Psychiatric Annals

CME Article 

Sleep Problems and Disorders in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

Lalita D. Ramnaraine, MD; Mariam Rahmani, MD; Khurshid A. Khurshid, MD, FAASM

Abstract

Sleep disturbances are more common among children and adolescents with co-morbid attention-deficit/hyperactivity disorder (ADHD). Some children with ADHD may have sleep-onset insomnia; others may have a predilection for delayed-sleep onset. Medications used to treat ADHD may contribute to sleep disturbances. Sleep disorders like obstructive sleep apnea and restless legs syndrome may cause or contribute to the symptoms of ADHD. These disorders may also present with ADHD-like symptoms. These sleep problems and disorders affect the quality of life of children and adolescents with ADHD, with potential adverse effects on learning and memory processing. It is recommended that all children with ADHD be evaluated for sleep problems and primary sleep disorders. These children should also be treated for comorbid sleep problems and disorders, preferably with nonpharmacologic behavioral interventions before or concurrent with treatment of ADHD. Long-acting stimulants may also be more beneficial than short-acting stimulants to prevent sleep disturbances. [Psychiatr Ann. 2016;46(7):401–407.]

Abstract

Sleep disturbances are more common among children and adolescents with co-morbid attention-deficit/hyperactivity disorder (ADHD). Some children with ADHD may have sleep-onset insomnia; others may have a predilection for delayed-sleep onset. Medications used to treat ADHD may contribute to sleep disturbances. Sleep disorders like obstructive sleep apnea and restless legs syndrome may cause or contribute to the symptoms of ADHD. These disorders may also present with ADHD-like symptoms. These sleep problems and disorders affect the quality of life of children and adolescents with ADHD, with potential adverse effects on learning and memory processing. It is recommended that all children with ADHD be evaluated for sleep problems and primary sleep disorders. These children should also be treated for comorbid sleep problems and disorders, preferably with nonpharmacologic behavioral interventions before or concurrent with treatment of ADHD. Long-acting stimulants may also be more beneficial than short-acting stimulants to prevent sleep disturbances. [Psychiatr Ann. 2016;46(7):401–407.]

The global prevalence of attention-deficit/hyperactivity disorder (ADHD) is estimated to be 5.29%, and is more common in boys than in girls, according to the Diagnostic and Statistical Manual of Mental Disorders, fifth edition.1 Sleep disturbances are reported by 25% to 50% of parents who have children with ADHD, with complaints of problems falling and staying asleep.2 Ganelin-Cohen and Ashkenasi2 indicate that as many as 77% of children with significant ADHD and 70% of children with mild ADHD have sleep disturbances, irrespective of medication status.2 Incidence of night awakening and sleep-onset latency is higher among children with ADHD.3 According to Mayes et al.,4 ADHD-combined type (ADHD-CT) is associated with more sleep problems than ADHD-inattentive type (ADHD-IT) as well as controls. Yet, children with ADHDIT report more daytime sleepiness, suggesting there are different sleep problems across the different ADHD subtypes.4 Lycett et al.5 found that sleep problems in the ADHD population are generally transient, although they are persistent within a particular subgroup.

The presence of internalizing and externalizing comorbidities (depression, anxiety, and oppositional defiant disorder) is thought to be the strongest risk factor for transient and persistent sleep problems.4,6,7 Additionally, ADHD symptom severity is associated with persistent sleep problems. Hence, risk factors for persistent sleep problems include internalizing and externalizing comorbidities as well as greater ADHD severity.5

The Relationship Between Sleep and Learning

Healthy sleep is important for acquisition of new information and memory consolidation.8,9 Short sleep duration and poor sleep quality are associated with poor academic performance. Additionally, sleep deficits are associated with loss of supervisory control, problem-solving, and working memory.10 As rapid eye moment (REM) sleep is associated with learning/performance, executive functioning, attention and memory as well as language, sleep disturbances contribute to a significantly reduced quality of life.2 Children with ADHD have problems with attention, concentration, and tasks that demand sustained attention with decreased processing speed. As children with ADHD are predisposed to difficulties in learning, they are particularly vulnerable to the effects of sleep impairments as it relates to learning.11

Sleep Issues in People with ADHD

Clinical review of data indicates that 30% of children with ADHD and 60% to 80% of adults with ADHD have symptoms of sleep disorders including daytime sleepiness, insomnia, delayed sleep-phase syndrome, fractured sleep, restless legs syndrome (RLS), and sleep-disordered breathing (SDB). These data indicate that sleep problems likely persist into adulthood.12

Actigraphy and polysomnography data have shown that patients with ADHD have lower sleep efficiency and higher stage shifts per hour of sleep.2,13,14 Studies have also demonstrated increased nocturnal movements and decreased time spent in REM sleep.13,14 Studies conducted with the Multiple Sleep Latency Test reveal children with ADHD are sleepier during the day and have a longer reaction time.15 Taken together, the data might suggest that children with ADHD may be overcompensating with overactivity to maintain alertness and to stay awake.

