Prevalence and Clinical Characteristics of the Restless Legs Syndrome (RLS) in Patients Diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) in Antioquia

Sleep Related Rhythmic Movement Disorder in older children and adults and their association with comorbid conditions - experience from two centres and literature review

Sleep related rhythmic movement disorders (SRRMD) are highly prevalent among infants and children and tend to disappear into adolescence and adulthood. However, few reports have identified patients who had rhythmic movements at wake-sleep transition persisting into adulthood. This is a case series of SRRMD diagnosed on video-polysomnography from retrospective chart review of patients, who were 6 years or older, seen in Sleep Neurology clinics in two centres by the senior author, over a 10 years period. In addition, an updated review of all papers published on the topic, since year 2000 is being reported. A total of nine patients (2 females) with SRRMD were included in this series with age ranging between 9 and 62 years. Five patients had comorbid primary sleep disorders and four others had associated neurodevelopmental disorders. Association with other primary sleep disorders like sleep apnea and restless legs syndrome and relief with treatment of the latter, has been highlighted.

Attention deficit hyperactivity disorder and restless leg syndrome across the lifespan: A systematic review and meta-analysis

This systematic review aims to assess the association between attention deficit hyperactivity disorder (ADHD) and restless legs syndrome (RLS) in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Databases were searched for original articles that reported prevalence data on ADHD and RLS until January 24th, 2023. Two independent reviewers evaluated the quality of the articles using the National Institutes of Health assessment tool. Among the 208 articles identified between 1996 and 2022, 29 were included. In large general population studies, 2.6-15.3% of participants met the RLS criteria, of which 3.2-17.4% presented with ADHD. In the ADHD group, RLS symptoms ranged from 11 to 42.9% in children and 20-33.0% in adults. This suggests a strong co-occurrence between RLS and ADHD. A common characteristic of these conditions is sleep fragmentation, as discussed in the reviewed papers. Although large-scale studies with comparable diagnostic criteria across the lifespan are required, our findings may advocate a possible common physiological pathway, including sleep fragmentation and dopaminergic system impairment.

Role of Psychologists in Pediatric Sleep Medicine

Sleep disorders commonly afflict infants, children, and adolescents and have a significant adverse impact on them and their families, sometimes to a severe degree. They can cause immediate stress and suffering and long-term loss of opportunities and potential. Many of these disorders can be well managed by the psychologist and often one is required, either as the sole provider or as an integral part of a team. Sleep disorders have a bidirectional interplay with mental health disorders. The patient may therefore present initially to the psychologist, primary care provider, or the sleep medicine specialist.

A Cross-Sectional Comparative Study of Sleep Disturbances in Children with ADHD and Matched Controls

Background: Systematic reviews conducted on sleep disturbances in attention deficit hyperactivity disorder (ADHD) have found inconsistent results due to the presence of several moderating variables which were not controlled for in previous studies. The aim of this study was to examine sleep disturbances in children with ADHD compared to their typically developing peers after controlling for moderating variables (age, sex, medication status, body mass index, and psychiatric and medical comorbidities). Methods: ADHD was diagnosed using DSM-IV-TR criteria (Diagnostic and Statistical Manual of Mental Disorders) and Conners’ Parent Rating Scales. Children recruited (aged 6−12 years) for the ADHD group (n = 40) met the following criteria: IQ > 80, unmedicated, and no psychiatric or medical comorbidities. The control group consisted of age- and sex-matched typically developing peers (n = 40). Sleep was assessed subjectively (through parent reported questionnaires and sleep logs) and objectively (using video polysomnography). Results: 65% of children with ADHD had a sleep disorder, as compared to 17% of controls. The ADHD group reported more sleep disturbances and disorders, both on subjective measures and objective measures. Conclusions: Sleep disturbances and primary sleep disorders in children with ADHD exist independent of moderating variables and differences in sleep assessment methods, thereby bolstering support for previously documented literature on the ADHD and sleep connection.

Restless legs syndrome and iron deficiency in adults with attention-deficit/hyperactivity disorder

STUDY OBJECTIVE

The association between restless legs syndrome (RLS), periodic leg movements during sleep (PLMS) and iron deficiency has been reported in children with attention-deficit/hyperactivity disorder (ADHD); however little is known in adults. The aim of this study was to assess frequencies of RLS, PLMS and other leg movements (LM) and iron deficiency and their relationships with ADHD phenotype in adults with ADHD.

METHODS

Two hundred adults with ADHD (112 males, median age 31 years) were evaluated on lifetime ADHD symptoms and sleep characteristics. RLS was diagnosed according to standard criteria. Serum ferritin levels were measured, with iron deficiency defined as <50 ng/mL. A subgroup of 48 ADHD patients with RLS, 48 ADHD without RLS and 48 controls underwent a polysomnography to record sleep, LM, and PLMS.

RESULTS

RLS was diagnosed in 33.0%, associated with earlier onset of ADHD, hyperactive presentation and more severe lifetime ADHD symptoms. Iron deficiency was found in 35.5% with higher frequency in patients with RLS. LM were more frequent in ADHD patients, with higher LM periodicity levels in those with comorbid RLS in comparison to controls. However, PLMS index did not differ between groups. Patients with ADHD and RLS had higher frequency of iron deficiency than other groups.

CONCLUSIONS

In a large sample of adults with ADHD, we individualized a subgroup characterized by earlier and severe ADHD symptoms, RLS, higher LM during sleep and iron deficiency. This endophenotype may reflect a different neurobiological mechanism that remains to be further studied.