstructive hypoventilation. The ADHD group showed decreased sleep efficiency, increased arousal index, increased wake after sleep onset, decreased oxygen saturation nadir, and increased snoring, compared with control subjects. Compared with ADHD children without sleep disordered breathing, those who had sleep disordered breathing were significantly more obese and had more sleep architectural abnormalities (including increased sleep latency, increased rapid eye movement latency, increased wake after sleep onset, and increased arousal index with more oxygen desaturations), although total sleep time and sleep efficiency were not significantly different. Sleep disordered breathing and periodic limb movements of sleep appear to be common among children with ADHD who have symptoms of disturbed sleep. Ó
Sleep Medicine, 2009
To outline specific sleep disturbances in different clinical subsets of Attention Deficit/Hyperactivity Disorder (ADHD) and to confirm, by means of nocturnal video-polysomnography (video-PSG), a variety of sleep disorders in ADHD besides the classically described periodic leg movement disorder (PLMD), restless legs syndrome (RLS) and sleep related breathing disorder (SRBD).Fifty-five ADHD children (47 M, 8F; mean age = 8.9y) were included: 16 had Inattentive and 39 Hyperactive/Impulsive or Combined ADHD subtype. Behavior assessment by Conners and SNAP-IV Scales, a structured sleep interview and a nocturnal video-PSG were administered.Most children/parents reported disturbed, fragmentary sleep at night; complaints were motor restlessness (50%), sleep walking (47.6%), night terrors (38%), confusional arousals (28.5%), snoring (21.4%), and leg discomfort at night associated with RLS (11.9%). There is a significant difference (p value <0.05 or <0.001) in almost all the studied sleep variables between ADHD children and controls. International RLS Rating Scale scoring, Periodic Limb Movements during Sleep (PLMS) and Wake (PLMW) indexes, hyperactivity and opposition scores and ADHD subtype appear related. Different sleep disorders seem to address specific ADHD phenotypes and correlate with severity of symptoms as in sleep related movement disorders occurring in Hyperactive/Impulsive and Combined ADHD subtypes. Besides, an abnormality of the arousal process in slow wave sleep with consequent abnormal prevalence of disorders of arousal possibly enhanced by SRBD has also been detected in 52% of our sample.This study underlines the opportunity to propose and promote the inclusion of sleep studies, possibly by video-PSG, as part of the diagnostic screening for ADHD. This strategy could address the diagnosis and treatment of different specific ADHD phenotypic expressions that might be relevant to children’s symptoms and contribute to ADHD severity.