Sleep Problems in Children with ADHD

Studies indicate that parents of children with ADHD tend to report more sleep problems than parents with typically developing children.16,17 Sleep problems in ADHD include delayed-sleep onset, night awakenings, bedtime resistance, parasomnias, and early and middle insomnia. A cross-sectional study by Accardo et al.7 suggests that children with ADHD and comorbid anxiety or depression have a predilection for sleep problems. There is a stronger correlation between increased night awakening in children with ADHD and comorbid anxiety than in children with ADHD alone.7 The study by Accardo et al.7 also shows that bedtime resistance is increased in children with ADHD and comorbid anxiety.

Sleep Disorders in ADHD

SDB encompasses the following disorders (from minimal to severe): primary snoring, upper airway resistance syndrome, obstructive hypoventilation, and severe cases of obstructive sleep apnea (OSA). Several studies have shown a positive association between ADHD and SDB (Table 1). A moderate relationship was found between ADHD and SDB, which may cause inattention due to sleep disruption, sleep deprivation, and inadequate oxygenation.18,19 Several studies have shown that 25% to 57% of children with ADHD have sleep-related breathing disorders (SRBD).20 Goraya et al.15 evaluated polysomnographic data retrospectively and found that results supported the relationship of SDB (with most of these patients obese) and periodic limb movement disorder (PLMD) with disturbed sleep in children with ADHD. Snoring is significantly increased in this population. Patients with SDB had more sleep architecture abnormalities, such as increased sleep latency, increased REM latency, increased awakenings after sleep onset, and increased arousal index with more O2 desaturations.


            The Relationship Between Sleep-Disordered Breathing and ADHD

Table 1:

The Relationship Between Sleep-Disordered Breathing and ADHD

Habitual Snoring

In the general population, 7% to 12% of children reportedly snore habitually and have a high risk for SDB.19 Comparatively, however, 30% of children who have ADHD are likely to experience habitual snoring.2 Chervin et al.19 performed a study and found that boys younger than age 8 years were more likely to have issues with snoring (associated with hyperactivity), although not necessarily with sleepiness. The study results indicated that inattentive and hyperactive children had more frequent snoring, more severe daytime sleepiness, and a higher likelihood of SDB.19

Obstructive Sleep Apnea

OSA affects 1% to 3% of school-aged children with obstructive SDB, occurring nearly equally among boys and girls.19 Adenotonsillectomy for SDB has been shown to improve inattention and hyperactivity symptoms.2,20 In fact, in a study by Goraya et al.,15 3 of 10 children with OSA had adenotonsillectomy. In fact, in a study by Goraya et al.,15 3 of 10 children with OSA had adenotonsillectomy performed with postprocedural polysomonographic data indicating improvement in OSA without any desaturation events. A clinical review by Sedky et al.18 suggested that adenotonsillectomy was associated with decreased ADHD symptoms at 2 to 13 months postoperatively.

Several studies have shown a positive association between ADHD and sleep-related motor disorders (Table 2). In a nocturnal video-polysomnography study by Silverstri et al.,21 a high prevalence of sleep-related motor disorders was found in children with ADHD: 26.1% with RLS, 40.4% with periodic leg movements of sleep (PLMS), 21.8% with sleep-related rhythmic movement disorder (SRRMD), and 32.7% with bruxism. SRRMD appeared to co-occur significantly with PLMS and bruxism. The study also suggested a specific dys-function in slow-wave sleep, possibly due to SRBD.21 In a study by Chervin et al.,22 inattention and hyperactivity among general pediatric patients were associated with PLMS and RLS.


