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Liang X, Qiu H, Li SX. Objectively measured sleep continuity in children and adolescents with ADHD: A systematic review and meta-analysis. Psychiatry Res 2023; 328:115447. [PMID: 37657199 DOI: 10.1016/j.psychres.2023.115447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/25/2023] [Accepted: 08/27/2023] [Indexed: 09/03/2023]
Abstract
Sleep disturbances are often linked to attention-deficit/hyperactivity disorder (ADHD). Consistent findings document that children and adolescents with ADHD report more sleep problems than their typically developing (TD) peers across subjective sleep domains. However, few differences between these groups were observed in objectively measured sleep parameters, such as polysomnography (PSG) and actigraphy. This study synthesized empirical studies to identify objectively measured sleep continuity differences between children and adolescents with ADHD and TD. We included observational research and baseline data from intervention studies between 5- to 18-year-old individuals with ADHD and their TD peers at five databases from inception and September 2022. This systematic review and meta-analysis of 45 articles, including 1622 children and adolescents with ADHD and 2013 TD, found that compared with TD, children and adolescents with ADHD have higher sleep latency and moderately decreased sleep efficiency measured by actigraphy. Polysomnography-measured differences between ADHD and TD were not significant. Medication status and comorbid psychiatric status significantly moderated the group differences in sleep efficiency between ADHD and TD. Also, the group differences in sleep latency between ADHD and TD were moderated by actigraphy recorded nights. These findings highlight the importance of reducing disparities in sleep parameters among children and adolescents with and without ADHD.
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Affiliation(s)
- Xiao Liang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
| | - Hui Qiu
- Department of Educational Administration and Policy, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Shirley Xin Li
- Department of Psychology, University of Hong Kong, Hong Kong SAR, China; State Key Laboratory of Brain and Cognitive Sciences, University of Hong Kong, Hong Kong SAR, China
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Malkani MK, Pestell CF, Sheridan AMC, Crichton AJ, Horsburgh GC, Bucks RS. Behavioral Sleep Interventions for Children With ADHD: A Systematic Review and Meta-Analysis. J Atten Disord 2022; 26:1805-1821. [PMID: 35758199 DOI: 10.1177/10870547221106239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE To evaluate intervention characteristics and components within behavioral sleep interventions in school-aged children with ADHD and examine evidence related to effectiveness. METHOD A systematic review was conducted using PsycINFO, Embase, MEDLINE, PubMed, and OpenGray. The subsequent meta-analysis used sleep outcomes to produce comparable effect sizes (Hedges' g) and compare intervention effects between randomized controlled trials and pre-post studies. RESULTS Eleven articles satisfied the inclusion criteria (562 children, across all groups, aged 5-14 years, M = 8.71). Studies reported improvements in sleep although there was marked heterogeneity between studies and limited use of objective sleep measures within them. On average, intervention groups improved more than control groups in the five randomized controlled trials (-0.46, 95% CI = [-0.58, -0.35], k = 4). CONCLUSION The findings support the use of behavioral sleep interventions for school-aged children with ADHD. Findings suggest that brief, individualized intervention may be more effective than standardized.
