Sleep Characteristics in Children with Attention Deficit Hyperactivity Disorder: Systematic Review and Meta-Analyses
Amparo Díaz-Román1, Eva Hita-Yáñez1, Gualberto Buela-Casal1
1Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Granada, Spain.
Insights
This study found children with Attention Deficit Hyperactivity Disorder (ADHD) spend more time in stage 1 sleep compared to controls, suggesting a potential sleep physiology link. Further research is needed to confirm these findings.
Area of Science:
- Neuroscience
- Pediatrics
- Sleep Medicine
Background:
- Sleep disturbances are frequently reported in children with Attention Deficit Hyperactivity Disorder (ADHD).
- However, conclusive evidence for a distinct sleep physiology inherent to ADHD remains unclear.
- Existing studies lack sufficient data to establish a definitive relationship.
Purpose of the Study:
- To investigate whether a specific sleep physiology exists in children diagnosed with ADHD.
- To compare sleep parameters between children with ADHD and neurotypical control groups.
Main Methods:
- A comprehensive literature search was conducted across major databases (Web of Science, Scopus, PubMed, PsycINFO) and manual searches from 1987 to March 2014.
- Eleven studies meeting inclusion and quality criteria were selected from 8,678 retrieved articles.
- Two meta-analyses were performed using polysomnographic and actigraphic data from eight studies, employing a fixed-effects model and standardized mean difference (SMD).
Main Results:
- A statistically significant difference was observed in the polysomnography meta-analysis.
- Children with ADHD exhibited increased time spent in stage 1 sleep compared to control children (pooled SMD = 0.32, 95% CI = 0.08-0.55, p = 0.009).
- No significant differences were found in the actigraphy-based meta-analysis.
Conclusions:
- This review identified limited sleep differences between children with ADHD and controls.
- Further research is recommended, considering variables like assessment criteria and ADHD subtypes.
- Reliable conclusions for clinical practice and research necessitate addressing these factors in future studies.
Study Objectives:
Sleep disturbances have been associated with attention deficit hyperactivity disorder (ADHD), but such relationship is still unclear. The results from the studies conducted do not provide enough evidence to support a sleep physiology inherent to ADHD. This study tries to determine if that sleep physiology really exists by comparing children with ADHD and control children in some sleep parameters.
Methods:
A search was conducted in several databases (Web of Science, Scopus, Pubmed and PsycINFO), and a manual search, to retrieve all the articles available from 1987 until March 2014. Of 8,678 non-duplicate studies retrieved, 11 studies met the inclusion and methodological quality criteria. Two meta-analyses were performed with eight of those studies, depending on data provided by them: polysomnographic or actigraphic. A fixed-effects model, and the standardized mean difference (SMD) as the index of effect size, were used in both meta-analyses.
Results:
Significant differences were found only in the meta-analysis with polysomnography as outcome. Children with ADHD were found to spend more time in stage 1 sleep than controls (pooled SMD = 0.32, 95% CI = 0.08-0.55, p value = 0.009).
Conclusions:
Although few differences in sleep between children with ADHD and controls have been found in this review, further studies are required on this matter. Those studies should consider some variables discussed in this review, in order to obtain useful and reliable conclusions for research and clinical practice. Particularly, the influence of assessment criteria and ADHD subtypes in the sleep characteristics of children with ADHD should be addressed.
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