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      Associations of sleep disturbance with ADHD: implications for treatment

      review-article
      Attention Deficit and Hyperactivity Disorders
      Springer Vienna
      Sleep, ADHD, Stimulant, Amfetamine, Methylphenidate, Atomoxetine

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          Abstract

          Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep. The relationships of ADHD with sleep problems, psychiatric comorbidities and medications are complex and multidirectional. Evidence from published studies comparing sleep in individuals with ADHD with typically developing controls is most concordant for associations of ADHD with: hypopnea/apnea and peripheral limb movements in sleep or nocturnal motricity in polysomnographic studies; increased sleep onset latency and shorter sleep time in actigraphic studies; and bedtime resistance, difficulty with morning awakenings, sleep onset difficulties, sleep-disordered breathing, night awakenings and daytime sleepiness in subjective studies. ADHD is also frequently coincident with sleep disorders (obstructive sleep apnea, peripheral limb movement disorder, restless legs syndrome and circadian-rhythm sleep disorders). Psychostimulant medications are associated with disrupted or disturbed sleep, but also ‘paradoxically’ calm some patients with ADHD for sleep by alleviating their symptoms. Long-acting formulations may have insufficient duration of action, leading to symptom rebound at bedtime. Current guidelines recommend assessment of sleep disturbance during evaluation of ADHD, and before initiation of pharmacotherapy, with healthy sleep practices the first-line option for addressing sleep problems. This review aims to provide a comprehensive overview of the relationships between ADHD and sleep, and presents a conceptual model of the modes of interaction: ADHD may cause sleep problems as an intrinsic feature of the disorder; sleep problems may cause or mimic ADHD; ADHD and sleep problems may interact, with reciprocal causation and possible involvement of comorbidity; and ADHD and sleep problems may share a common underlying neurological etiology.

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          Most cited references164

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          Diagnostic and statistical manual of mental disorders.

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            Cognitive, behavioral, and functional consequences of inadequate sleep in children and adolescents.

            Dean Beebe (2011)
            This article summarizes correlational, case-control, quasi-experimental, and experimental studies that have examined whether sleep during childhood and adolescence is related to daytime functioning. Published findings suggest that inadequate sleep quality and/or quantity can cause sleepiness, inattention and, very likely, other cognitive and behavioral deficits that significantly impact children and adolescents in functional settings. This article then integrates findings from longitudinal studies within a developmental psychopathology model. Important questions remain, but evidence supports the integration of sleep screening and interventions into routine clinical care and also supports advocacy for public policy changes to improve the sleep of children and adolescents. Copyright © 2011 Elsevier Inc. All rights reserved.
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              Sleep-disordered breathing and school performance in children.

              D Gozal (1998)
              To assess the impact of sleep-associated gas exchange abnormalities (SAGEA) on school academic performance in children. Prospective study. Urban public elementary schools. Two hundred ninety-seven first-grade children whose school performance was in the lowest 10th percentile of their class ranking. Children were screened for obstructive sleep apnea syndrome at home using a detailed parental questionnaire and a single night recording of pulse oximetry and transcutaneous partial pressure of carbon dioxide. If SAGEA was diagnosed, parents were encouraged to seek medical intervention for SAGEA. School grades of all participating children for the school year preceding and after the overnight study were obtained. SAGEA was identified in 54 children (18.1%). Of these, 24 underwent surgical tonsillectomy and adenoidectomy (TR), whereas in the remaining 30 children, parents elected not to seek any therapeutic intervention (NT). Overall mean grades during the second grade increased from 2.43 +/- 0.17 (SEM) to 2.87 +/- 0.19 in TR, although no significant changes occurred in NT (2.44 +/- 0.13 to 2.46 +/- 0.15). Similarly, no academic improvements occurred in children without SAGEA. SAGEA is frequently present in poorly performing first-grade students in whom it adversely affects learning performance. The data suggest that a subset of children with behavioral and learning disabilities could have SAGEA and may benefit from prospective medical evaluation and treatment.
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                Author and article information

                Contributors
                +45 9944 7300 , allan.hvolby@rsyd.dk
                Journal
                Atten Defic Hyperact Disord
                Atten Defic Hyperact Disord
                Attention Deficit and Hyperactivity Disorders
                Springer Vienna (Vienna )
                1866-6116
                1866-6647
                17 August 2014
                17 August 2014
                2015
                : 7
                : 1
                : 1-18
                Affiliations
                Department of Child and Adolescent Psychiatry, Psychiatry of Southern Denmark, Gl. Vardevej 101, 6715 Esbjerg N, Denmark
                Article
                151
                10.1007/s12402-014-0151-0
                4340974
                25127644
                31a8c251-a542-427d-84d7-a4a4766fe174
                © The Author(s) 2014

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution License which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

                History
                : 9 April 2014
                : 8 July 2014
                Categories
                Review Article
                Custom metadata
                © Springer-Verlag Wien 2015

                Neurology
                sleep,adhd,stimulant,amfetamine,methylphenidate,atomoxetine
                Neurology
                sleep, adhd, stimulant, amfetamine, methylphenidate, atomoxetine

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