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Lyu J, Groeger JA, Barnett AL, Li H, Wang L, Zhang J, Du W, Hua J. Associations between gestational age and childhood sleep: a national retrospective cohort study. BMC Med 2022; 20:253. [PMID: 35934710 PMCID: PMC9358861 DOI: 10.1186/s12916-022-02443-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Accepted: 06/16/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Both sleep quality and quantity are essential for normal brain development throughout childhood; however, the association between preterm birth and sleep problems in preschoolers is not yet clear, and the effects of gestational age across the full range from preterm to post-term have not been examined. Our study investigated the sleep outcomes of children born at very-preterm (<31 weeks), moderate-preterm (32-33 weeks), late-preterm (34-36 weeks), early-term (37-38 weeks), full-term (39-40 weeks), late-term (41 weeks) and post-term (>41 weeks). METHODS A national retrospective cohort study was conducted with 114,311 children aged 3-5 years old in China. Children's daily sleep hours and pediatric sleep disorders defined by the Children's Sleep Habits Questionnaire (CSHQ) were reported by parents. Linear regressions and logistic regression models were applied to examine gestational age at birth with the sleep outcomes of children. RESULTS Compared with full-term children, a significantly higher CSHQ score, and hence worse sleep, was observed in very-preterm (β = 1.827), moderate-preterm (β = 1.409), late-preterm (β = 0.832), early-term (β = 0.233) and post-term (β = 0.831) children, all p<0.001. The association of pediatric sleep disorder (i.e. CSHQ scores>41) was also seen in very-preterm (adjusted odds ratio [AOR] = 1.287 95% confidence interval [CI] (1.157, 1.433)), moderate-preterm (AOR = 1.249 95% CI (1.110, 1.405)), late-preterm (AOR = 1.111 95% CI (1.052, 1.174)) and post-term (AOR = 1.139 95% CI (1.061, 1.222)), all p<0.001. Shorter sleep duration was also found in very-preterm (β = -0.303), moderate-preterm (β = -0.282), late-preterm (β = -0.201), early-term (β = -0.068) and post-term (β = -0.110) compared with full-term children, all p<0.01. Preterm and post-term-born children had different sleep profiles as suggested by subscales of the CSHQ. CONCLUSIONS Every degree of premature, early-term and post-term birth, compared to full-term, has an association with sleep disorders and shortened daily sleep duration. Preterm, early-term, and post-term should therefore all be monitored with an increased threat of sleep disorder that requires long-term monitoring for adverse sleep outcomes in preschoolers.
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Affiliation(s)
- Jiajun Lyu
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke Road, Shanghai, China
| | - John A Groeger
- NTU Psychology, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK
| | - Anna L Barnett
- Centre for Psychological Research, Oxford Brookes University, Oxford, UK
| | - Haifeng Li
- Department of Rehabilitation, The Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Zhejiang, China
| | - Lei Wang
- Maternal and Child Health Care Hospital of Yangzhou, Affiliated Hospital of Medical College Yangzhou University, Jiangsu, China
| | - Jiajia Zhang
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke Road, Shanghai, China
| | - Wenchong Du
- NTU Psychology, Nottingham Trent University, Burton Street, Nottingham, NG1 4BU, UK.
| | - Jing Hua
- Shanghai Key Laboratory of Maternal Fetal Medicine, Shanghai First Maternity and Infant Hospital, School of Medicine, Tongji University, 2699 Gaoke Road, Shanghai, China.
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Larsson I, Aili K, Nygren JM, Jarbin H, Svedberg P. Parents' Experiences of Weighted Blankets' Impact on Children with Attention-Deficit/Hyperactivity Disorder (ADHD) and Sleep Problems-A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:12959. [PMID: 34948571 PMCID: PMC8700927 DOI: 10.3390/ijerph182412959] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/10/2023]
Abstract
Sleep disturbances are common among children with attention-deficit/hyperactivity disorder (ADHD). While pharmacological treatment has increased dramatically, parents often prefer non-pharmacological interventions. Research on experiences of weighted blankets and their effect in sleep improvement is scarce. The aim of this study was to explore parents' experiences of weighted blankets for children with ADHD and sleep problems, and the impact on their children's sleep. The explorative design was based on qualitative content analysis. Interviews were conducted with a purposeful sample of 24 parents of children with ADHD and sleep problems, after completing a sleep intervention with weighted blankets for 16 weeks. Parents reported that children sleeping with weighted blankets: (1) achieved satisfactory sleep, including improved sleep onset latency, sleep continuity, and sleep routines; (2) achieved overall well-being, including improved relaxation and reduced anxiety; and (3) mastered everyday life, including improved balance in life, family function, and participation in school and leisure activities. This study brings forward novel aspects of the effects of improved sleep among children with ADHD. The findings contribute to the understanding of potential positive effects of an intervention with weighted blankets critical for clinical practice to improve sleep, well-being, and everyday life of children with ADHD and their families.
