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Sleep and alertness in children with ADHD
M Lecendreux1, E Konofal, M Bouvard
1Service de Psychopathologie de I'Enfant et de I'Adolescent, Hôpital Robert Debré, Paris, France. Marie-Christine.Mouren-Siméoni@rdb.ap-hp-Paris.fr
Insights
Children with attention-deficit/hyperactivity disorder (ADHD) exhibit increased daytime sleepiness and slower reaction times, indicating an alertness deficit not linked to nocturnal sleep quality. These findings highlight potential physiological markers for ADHD subtypes.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Sleep disturbances and alertness issues are frequently reported in children with ADHD, but underlying mechanisms require clarification.
Purpose of the Study:
- To evaluate sleep patterns and alertness levels in children diagnosed with ADHD.
- To investigate potential sleep-wake disorders contributing to ADHD symptoms.
- To explore the relationship between sleep/alertness measures and ADHD subtypes.
Main Methods:
- Polysomnography (PSG), Multiple Sleep Latency Test (MSLT), and reaction time (RT) tests were administered to 30 boys with ADHD (ages 5-10) and 22 controls.
- Participants were medication-free and had no clinical signs of sleep problems prior to the study.
- Sleep studies included 3 adaptation nights followed by daytime testing.
Main Results:
- No significant differences in nocturnal sleep variables were observed between children with ADHD and controls.
- Children with ADHD showed significantly shorter mean sleep latency on the MSLT (MSLT 1, 2, and 3; p < .05), indicating increased daytime sleepiness.
- Mean reaction times were significantly longer in children with ADHD across all tests (p < .05).
- MSLT sleep onset number and duration correlated significantly with hyperactivity-impulsivity and inattentive-passivity indices.
Conclusions:
- Children with ADHD demonstrate greater daytime sleepiness and prolonged reaction times, suggesting an alertness deficit.
- These findings are independent of alterations in nocturnal sleep quality.
- MSLT measures of daytime sleep onset are relevant physiological indices for differentiating ADHD subtypes.
- The results suggest a primary alertness deficit in ADHD, warranting further investigation.
Objective:
To evaluate sleep and alertness and to investigate the presence of possible underlying sleep/wake disorders in children with attention-deficit/hyperactivity disorder (ADHD).
Method:
After 3 nights of adaptation in a room reserved for sleep studies in the department of child psychiatry, children underwent polysomnography (PSG) followed by the Multiple Sleep Latency Test (MSLT) and reaction time tests (RT) during the daytime. Thirty boys diagnosed as having ADHD (DSM-IV), aged between 5 and 10 years, and 22 age- and sex-matched controls participated in the study. All children were medication-free and showed no clinical signs of sleep and alertness problems.
Results:
No significant differences in sleep variables were found between boys with ADHD and controls. The mean latency period was shorter in children with ADHD. Significant differences were found for MSLT 1, 2 and 3 (p < .05). Mean reaction time was longer in children with ADHD, with significant differences in all tests (p < .05). Number and duration of sleep onsets measured by the MSLT correlated significantly with the hyperactivity-impulsivity and inattentive-passivity indices of the CTRS and CPRS.
Conclusion:
Children with ADHD were more sleepy during the day, as shown by the MSLT, and they had longer reaction times. These differences are not due to alteration in the quality of nocturnal sleep. The number of daytime sleep onsets and the rapidity of sleep-onsets measured as MSLT were found to be pertinent physiological indices to discriminate between ADHD subtypes. These results suggest that children with ADHD have a deficit in alertness. Whether this deficit is primary or not requires further studies.