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Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit
D L Picchietti1, D J Underwood, W A Farris
1Pediatric Neurology, Carle Clinic, Urbana, Illinois, USA.
Insights
Children with attention-deficit hyperactivity disorder (ADHD) often experience more Periodic Limb Movements in Sleep (PLMS), leading to significant sleep disruption. This study highlights the necessity of sleep studies to accurately diagnose PLMS in ADHD patients.
Area of Science:
- Neurology
- Sleep Medicine
- Pediatrics
Background:
- Attention-deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder.
- Sleep disturbances, including Periodic Limb Movements in Sleep (PLMS), are frequently reported in children with ADHD.
- Parental reports of PLMS can be unreliable, necessitating objective sleep assessments.
Purpose of the Study:
- To investigate the prevalence of PLMS in children newly diagnosed with ADHD compared to controls.
- To explore the association between PLMS, sleep disruption, and ADHD symptoms.
- To examine the co-occurrence of Restless Legs Syndrome (RLS) in parents of children with ADHD.
Main Methods:
- Polysomnographic studies were conducted on 14 children with newly diagnosed ADHD and 10 control children.
- Periodic Limb Movements in Sleep (PLMS) and arousals were quantified during sleep studies.
- Parental interviews were conducted to assess for Restless Legs Syndrome (RLS) symptoms.
Main Results:
- Children with ADHD showed a significantly higher prevalence of PLMS (>5 per hour) than control children (64% vs. 0%, p <0.0015).
- Children with ADHD and PLMS experienced significantly less sleep at home (43 minutes less, p = 0.0091).
- Parents of children with ADHD had a higher likelihood of reporting RLS symptoms (32% vs. 0%, p = 0.011).
Conclusions:
- PLMS is more prevalent in children with ADHD and is associated with significant sleep disruption.
- PLMS may contribute to ADHD symptoms through sleep disturbance, or share common genetic or neurobiological factors with ADHD.
- Sleep studies are crucial for accurate diagnosis of PLMS in children with ADHD, and RLS screening in parents may be beneficial.
Abstract:
Fourteen consecutive children who were newly diagnosed with attention-deficit hyperactivity disorder (ADHD) and who had never been exposed to stimulants and 10 control children without ADHD underwent polysomnographic studies to quantify Periodic Limb Movements in Sleep (PLMS) and arousals. Parents commonly gave both false-negative and false-positive reports of PLMS in their children, and a sleep study was necessary to confirm their presence or absence. The prevalence of PLMS on polysomnography was higher in the children with ADHD than in the control subjects. Nine of 14 (64%) children with ADHD had PLMS at a rate of >5 per hour of sleep compared with none of the control children (p <0.0015). Three of 14 children with ADHD (21%) had PLMS at a rate of >20 per hour of sleep. Many of the PLMS in the children with ADHD were associated with arousals. Historical sleep times were less for children with ADHD. The children with ADHD who had PLMS chronically got 43 minutes less sleep at home than the control subjects (p = 0.0091). All nine children with ADHD who had a PLMS index of >5 per hour of sleep had a long-standing clinical history of sleep onset problems (>30 minutes) and/or maintenance problems (more than two full awakenings nightly) thus meeting the criteria for Periodic Limb Movement Disorder (PLMD). None of the control children had a clinical history of sleep onset or maintenance problems. The parents of the children with ADHD were more likely to have restless legs syndrome (RLS) than the parents of the control children. Twenty-five of 28 biologic parents of the children with ADHD and all of the biologic parents of the control children were reached for interview. Eight of twenty-five parents of the children with ADHD (32%) had symptoms of RLS as opposed to none of the control parents (p = 0.011). PLMS may directly lead to symptoms of ADHD through the mechanism of sleep disruption. Alternative explanations for the association between ADHD and RLS/PLMS are that they are genetically linked, they share a common dopaminergic deficit, or both.
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