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Affiliation(s)
- Ingrid Larsson
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
| | - Katarina Aili
- Department of Health and Sport, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden;
| | - Jens M. Nygren
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
| | - Håkan Jarbin
- Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, SE-22184 Lund, Sweden;
- Child and Adolescent Psychiatry, Region Halland, SE-30185 Halmstad, Sweden
| | - Petra Svedberg
- Department of Health and Care, School of Health and Welfare, Halmstad University, SE-30118 Halmstad, Sweden; (J.M.N.); (P.S.)
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Pratiwi RDN, Fitri SYR, Mulya AP. The Interventions for Sleep Disorders in Children with Attention Deficit and Hyperactivity Disorder: A Narrative Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.7585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: Attention deficit and hyperactivity disorder (ADHD) is the most common neurodevelopmental disorder in childhood. Children with ADHD have more frequent comorbid sleep disorders than healthy children. The current methods of treating sleep disorders in ADHD children are still focused on pharmacological interventions which in fact only provide little benefit.
AIM: This study aims to identify existing studies regarding the types of nonpharmacological and complementary interventions for sleep disorders in children with ADHD using a narrative review approach.
METHODS: This was a narrative review. Inclusion criteria included articles in English and Bahasa, full-text articles, primary studies, and children with ADHD aged 18 years with or without comorbidities as the research sample, and the article having been published in the last 10 years. Searches were performed in several databases: PubMed, Springer, Web of Science, and Google Scholar.
RESULTS: The result showed that programs for managing sleep disorder in ADHD are behavioral therapy, behavioral parent training (BPT), behavioral sleep intervention, neurofeedback, mind-body therapy, L-theanine supplementation, horse milk supplementation, and play therapy. The programs are found to be effective in improving sleep.
CONCLUSION: The program most comprehensive with a high level of ease of implementation was BPT.
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Kalashnikova TP, Anisimov GV. [Features of the organization of sleep in children with attention deficit hyperactivity disorder]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 121:55-60. [PMID: 34078861 DOI: 10.17116/jnevro202112104255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The article presents modern ideas about the clinical features of sleep in children with attention deficit hyperactivity disorder (ADHD), the macrostructure of sleep, its cyclic organization and possible common links in the pathogenesis of sleep disorders and behavioral problems in patients. The relationship between the structure of sleep and impaired executive functions, the level of social maladjustment in patients with ADHD has been proven. Typical of children with ADHD are difficulty in going to sleep and falling asleep for a long time (resistance to sleep time), increased motor activity associated with sleep, including the association of ADHD with Restless legs syndrome (RLS) and periodic leg movement syndrome (PLMS), daytime sleepiness. The presence of circadian desynchrony in children with ADHD explains the relationship between chronotype, circadian typology, and clinical manifestations of the syndrome. Multidirectional data on the representation of REM sleep by nocturnal polysomnography in children with ADHD depend on age. However, the change in the proportion of REM sleep during the night is considered as a leading factor in the pathogenesis of ADHD manifestations. Various variants of metabolic disorders of melatonin, dopamine, serotonin, aggravated by social jet lag, are considered by the conjugatedcommon pathogenetic mechanisms of sleep disturbance and ADHD. As well as changes in the concentration of iron and ferritin in the blood, which may explain the frequency of RLS and PLMS in children with ADHD. The change in the number of sleep cycles during the night in patients has been demonstrated. Possible strategies for correcting sleep disorders in children with ADHD and their impact on the manifestation of ADHD are discussed.
