Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactivity disorder: a two-night
Iva Prihodova1, Ivo Paclt, David Kemlink
1Department of Neurology, Charles University in Prague, 1st Faculty of Medicine and General Teaching Hospital, Prague, Czech Republic. iva.prihodova@lf1.cuni.cz
Insights
Children with attention-deficit/hyperactivity disorder (ADHD) show no significant differences in basic sleep macrostructure or sleep disorders compared to controls. However, ADHD children exhibited a first-night effect and greater vigilance variability, suggesting dysregulated arousal.
Area of Science:
- Pediatric Neurology
- Sleep Medicine
- Neurodevelopmental Disorders
Background:
- Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in children.
- Sleep disturbances are frequently anecdotally reported in children with ADHD.
- Objective evaluation of sleep patterns in ADHD is crucial.
Purpose of the Study:
- To compare sleep macrostructure, sleep disorders, and daytime sleepiness in children with ADHD versus controls.
- To investigate the impact of an adaptation night on sleep parameters in ADHD.
- To assess vigilance regulation using the Multiple Sleep Latency Test (MSLT).
Main Methods:
- Nocturnal polysomnography (PSG) for two nights followed by MSLT in 31 treatment-naïve children with ADHD and 26 age/sex-matched controls.
- Diagnosis of ADHD based on DSM-IV criteria, excluding comorbidities.
- Analysis of sleep macrostructure, sleep-disordered breathing (SDB), periodic limb movements in sleep (PLMS), and MSLT parameters.
Main Results:
- No significant differences in basic sleep macrostructure or sleep onset latency between ADHD and control groups.
- A first-night effect on sleep variables was observed exclusively in the ADHD group.
- No differences in the incidence of SDB, PLMS, or parasomnias; however, a significant trend difference in periodic limb movement index (PLMI) between nights was noted.
- Comparable mean sleep latency on MSLT, but significant inter-test variability in vigilance was found in the ADHD group.
Conclusions:
- PSG reveals no fundamental sleep macrostructure or sleep disorder differences in children with ADHD after accounting for adaptation night and excluding comorbidities.
- The findings do not support a direct link between ADHD and specific sleep macrostructure alterations or common sleep disturbances.
- Significant vigilance variability in the ADHD group during MSLT suggests potential dysregulated arousal, warranting further investigation.
Objective:
To evaluate sleep macrostructure, sleep disorders incidence and daytime sleepiness in attention-deficit/hyperactivity disorder (ADHD) affected children compared with controls.
Methods:
Thirty-one patients (26 boys, 5 girls, mean age 9.3±1.7, age range 6-12 years) with ADHD diagnosed according to DSM-IV criteria, without comorbid psychiatric or other disorders, as never before pharmacologically treated for ADHD. The controls were 26 age- and sex-matched children (22 boys, 4 girls, age range 6-12 years, mean age 9.2±1.5). Nocturnal polysomnography (PSG) was performed for two nights followed by the multiple sleep latency test (MSLT).
Results:
No differences between the two groups comparing both nights were found in the basic sleep macrostructure parameters or in the time (duration) of sleep onset. A first-night effect on sleep variables was apparent in the ADHD group. Occurrence of sleep disorders (sleep-disordered breathing [SDB], periodic limb movements in sleep [PLMS], parasomnias) did not show any significant differences between the investigated groups. A statistically significant difference (p=0.015) was found in the trend of the periodic limb movement index (PLMI) between two nights (a decrease of PLMI in the ADHD group and an increase of PLMI in the control group during the second night). While the mean sleep latency in the MSLT was comparable in both groups, children with ADHD showed significant (sleep latency) inter-test differences (between tests 1 and 2, 1 and 4, 1 and 5, p<0.01).
Conclusion:
After the inclusion of adaptation night and exclusion of psychiatric comorbidities, PSG showed no changes in basic sleep parameters or sleep timing, or in the frequency of sleep disorders (SDB, PLMS) in children with ADHD compared with controls, thus not supporting the hypothesis that specific changes in the sleep macrostructure and sleep disturbances are connected with ADHD. A first-night effect on sleep variables was apparent only in the ADHD group. Though we found no proof of increased daytime sleepiness in children with ADHD against the controls, we did find significant vigilance variability during MSLT in the ADHD group, possibly a sign of dysregulated arousal.
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