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Actigraphy-Derived Sleep Profiles of Children with and without Attention-Deficit/Hyperactivity Disorder (ADHD) over
Mirjam Ziegler1, Anna Kaiser1, Christine Igel1
1Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159 Mannheim, Germany.
Insights
Children with ADHD experience more sleep problems, including longer sleep onset latency and increased sleep disturbances. Early childhood sleep issues can predict later sleep difficulties in both children with and without ADHD.
Area of Science:
- Pediatric neurology
- Sleep medicine
- Neurodevelopmental disorders
Background:
- Sleep disturbances are prevalent in children with Attention-Deficit/Hyperactivity Disorder (ADHD).
- The extent, risk factors, and neurobiological underpinnings of sleep issues in ADHD remain incompletely understood.
- Intra-individual variability (IIV) in sleep patterns and chronotype have not been extensively studied in this population.
Purpose of the Study:
- To investigate sleep variables, including IIV, in school-aged children with ADHD compared to controls.
- To explore the role of precursor sleep symptoms and chronotype in ADHD-related sleep disturbances.
- To examine the association between sleep characteristics and neurobehavioral functioning in a subgroup of children.
Main Methods:
- Actigraphy was used for two weeks to collect sleep data from 57 children (6-12 years), including 24 with ADHD and 33 without.
- Linear mixed models were employed to analyze actigraphy-derived sleep variables, focusing on group differences and IIV.
- A stepwise regression model assessed the relationship between sleep parameters and neuropsychological functioning.
Main Results:
- Children with ADHD exhibited longer sleep onset latency (SOL), higher IIV in SOL, increased sleep movements, and lower sleep efficiency.
- A slightly greater sleep deficit was observed on school days versus free days in children with ADHD.
- Infancy sleep problems predicted later SOL and sleep movements in all children, irrespective of ADHD status.
- No significant group differences were found in chronotype or sleep onset time.
- Sleep problems did not show an additional impact on neuropsychological functioning beyond ADHD symptom severity.
Conclusions:
- Children with ADHD frequently experience significant sleep disturbances and variability.
- Early childhood sleep problems are predictive of later sleep issues, highlighting the importance of early intervention.
- Screening for and addressing sleep disturbances in children with ADHD is crucial for preventing long-term complications and enabling personalized treatment.
Abstract:
Although sleep problems are common in children with ADHD, their extent, preceding risk factors, and the association between neurocognitive performance and neurobiological processes in sleep and ADHD, are still largely unknown. We examined sleep variables in school-aged children with ADHD, addressing their intra-individual variability (IIV) and considering potential precursor symptoms as well as the chronotype. Additionally, in a subgroup of our sample, we investigated associations with neurobehavioral functioning (n = 44). A total of 57 children (6-12 years) with (n = 24) and without ADHD (n = 33) were recruited in one center of the large ESCAlife study to wear actigraphs for two weeks. Actigraphy-derived dependent variables, including IIV, were analyzed using linear mixed models in order to find differences between the groups. A stepwise regression model was used to investigate neuropsychological function. Overall, children with ADHD showed longer sleep onset latency (SOL), higher IIV in SOL, more movements during sleep, lower sleep efficiency, and a slightly larger sleep deficit on school days compared with free days. No group differences were observed for chronotype or sleep onset time. Sleep problems in infancy predicted later SOL and the total number of movements during sleep in children with and without ADHD. No additional effect of sleep problems, beyond ADHD symptom severity, on neuropsychological functioning was found. This study highlights the importance of screening children with ADHD for current and early childhood sleep disturbances in order to prevent long-term sleep problems and offer individualized treatments. Future studies with larger sample sizes should examine possible biological markers to improve our understanding of the underlying mechanisms.
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