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Affiliation(s)
| | - G V Anisimov
- The First Medical and Pedagogical Center «Lingua Bona», Perm, Russia
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Kapoor V, Ferri R, Stein MA, Ruth C, Reed J, DelRosso LM. Restless sleep disorder in children with attention-deficit/hyperactivity disorder. J Clin Sleep Med 2021; 17:639-643. [PMID: 33155540 PMCID: PMC8020699 DOI: 10.5664/jcsm.8984] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
STUDY OBJECTIVES Restless sleep is a very common parental complaint in children with attention-deficit/hyperactivity disorder (ADHD), but restless sleep has been seen in association with other comorbidities such as restless legs syndrome and obstructive sleep apnea. Restless sleep disorder (RSD) needs to be identified from other disorders when evaluating children with ADHD. In this study we aim to identify the prevalence of RSD in children with ADHD referred to our sleep center. METHODS This is a retrospective study of children with ADHD who underwent polysomnography. The following diagnostic and descriptive data were obtained for each patient: age, sex, presence/absence of RSD, other sleep disorders, psychiatric comorbidities, and medications. RSD was diagnosed per diagnostic criteria. RESULTS There were 66 children with ADHD. All of them underwent polysomnography, 17 were females, and 49 were males. Mean age was 11.6 years (± 3.6 standard deviation). The complaint of restless sleep was reported by the parents of 54 (81.1%) of the children; however, only 6 of them (9.1%) were diagnosed with RSD. Seventy-one percent had obstructive sleep apnea and 19.7% had restless legs syndrome. A significant number of patients had psychiatric comorbidities and were on various medications. CONCLUSIONS Although restless sleep is a common complaint reported in 81.1% of children with ADHD, only 9.1% had RSD. Most causes of restless sleep are secondary and associated with other sleep disorders, psychiatric comorbidities, or medication use.
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Affiliation(s)
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy
| | - Mark A. Stein
- University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
| | - Chris Ruth
- Seattle Children’s Hospital, Seattle, Washington
| | | | - Lourdes M. DelRosso
- University of Washington, Seattle, Washington
- Seattle Children’s Hospital, Seattle, Washington
- Address correspondence to: Lourdes M. DelRosso, Seattle Children’s Hospital, 4800 Sand Point Way NE, Seattle, WA 98105; Tel: (267) 559-4515;
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Abstract
Objective: Children with ADHD display higher rates of sleep problems, and both sleep disorders and ADHD have been shown to affect functioning in childhood. The current study examines the frequency and relationship between sleep problems and ADHD, and their impact on quality of life (QoL) and functional impairment. Method: Parents of 192 children with ADHD (M = 10.23 years) completed measures regarding their child's ADHD symptoms (Swanson, Nolan and Pelham [SNAP]), sleep disorders (Pediatric Sleep Questionnaire [PSQ]), QoL (Child Health Illness Profile [CHIP-PE]), and functioning (Weiss Functional Impairment Rating Scale-Parent Report [WFIRS-P]). Results: Common sleep complaints in participants were insomnia, excessive daytime sleepiness (EDS), and variability in sleep schedule. Regression analysis indicated that sleep problems and ADHD symptoms independently predicted lower levels of QoL (ΔR2 = .12, p < .001) and social functioning (ΔR2 = .12, p < .001). Conclusion: The results suggest that ADHD may coexist with somnolence and that both conditions have a significant impact on a child's functioning and QoL.
