Sleep quality and restless legs syndrome in children with ADHD and their mothers: A case-control study

To compare sleep quality and restless legs syndrome (RLS) prevalence in children with attention-deficit/hyperactivity disorder (ADHD) and their mothers versus healthy controls, and to assess interrelations between sleep quality, RLS severity, and iron status in ADHD child-mother dyads.

This prospective, cross-sectional case-control study included 99 children aged 8-15 years with ADHD and their mothers, and 95 age- and sex-matched control dyads. The Pittsburgh Sleep Quality Index (PSQI) and International Restless Legs Syndrome Study Group (IRLSSG) criteria were used to assess sleep quality and RLS. Correlation analyses were used to explore the associations between sleep metrics and RLS severity.

The study enrolled 194 child-mother dyads: the mean age was 11.3 ± 1.9 years for children with ADHD and 11.2 ± 1.8 years for controls (p = 0.742). Children with ADHD showed poorer sleep quality than controls, with higher rates of sleep irregularity (43.4 % vs. 22.1 %, p = 0.001), difficulty initiating sleep (32.3 % vs. 12.6 %, p = 0.001), and daytime sleepiness (41.4 % vs. 11.6 %, p < 0.001). The mean PSQI scores were higher in children with ADHD than in those without (3.7 ± 2.5 vs. 2.4 ± 2.2, p < 0.001). Mothers of children with ADHD had poorer sleep profiles, with higher sleep irregularity (49.5 % vs. 22.1 %, p < 0.001) and higher PSQI scores (4.19 ± 2.88 vs. 3.7 ± 2.0, p = 0.043). RLS was found in 10.1 % of ADHD children and 19.2 % of mothers of children with ADHD (vs. 6.3 % and 9.5 % in the controls), the differences were not statistically significant. In children with ADHD, PSQI scores correlated positively with maternal PSQI scores (r = 0.457, p < 0.001), maternal RLS severity (r = 0.273, p = 0.007), and child RLS severity (r = 0.369, p < 0.001). Child sleep quality was inversely correlated with sleep duration (r = -0.502, p < 0.001). Among ADHD children with ferritin data (n = 64), those with ferritin ≥30 ng/mL had higher PSQI scores (4.3 ± 2.0 vs. 2.9 ± 1.6, p = 0.049).

Children with ADHD and their mothers experience significantly poorer sleep quality than matched control. Although RLS prevalence was not statistically different, the symptom severity and frequency were higher in the ADHD group. The observed correlations between child and maternal sleep quality and RLS severity underscore the necessity of a family-centered clinical approach in managing ADHD-related sleep disturbances.