Sleep disorders in Tourette syndrome: a primary or unrelated problem?

Sleep disturbances are a common complaint in children with either Tourette syndrome (TS) or attention-deficit hyperactivity disorder (ADHD). Because a significant number of individuals with TS also have ADHD, we attempted to determine whether sleep difficulties reported in TS are a primary problem or are related to the co-occurrence of ADHD. Using a parent-completed sleep questionnaire, data were collected on boys, ages 7-14 years. Three groups, TS-only (N = 57), ADHD-only (N = 21), and TS+ADHD (N = 89), were compared to an age-matched control population (N = 146). The complaint of "poor sleep" occurred in 26% with TS-only, 48% with ADHD-only, and 41% with TS+ADHD; all were significantly different from 10% found in controls. Of 19 sleep questionnaire items, the incidence of problems occurred statistically more frequently in 5 of 19 for the TS-only group, in 6 of 19 for the ADHD-only group, and in 17 of 19 for the TS+ADHD group. Boys with TS+ADHD had many sleep problems which appeared to be related to an arousal disorder. Although the use of medications, especially stimulants and anti-depressants, were different between the TS-only and TS+ADHD groups, this factor did not account for the large discrepancies in sleep disturbance. In boys with TS, sleep problems usually occurred with the co-morbid feature ADHD.