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Ruiz-Herrera N, Guillén-Riquelme A, Díaz-Román A, Cellini N, Buela-Casal G. Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures. Int J Clin Health Psychol 2019; 20:54-61. [PMID: 32021619 PMCID: PMC6994748 DOI: 10.1016/j.ijchp.2019.08.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/12/2019] [Indexed: 01/27/2023] Open
Abstract
To examine subjective and objective sleep patterns in children with different Attention-Deficit/Hyperactivity Disorder (ADHD) presentations. METHOD We assessed 92 children diagnosed with ADHD (29 ADHD-Inattentive [ADHD-I], 31 ADHD-Hyperactive/Impulsive [ADHD-H/I], and 32 ADHD-Combined [ADHD-C)]) aged 7-11 years. The Pediatric Sleep Questionnaire (PSQ), Pediatric Daytime Sleepiness Scale (PDSS), and a sleep diary were used as subjective sleep measures, and polysomnography was used to objectively assess sleep quantity, quality, and fragmentation. RESULTS Subjective data showed impaired sleep in 12.7% of the sample. No significant differences were found between ADHD presentations in any objective and subjective sleep variable. Nevertheless, data on sleep fragmentation suggested a worse sleep continuity for the ADHD-H/I group, and correlation analyses confirmed that sleep is affected by age. CONCLUSIONS Children with ADHD may suffer from sleep breathing problems and daytime sleepiness, as reported by their parents, even when their total sleep time and sleep efficiency are not affected. It seems that sleep in this population does not largely vary as a function of the ADHD presentation. Sleep in children with ADHD evolves with age.
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Affiliation(s)
- Noelia Ruiz-Herrera
- Laboratorio del Sueño y Promoción de la Salud; Centro de Investigación, Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, España
| | | | - Amparo Díaz-Román
- Laboratorio del Sueño y Promoción de la Salud; Centro de Investigación, Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, España
| | - Nicola Cellini
- Departamento de Psicología General, Universidad de Padua, Italia
| | - Gualberto Buela-Casal
- Laboratorio del Sueño y Promoción de la Salud; Centro de Investigación, Mente, Cerebro y Comportamiento (CIMCYC), Universidad de Granada, España
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Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies ✰. J Affect Disord 2019; 256:62-69. [PMID: 31158717 DOI: 10.1016/j.jad.2019.05.071] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 05/17/2019] [Accepted: 05/28/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND Several previous meta-analyses have investigated the association between sleep quality and attention-deficit/hyperactivity disorder (ADHD). To examine the relationship between short or long sleep duration and ADHD, a meta-analysis of observational studies was conducted. METHODS The PubMed, EMBASE, and Cochrane Library databases were systematically searched in March 2019 to retrieve observational studies. A random-effects model was used to analyze meta-estimates of sleep duration. Three evaluators independently reviewed and selected the articles based on pre-determined selection criteria. RESULTS Of 1466 articles retrieved, 10 observational epidemiological studies, comprising six case-control studies and four prospective cohort studies, were included in the final analysis. Short sleep duration was significantly linked to ADHD compared with average sleep duration (odds ratio [OR] or relative risk [RR] 1.28 [95% confidence interval (CI) 1.16-1.41]), and especially with hyperactivity (OR/RR 1.60 [95% CI 1.18-2.17]). Subgroup meta-analyses according to various factors, such as study design, number of participants, methodological quality, and adjustment for smoking status and education, yielded consistent results. A significant association between long sleep duration and ADHD was not observed. LIMITATIONS Publication bias and substantial heterogeneity due to the diverse measurement tools used to determine ADHD were observed. Lack of prospective cohort studies was another limitation. CONCLUSION Short sleep duration was associated with ADHD in the current meta-analysis. Clinicians may need to be more aware of this association.
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Díaz-Román A, Buela-Casal G. Shorter REM latency in children with attention-deficit/hyperactivity disorder. Psychiatry Res 2019; 278:188-193. [PMID: 31207456 DOI: 10.1016/j.psychres.2019.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 01/19/2023]
Abstract
The discrepancies in prior research about the actual sleep problems underlying attention-deficit/hyperactivity disorder (ADHD) demand more studies of children with this disorder. This study aimed to compare the subjective and objective sleep characteristics of 20 children with ADHD (DSM-IV criteria) and 20 typically developing children (aged 7-11 years). We assessed the children using sleep questionnaires and polysomnography recordings and analysed differences between the two groups using two-tailed Mann-Whitney U exact tests and Rosenthal's r as effect size measure. We also assessed associations between sleep measures and psychopathology using Spearman's correlation coefficients. No significant difference was found between the groups in almost any objective sleep variable, except for shorter REM latency in the ADHD group. Children with ADHD also showed significantly higher levels of daytime sleepiness and greater general sleep problems than control children, as reported by their parents, after discarding the primary sleep problems commonly associated with ADHD. Significant correlations were found between psychopathology and sleep measures. Our findings might support the link between narcolepsy-like sleep phenotype and ADHD. However, longitudinal research combining objective and subjective assessments should further explore the involvement of other variables, such as ADHD subtypes, medication, and comorbid symptoms in this relationship.
