Resting-state microstate dynamics abnormalities in children with ADHD and co-occurring sleep problems

Children with attention-deficit/hyperactivity disorder often experience sleep problems, exacerbating symptoms, and cognitive deficits. However, the neurophysiological mechanisms underlying such deficits remained unclear. This study aims to use resting-state microstate analysis to investigate the neurophysiological characteristics in children with ADHD and sleep problems and explore whether neurophysiological abnormalities are associated with sleep problems.

Five-minute eyes-closed resting-state EEG data were collected in 34 children with both ADHD and sleep problems, 32 children with ADHD without sleep problems, and 22 healthy controls aged 6-12 years. Participants' parents completed the ADHD Rating Scale, Behavioral Rating Inventory of Executive Function, and Children's Sleep Habits Questionnaire. Five minutes of eyes-closed resting-state EEG data were collected, and agglomerative hierarchical clustering was used for microstate analysis. ANCOVAs, adjusted for sex and IQ, were used to compare ADHD symptoms, executive function, and microstate parameters across groups. Pearson partial correlations, controlling for sex and IQ, examined the association between microstate parameters and sleep problems.

Children with both ADHD and sleep problems exhibited more severe inattentive (20.4 ± 3.1 vs 18.0 ± 3.4, p < 0.05) and total symptoms (14.3 ± 6.0 vs 13.0 ± 5.3, p < 0.05), along with greater deficits in emotional regulation (1.88 ± 0.58 vs 1.60 ± 0.42, p < 0.05, organizational of materials 2.56 ± 0.41 vs 2.20 ± 0.55, p < 0.05, behavioral regulation (1.88 ± 0.40 vs 1.70 ± 0.36, p < 0.05), and global executive function (2.14 ± 0.30 vs 1.95 ± 0.30, p < 0.05), compared to children with ADHD without sleep problems. Moreover, Both ADHD groups exhibited significantly reduced microstate D occurrence and lower transition probability from microstate C to D compared to healthy controls (all p < 0.05). Additionally, no significant correlation was found between sleep problems and microstate parameters in all three groups after adjustment (all p > 0.05).

Children with both ADHD and sleep problems showed greater symptom severity and more pronounced executive function deficits compared to children with ADHD without sleep problems and healthy controls. Additionally, both ADHD groups showed overlapping atypical microstate parameters, suggesting children with co-occurring ADHD and sleep problems may share similar aberrant neurophysiological characteristics with children with ADHD alone. Resting-state EEG microstate parameters may serve as a sensitive tool for assessing sleep problems in children with ADHD, distinguishing them from typically developing children.