Differences between objective and subjective sleep measures in children with attention deficit hyperactivity disorder
Jiae Choi1, In-Young Yoon, Hyo-Won Kim
1Department of Neuropsychiatry, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea.
Insights
Parent-reported sleep issues in children with Attention-Deficit/Hyperactivity Disorder (ADHD) were not confirmed by polysomnography. This suggests behavioral disturbances may contribute to perceived sleep problems in ADHD.
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- Attention-Deficit/Hyperactivity Disorder (ADHD) is frequently associated with sleep disturbances.
- Objective assessment of sleep in children with ADHD is crucial for understanding underlying mechanisms.
Purpose of the Study:
- To compare sleep characteristics between children with ADHD and healthy controls using polysomnography and parental reports.
- To investigate the correlation between reported sleep problems and neurobehavioral functioning.
Main Methods:
- Polysomnography was conducted on 27 children with ADHD and 26 controls (aged 7-12).
- Parental questionnaires, including the Children's Sleep Habits Questionnaire and Child Behavioral Checklist (CBCL), assessed sleep problems and behavior.
- ADHD diagnosis was confirmed using the K-SADS-PL-K.
Main Results:
- Parents reported significantly more sleep problems in the ADHD group, including delayed sleep onset, shorter duration, night waking, parasomnias, and daytime sleepiness.
- Polysomnography revealed no significant differences in sleep structure, arousals, or respiratory disturbances between groups.
- Reported sleep issues correlated with various CBCL subscales and the total score.
Conclusions:
- Parental reports of sleep problems in children with ADHD are not consistently supported by objective polysomnographic findings.
- The discrepancy suggests that behavioral factors common in ADHD may contribute to perceived sleep disturbances rather than objective sleep pathology.
Study Objectives:
To assess sleep characteristics in children with ADHD through polysomnographic recordings and parental reports of sleep problems.
Methods:
Standard overnight polysomnography evaluation was performed to record sleep in 27 children with ADHD and 26 healthy controls, aged 7 to 12 years. The diagnosis of ADHD was determined by the Korean version of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL-K). Children taking any medications or in poor health were excluded. All the subjects were assessed with the Children's Sleep Habits Questionnaire which was completed by parents. Overall neurobehavioral functioning was examined using various questionnaires, including the Child Behavioral Checklist (CBCL).
Results:
Based on the findings from the questionnaire, the ADHD group had significantly higher scores on the sleep onset delay (p = 0.027), sleep duration (p = 0.032), night waking (p = 0.006), parasomnias (p = 0.016), daytime sleepiness (p = 0.007), and total sleep disturbance factors (p < 0.001) than children in the control group. However, there were no differences between ADHD and healthy groups on any polysomnographic variables, including sleep structure, arousals, and respiratory disturbances. Reported sleep problems were significantly associated with almost all subscales of CBCL as well as CBCL total score.
Conclusions:
The majority of sleep problems reported by the parents of ADHD children were not verified through the use of polysomnography. These findings raise the possibility that some of the reported sleep problems in ADHD may be related to disturbing behaviors which often characterize children with ADHD.
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