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Affiliation(s)
- Amparo Díaz-Román
- Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Spain.
| | - Gualberto Buela-Casal
- Sleep and Health Promotion Laboratory, Mind, Brain and Behavior Research Center, CIMCYC, University of Granada, Spain
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Sleep Disturbances Induced by Stimulants in Children with Attention-Deficit Hyperactivity Disorder. J Dev Behav Pediatr 2018; 37:775. [PMID: 27681098 DOI: 10.1097/dbp.0000000000000355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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13
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Garbazza C, Sauter C, Paul J, Kollek J, Dujardin C, Hackethal S, Dorn H, Peter A, Hansen ML, Manconi M, Ferri R, Danker-Hopfe H. Leg Movement Activity During Sleep in Adults With Attention-Deficit/Hyperactivity Disorder. Front Psychiatry 2018; 9:179. [PMID: 29780335 PMCID: PMC5945883 DOI: 10.3389/fpsyt.2018.00179] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 04/17/2018] [Indexed: 11/13/2022] Open
Abstract
Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls. Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of "periodicity," i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires. Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients. Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.
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Affiliation(s)
- Corrado Garbazza
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany.,Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Cornelia Sauter
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Juliane Paul
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Jenny Kollek
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Catharine Dujardin
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Sandra Hackethal
- Department of Neurology, University Hospital of Zurich, Zurich, Switzerland
| | - Hans Dorn
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Anita Peter
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Marie-Luise Hansen
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Mauro Manconi
- Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), Lugano, Switzerland
| | - Raffaele Ferri
- Sleep Research Centre, Department of Neurology I.C., Oasi Institute for Research on Mental Retardation and Brain Aging (IRCCS), Troina, Italy
| | - Heidi Danker-Hopfe
- Competence Centre of Sleep Medicine, Charité-Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health (BIH), Berlin, Germany
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Sakamoto N, Gozal D, Smith DL, Yang L, Morimoto N, Wada H, Maruyama K, Ikeda A, Suzuki Y, Nakayama M, Horiguchi I, Tanigawa T. Sleep Duration, Snoring Prevalence, Obesity, and Behavioral Problems in a Large Cohort of Primary School Students in Japan. Sleep 2017; 40:2980939. [PMID: 28364432 DOI: 10.1093/sleep/zsw082] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Study Objectives Poor or short sleep and the presence of snoring indicative of sleep-disordered breathing (SDB) have been associated with behavioral problems in school-aged children. We examined the relationship between SDB, sleep duration, obesity risk, and behavioral characteristics in Japanese elementary school students using a large-scale survey. Methods We conducted a cross-sectional study of children enrolled in all 46 public primary schools in Matsuyama city, Japan. The children's parents or guardians completed a questionnaire that covered sleep habits, presence of SDB risk, and behavioral characteristics. Results In total, 24 296 responses were received (90% response rate). After excluding incomplete responses, we analyzed complete datasets for 17 769 children. Mean sleep duration decreased with age, as did the prevalence of pediatric SDB. We found an increased risk for the presence of SDB and short sleep among overweight/obese children. With SDB or short sleep, we observed significantly increased odds of restless behaviors, fidgety behaviors, and poor concentration in school. Conclusions Shorter sleep duration was associated with increased risk of obesity, and in turn, obesity increased SDB risk. Both short sleep duration and SDB risk were significantly associated with behavioral problems in school.
