Effects of atomoxetine and methylphenidate on sleep in children with ADHD
R Bart Sangal1, Judith Owens, Albert J Allen
1Clinical Neurophysiology Services, PC, Troy, MI, USA.
Insights
Atomoxetine improved sleep onset latency and overall sleep quality in children with ADHD compared to methylphenidate. Both medications showed similar ADHD treatment efficacy, but atomoxetine had fewer sleep-related side effects.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Pharmacology
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Sleep disturbances are frequently observed in children with ADHD, impacting their daily functioning and treatment outcomes.
- Pharmacological interventions for ADHD, such as atomoxetine and methylphenidate, can have varying effects on sleep patterns.
Purpose of the Study:
- To compare the effects of atomoxetine and methylphenidate on sleep in children diagnosed with ADHD.
- To evaluate and compare the efficacy of atomoxetine and methylphenidate in treating ADHD symptoms in this pediatric population.
Main Methods:
- A randomized, double-blind, crossover trial was conducted across two sleep disorder centers.
- Eighty-five children diagnosed with ADHD received either twice-daily atomoxetine or thrice-daily methylphenidate for approximately 7 weeks each.
- Sleep parameters were assessed using actigraphy and polysomnography, alongside child and parent diaries for subjective reporting.
Main Results:
- Methylphenidate significantly increased sleep-onset latency compared to atomoxetine, as evidenced by actigraphy and polysomnography data (39.2 vs 12.1 minutes).
- Children and parents reported improved sleep onset, better morning wake-up, and overall better sleep with atomoxetine versus methylphenidate.
- No significant differences were found in the primary efficacy measures for ADHD treatment between the two medications, though atomoxetine showed benefits in secondary measures.
Conclusions:
- Twice-daily atomoxetine resulted in shorter sleep-onset latencies compared to thrice-daily methylphenidate in children with ADHD.
- Both medications reduced nighttime awakenings, with a more pronounced effect observed with methylphenidate.
- Atomoxetine was associated with fewer treatment-emergent adverse events related to sleep, such as insomnia, compared to methylphenidate.
Study Objectives:
This study compared the effects of atomoxetine and methylphenidate on the sleep of children with attention-deficit/hyperactivity disorder (ADHD). This study also compared the efficacy of these medications for treating ADHD in these children.
Design:
Randomized, double-blind, crossover trial.
Setting:
Two sleep disorders centers in the United States; 1 in a private-practice setting and 1 in a hospital setting.
Patients:
85 children diagnosed with ADHD.
Interventions:
Twice-daily atomoxetine and thrice-daily methylphenidate, each for approximately 7 weeks.
Measurements And Results:
Relative to baseline, the actigraphy data indicated that methylphenidate increased sleep-onset latency significantly more than did atomoxetine (39.2 vs 12.1 minutes, p < .001). These results were consistent with the polysomnography data. Child diaries indicated that it was easier to get up in the morning, it took less time to fall asleep, and the children slept better with atomoxetine, compared with methylphenidate. Parents reported that it was less difficult getting their children up and getting them ready in the morning and that the children were less irritable, had less difficulty getting ready for bed, and had less difficulty falling asleep with atomoxetine, compared with methylphenidate. There were no significant differences between medications using the main measures of efficacy for ADHD treatment. Atomoxetine was superior on some secondary ADHD treatment-efficacy measures, based on parent reports. The only significant differences in treatment-emergent adverse events were greater incidence of decreased appetite and greater incidence of insomnia with methylphenidate.
Conclusions:
Patients receiving twice-daily atomoxetine had shorter sleep-onset latencies, relative to thrice-daily methylphenidate, based on objective actigraphy and polysomnography data. Although both medications decreased nighttime awakenings, the decrease was greater for methylphenidate.
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