            The Relationship Between Sleep-Related Motor Disorders and ADHD

Table 2:

The Relationship Between Sleep-Related Motor Disorders and ADHD

Restless Legs Syndrome

In the ADHD population, 44% experience RLS compared to 10% of the general population.2 Bioulac et al.20 found that as many as 26% of children with RLS have ADHD-like symptoms. The number of disruptive movements at night and the degree of hyperactivity severity during the day appears to be interrelated.12 Iron deficiency is correlated with both ADHD and RLS. Iron is known to be a coenzyme in dopamine synthesis, suggesting altered dopamine central nervous system functioning as the etiology.2,23 Supporting the hypothesis that iron deficiency might co-occur with ADHD, data by Lahat et al.23 demonstrate that ferritin levels less than 20 ng/mL correlate with more severe ADHD symptoms and cognitive deficits.23

Periodic Limb Movement Disorder

PLMD is a clinical syndrome in which there are periodic leg movements during sleep, which is a polysomnographic measure and is present in up to 80% of patients with RLS.20 PLMS are involuntary limb movements in which there is flexion of the hips, knees, and ankles, and patients are not generally aware of the restlessness of their sleep. Sleep is generally described as nonrestorative with frequent awakenings and daytime fatigue or sleepiness.20,22 In a study by Crabtree et al.,24 the authors found that children with ADHD and PLMD were more likely to have less REM sleep and a greater number of arousals associated with PLMS than children with PLMD alone.24 Additionally, Crabtree et al.24 suggest that fragmented sleep may be more a function of hyperactive behavior than the PLMS itself.

Circadian Rhythm Sleep-Wake Disorders

It is thought that children with ADHD have a circadian sleep disorder with a phase delay. The findings of several studies that researched the relationship between ADHD and circadian rhythm sleep-wake disorders are summarized in Table 3. Van der Heijeden et al.25 showed that dim-light melatonin onset, a marker of circadian function, is delayed in ADHD children with chronic sleep-onset insomnia. The children in this study were not taking medication; therefore, treatment of ADHD was not a confounding factor. Furthermore, the sleep-onset delay was found to be reversed when children were supplemented with oral melatonin.26 Studies suggest the tendency to be more alert and awake at night is associated with ADHD, and a particular subgroup of ADHD children are thought to have a circadian disorder. Some literature has suggested this predilection is stronger in those with ADHD-IT.20,27,28


            The Relationship Between Circadian Rhythm Sleep-Wake Disorders and ADHD

Table 3:

The Relationship Between Circadian Rhythm Sleep-Wake Disorders and ADHD

Central Disorders of Hypersomnolence (Hypersomnias)

Narcolepsy is characterized by excessive daytime sleepiness with or without cataplexy. Several studies have found a positive association between ADHD and hypersomnias (Table 4). Bioulac et al.20 found that the rate of narcolepsy was higher in children with ADHD than in controls (5.4% vs 2.5%). In a cross-sectional study,29 involving children and adolescents with narcolepsy, ADHD symptoms were twice as likely to be present when compared to controls. The study29 found that ADHD symptoms in patients with narcolepsy are likely more resistant to treatment and may need to be treated with higher doses of methylphenidate.


            The Relationship Between Central Disorders of Hypersomnolence (Hypersomnias) and ADHD

Table 4:

The Relationship Between Central Disorders of Hypersomnolence (Hypersomnias) and ADHD

The Effect of Medications on Sleep in Children with ADHD

ADHD generally does not occur alone; at least 60% of patients have a psychiatric comorbidity that is usually treated with medications.2 Ganelin-Cohen and Ashkenasi2 suggest that medications can affect sleep quality. In fact, tricyclic antidepressants are said to decrease sleep-onset latency, decrease arousals during sleep-stage transitions, and increase daytime sleepiness.2 Selective serotonin reuptake inhibitors are thought to cause daytime sedation, increase sleep-onset latency, and suppress REM sleep.2 According to Ironside et al.,30 methylphenidate (MPH) is associated with increased motor activity during the sleep-onset latency period with a decrease in circadian amplitude and a phase delay. Meanwhile, Boonstra et al.31 showed that although MPH decreased total sleep time, it also decreased total frequency of night-time awakenings; thereby, consolidating sleep and improving quality of sleep. This study, however, was performed with adults.31 According to another review, sleep disturbances seen with MPHs are likely to occur more frequently with short-acting stimulants than with long-acting stimulants, which appear not to cause as many impairments in sleep.32

There is also literature discussing ADHD behavior symptoms and how that might correlate with sleep disturbances seen in children with ADHD. Hvolby32 suggests that children with RLS and PLMD may exhibit bedtime resistance due to unpleasant symptoms of ADHD at night. Another study14 noted that parents indicated more problematic behaviors in children with ADHD especially in the evening hours leading up to bedtime; this may account for parents perceiving that there is a delay in sleep-onset latency despite conflicting evidence. Hence, treatment may target the parent-child behavioral interactions.

