Sleep interventions for children with attention deficit hyperactivity disorder (ADHD): A systematic literature review

Sleep duration, sleep problems and developmental trajectories of urinary incontinence: a prospective cohort study

To examine if preschool sleep duration and sleep problems are associated with urinary incontinence (UI) at primary school-age. We used multinomial logistic regression to examine the association of child sleep duration/problems (3½ years) with UI trajectories (4-9 years) in 8751 (4507 boys, 4244 girls) from the Avon Longitudinal Study of Parents and Children. We adjusted for sex, socioeconomic indicators, mothers' emotional/practical/financial support, developmental delay, stressful life events, temperament, and emotional/behaviour problems. Preschool children who slept more than 8½ hours per night had a decreased probability of UI at school-age. There was a 33% reduction in odds of daytime wetting per additional hour of sleep (odds ratio [OR] = 0.67, 95% confidence interval [CI] 0.52-0.86). Sleep problems were associated with increased odds of UI e.g., getting up after being put to bed was associated with daytime wetting (OR = 2.20, 95% CI 1.43-3.39); breathing problems whilst sleeping were associated with delayed bladder control (OR = 1.68, 95% CI 1.12-2.52), and night-time waking was associated with persistent (day and night) wetting (OR = 1.53, 95% CI 1.16-2.00). Waking during the night and waking up early in the morning were associated with reduced odds of bedwetting at school-age (OR = 0.76, 95% CI 0.61-0.96 and OR = 0.80, 95% CI 0.64-0.99 respectively). Preschool children who sleep for longer have a lower likelihood of UI at school-age, whilst those with sleep problems are more likely to experience daytime wetting and combined (day and night) wetting, but not bedwetting alone. Short sleep duration and sleep problems in early childhood could be indicators of future problems attaining and maintaining bladder control.

"Tell Me More About Your Child's Sleep": A Qualitative Investigation Of Sleep Problems In Children With ADHD

OBJECTIVE

To investigate parental experiences and perceptions of sleep problems in their children with Attention Deficit Hyperactivity Disorder (ADHD), the perceived impacts of sleep problems and coping strategies deployed by parents.

METHODS

Semi-structured interviews with twenty-six parents of pre-adolescent children with a diagnosis of ADHD, followed by thematic analysis of the interview transcripts.

RESULTS

Three themes were generated from the data: Children's Sleep Difficulties; Impacts of Children's Sleep; and Improving Children's Sleep. Sleep initiation problems in children with ADHD were commonly reported by parents, were perceived to be linked in a bidirectional manner with executive and emotional problems, and were reported as being disruptive to parental sleep. Some parents reported that their children's sleep problems were the initial prompt that lead to a diagnosis of ADHD. Parents reported utilizing a range of coping strategies to mitigate sleep problems, such as controlling the bedroom sensory environment and using emotional "wind down" as part of the bedtime routine. Some parents endorsed a beneficial effect of melatonin on their children's sleep.

CONCLUSIONS

Sleep problems in children with ADHD were perceived as important issues by parents. Equipping parents with evidence-based strategies for the management of their children's sleep may lead to benefits for the children, parents and wider household.

The efficacy of weighted blankets for sleep in children with attention-deficit/hyperactivity disorder-A randomized controlled crossover trial

Weighted blankets are a non-pharmacological intervention for treating sleep and anxiety problems in children with attention-deficit/hyperactivity disorder. However, research on the efficacy of weighted blankets is sparse. The aim of this randomized controlled trial with a crossover design (4 + 4 weeks) was to evaluate the efficacy of weighted blankets on sleep among children with attention-deficit/hyperactivity disorder and sleeping problems. Children diagnosed with uncomplicated Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition attention-deficit/hyperactivity disorder with verified sleep problems were randomized to start with either a weighted blanket or a lighter control blanket. Data collection was performed at weeks 0, 4 and 8 using actigraphy, questionnaires and a daily sleep diary. T-tests were used to evaluate efficacy. The study included 94 children with attention-deficit/hyperactivity disorder (mean age 9.0 [sd 2.2] years; 54 [57.4%] boys). Weighted blankets had a significant effect on total sleep time (mean diff. 7.72 min, p = 0.027, Cohen's d = 0.24), sleep efficiency (mean diff. 0.82%, p = 0.038, Cohen's d = 0.23) and wake after sleep onset (mean diff. -2.79 min, p = 0.015, Cohen's d = -0.27), but not on sleep-onset latency (p = 0.432). According to our exploratory subgroup analyses, weighted blankets may be especially beneficial for improving total sleep time in children aged 11-14 years (Cohen's d = 0.53, p = 0.009) and in children with the inattentive attention-deficit/hyperactivity disorder subtype (Cohen's d = 0.58, p = 0.016). Our results suggest that weighted blankets may improve children's sleep and could be used as an alternative to pharmacological sleep interventions.

Individual sleep need is flexible and dynamically related to cognitive function

Given that sleep deprivation studies consistently show that short sleep causes neurocognitive deficits, the effects of insufficient sleep on brain health and cognition are of great interest and concern. Here we argue that experimentally restricted sleep is not a good model for understanding the normal functions of sleep in naturalistic settings. Cross-disciplinary research suggests that human sleep is remarkably dependent on environmental conditions and social norms, thus escaping universally applicable rules. Sleep need varies over time and differs between individuals, showing a complex relationship with neurocognitive function. This aspect of sleep is rarely addressed in experimental work and is not reflected in expert recommendations about sleep duration. We recommend focusing on the role of individual and environmental factors to improve our understanding of the relationship between human sleep and cognition.