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Affiliation(s)
- Naoko Sakamoto
- Department of Epidemiologic Research, Toho University, Tokyo, Japan
| | - David Gozal
- Department of Pediatrics, Pritzker School of Medicine, Biological Sciences Division, University of Chicago,Chicago, IL
| | - Dale L Smith
- Department of Health Sciences, University of Chicago, Chicago, IL
| | - Limin Yang
- Medical Support Center for Japan Environment and Children's Study, Tokyo, Japan
- National Center for Child Health and Development, Tokyo, Japan
| | - Noriko Morimoto
- National Center for Child Health and Development, Tokyo, Japan
| | - Hiroo Wada
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Kotatsu Maruyama
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Ai Ikeda
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Yohei Suzuki
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
| | - Meiho Nakayama
- Department of Otolaryngology and Good Sleep Center, Nagoya City University, Nagoya, Japan
| | - Itsuko Horiguchi
- Center for Relations Strategy, Nagasaki University, Nagasaki, Japan
| | - Takeshi Tanigawa
- Department of Public Health, Graduate School of Medicine, Juntendo University, Tokyo, Japan
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15
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Grünwald J, Schlarb AA. Relationship between subtypes and symptoms of ADHD, insomnia, and nightmares in connection with quality of life in children. Neuropsychiatr Dis Treat 2017; 13:2341-2350. [PMID: 28919767 PMCID: PMC5592957 DOI: 10.2147/ndt.s118076] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES This study examined the links between sleep disorders and subtypes of attention deficit-hyperactivity disorder (ADHD-inattention, ADHD-combined, ADHD-hyperactive/impulsive) in childhood. We set up a hypothetical model linking different symptoms of both disorders to construct the underlying and shared pathways. By examining a sample of children with ADHD we firstly tested parts of the model. METHODS A total of 72 children with symptoms of ADHD (aged 6-13 years; 79.2% boys) were diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition and the International Classification of Sleep Disorders, third edition in regards to ADHD and sleep disorders via standardized parent-rated questionnaires. Additionally, quality of life (QoL) was assessed. Overall, 46 children fulfilled the criteria of ADHD and were medication-naive. RESULTS On average, the whole sample had clinically elevated total scores of the Children's Sleep Habits Questionnaire in the validated German version (CSHQ-DE), indicating an increased prevalence of sleep disorders in children with ADHD. In accordance to our hypothetical model, children with primarily hyperactive-impulsive ADHD showed the highest CSHQ-DE scores. Moreover, we found a high impact for insomnia in this subgroup and a high comorbid load for the mutual occurrence of insomnia and nightmares. Furthermore, QoL was reduced in our whole sample, and again intensified in children with comorbid insomnia and nightmares. CONCLUSION We verified an elevated occurrence of sleep disorders in children with ADHD and were able to link them to specific subtypes of ADHD. These results were in line with our hypothetical model. Moreover, we found a clinically reduced QoL in mean for the whole sample, indicating the strong impact of ADHD in the lives of affected children, even intensified if children exhibited comorbid insomnia and nightmares. These results should be kept in mind regarding the treatment and therapy of this subgroup of children. Specific treatment strategies should be considered for these children.
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Affiliation(s)
- Julia Grünwald
- Department of Psychology, Faculty of Science, University of Tübingen, Tübingen
| | - Angelika Anita Schlarb
- Department of Clinical Psychology and Psychotherapy, Faculty of Psychology and Sports Science, University of Bielefeld, Bielefeld, Germany
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16
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Kalil Neto F, Nunes ML. Evaluation of sleep organization in patients with attention deficit hyperactivity disorder (ADHD) and ADHD as a comorbidity of epilepsy. Sleep Med 2017; 33:91-96. [DOI: 10.1016/j.sleep.2016.08.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2016] [Revised: 08/16/2016] [Accepted: 08/29/2016] [Indexed: 11/29/2022]
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