Developmental alcohol exposure is exhausting: Sleep and the enduring consequences of alcohol exposure during development

Prenatal alcohol exposure is the leading nongenetic cause of human intellectual impairment. The long-term impacts of prenatal alcohol exposure on health and well-being are diverse, including neuropathology leading to behavioral, cognitive, and emotional impairments. Additionally negative effects also occur on the physiological level, such as the endocrine, cardiovascular, and immune systems. Among these diverse impacts is sleep disruption. In this review, we describe how prenatal alcohol exposure affects sleep, and potential mechanisms of those effects. Furthermore, we outline the evidence that sleep disruption across the lifespan may be a mediator of some cognitive and behavioral impacts of developmental alcohol exposure, and thus may represent a promising target for treatment.

Factors contributing to U.S. parents' decisions to administer melatonin to children

OBJECTIVE

Pediatric melatonin use is increasingly prevalent in the U.S. despite limited research on its efficacy and long-term safety. The current study investigated factors contributing to parents' decisions whether to give children melatonin.

METHODS

Parents of children 1.0-13.9 years completed an online questionnaire on children's health, sleep, and melatonin use. Parents who reported giving melatonin to their child were asked open-ended follow-up questions on why their child takes melatonin and why they stopped (if applicable). Responses were assigned to categories through thematic coding.

RESULTS

Data were analyzed on 212 children who either consumed melatonin in the past 30 days (n = 131) or took melatonin previously (n = 81). Among children who recently took melatonin, 51.1 % exhibited bedtime resistance and 46.2 % had trouble falling asleep. Parents most commonly gave children melatonin to: help them fall asleep (49.3 %), wind down before bedtime (22.7 %), facilitate changes in their sleep routine (17.5 %), and/or change their circadian rhythm (11.4 %). Parents stopped giving melatonin because their child did not need it anymore (32.0 %), experienced negative side effects (9.3 %), and/or concerns about health and safety (13.3 %). Finally, parents initiated melatonin use on their own (50.0 %), were encouraged by a friend or family member (27.4 %), and/or followed the recommendation of a health provider (48.1 %).

CONCLUSIONS

Parents administered melatonin to children for a number of reasons and discontinued melatonin based on their own observations of a variety of effects. Parents frequently initiated use without the recommendation of a medical professional. Further research on indications and efficacy of melatonin and wider dissemination of guidelines are needed to help parents make informed decisions regarding children's sleep health.

MVPA and Motor Proficiency between Children with ADHD and Typical Development: Associations with Sleep Quality

PURPOSE

This study examined the associations of motor proficiency with moderate-to-vigorous physical activity (MVPA) and sleep quality in children with attention-deficit/hyperactivity disorder (ADHD) and children with typical development (TD).

METHODS

This cross-sectional study included 88 medical-naive children with ADHD age 6-12 yr (mean (SD) age, 8.43 (1.38) yr; 81.8% boys) and 40 age-matched children with TD (mean (SD) age, 8.46 (1.44) yr; 60% boys). MVPA was recorded by a wGT3X-BT accelerometer for 7 consecutive days. Motor proficiency was assessed using the Test of Gross Motor Development-Third Edition. Sleep quality was assessed using a self-report questionnaire.

RESULTS

Children with ADHD spent significantly less time in MVPA daily, displayed less proficiency in locomotor and ball skills, and reported poorer sleep quality (e.g., longer sleep latency, less sleep duration, and lower sleep efficiency) than children with TD. MVPA guideline attainment and sleep duration significantly predicted locomotor skills development; in turn, locomotor skills predicted MVPA guideline attainment. MVPA and ball skills increased by age in children with ADHD.

CONCLUSIONS

Our results highlight the importance of promoting MVPA, motor proficiency, and sleep duration in children with ADHD and TD since childhood.

2023 Guidelines on the Diagnosis and Treatment of Insomnia in Adults - Brazilian Sleep Association

Chronic insomnia disorder (simplified in this document as insomnia) is an increasingly common clinical condition in society and a frequent complaint at the offices of different areas of health practice (particularly Medicine and Psychology). This scenario has been accompanied by a significant evolution in treatment, as well as challenges in approaching patients in an appropriately way. This clinical guideline, coordinated by the Brazilian Sleep Association and the Brazilian Association of Sleep Medicine and counting on the active participation of various specialists in the area, encompasses an update on the diagnosis and treatment of insomnia in adults. To this end, it followed a structured methodology. Topics of interest related to diagnosis were written based on theoretical framework, evidence in the literature, and professional experience. As for the topics related to the treatment of insomnia, a series of questions were developed based on the PICO acronym (P - Patient, problem, or population; I - Intervention; C - Comparison, control, or comparator; O - Outcome). The work groups defined the eligible options within each of these parameters. Regarding pharmacological interventions, only the ones currently available in Brazil or possibly becoming available in the upcoming years were considered eligible. Systematic reviews were conducted to help prepare the texts and define the level of evidence for each intervention. The final result is an objective and practical document providing recommendations with the best scientific support available to professionals involved in the management of insomnia.