Management of ADHD and Sleep Problems/Disorders

Primary sleep disorders should be excluded prior to diagnosing ADHD. US guidelines recommend that children who undergo evaluation for ADHD should also be assessed for sleep apnea.32 In situations where ADHD and sleep disturbances coincide, the underlying sleep disturbance should be treated prior to the ADHD.18,32 Sedky et al.18 found that 85% of children with SDB improved with adenotonsillectomy with concomitant improvement in ADHD symptoms. The authors further suggest that improvement in SDB may lead to lower medication doses to treat residual ADHD symptoms.18 Because low levels of ferritin, a marker for iron stores, have been associated with ADHD symptoms, children should be evaluated routinely to determine whether iron supplementation is needed.23 It may also be important to consider the effect of pubertal status, which affects circadian timing on sleep-wake cycles.2

When treating ADHD symptoms, it may be beneficial to consider a long-acting stimulant versus a short-acting one because the latter have less sleep architectural changes.32 Sleep medications may have to be used to facilitate improved sleep as well. In a study by Efron et al.,33 sleep medication use was associated with ADHD medication use (3 times more likely), ADHD-CT (2.5 times more likely), internalizing and externalizing comorbidities (2 times more likely), and parent mental health (1.2 times more likely).33 This suggests that the more severe presentation of ADHD, the more likely sleep medications may be needed.

Prior to starting sleep medications, however, behavioral treatments should be initiated, with parenting interventions recommended as the first-line treatment options for ADHD in young children.34 In a study by Sciberras et al.,35 parents were provided with information about sleep hygiene, information on setting limits at bedtime, and the use of rewards/stickers. Sleep-onset association disorder was managed by removing the sleep association and checking in on the child at increasing intervals to promote extinction of the unwanted behavior(s) and self-settling. Once behavioral treatment was implemented, 67% of the parents, at the 5-month check-in, reported that the child's sleep problems had resolved. When the behavioral techniques were applied in an extended program, the child's quality of life and daily functioning improved and parental anxiety started to dissipate.35 Chronotherapy and bright light therapy have also been suggested as possible treatment for sleep problems in children.16

Conclusions

Sleep disturbances are common in children and adolescents with ADHD and include sleep-onset difficulties, SDB, snoring, OSA, RLS, PLMD, circadian rhythm disorders, and hypersomnias. Some people have a predilection for delayed-sleep onset. Certain medications used to treat ADHD may also contribute to sleep disturbances. These problems affect the quality of life of children and adolescents with ADHD and have potential adverse effects on learning and memory processing. Therefore, all children with ADHD should be evaluated for primary sleep disorders and treated for comorbid sleep problems and disorders, preferably with nonpharmacologic behavioral interventions, before treating ADHD. Older children especially should be treated with cognitive behavioral therapy for insomnia. Treatment of comorbid sleep problems in patients with ADHD improves the symptoms and the child's functioning and outcomes.

References

  1. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Publishing; 2013.
  2. Ganelin-Cohen E, Ashkenasi A. Disordered sleep in pediatric patients with attention deficit hyperactivity disorder: an overview. Isr Med Assoc J. 2013;15(11):705–709.
  3. Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry. 2009;48(9):894–908.
  4. Mayes SD, Calhoun SL, Bixler EO, et al. ADHD subtypes and comorbid anxiety, depression and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol. 2009;34(3):328–337. doi:10.1093/jpepsy/jsn083 [CrossRef]
  5. Lycett K, Mensah FK, Hiscock H, Sciberras E. A prospective study of sleep problems in children with ADHD. Sleep Med. 2014;15:1354–1361. doi:10.1016/j.sleep.2014.06.004 [CrossRef]
  6. Mick E, Biederman J, Jetton J, Faraone SV. Sleep disturbances associated with attention deficit hyperactivity disorder: the impact of psychiatric comorbidity and pharmacotherapy. J Child Adolesc Psychopharmacol. 2000;10(3):223–231. doi:10.1089/10445460050167331 [CrossRef]
  7. Accardo JA, Marcus CL, Leonard MB, Shults J, Meltzer LJ, Elia J. Associations between psychiatric comorbidities and sleep disturbances in children with attention-deficit/hyperactivity disorder. J Dev Behav Pediatr. 2012;33(2):97–105.
  8. Maquet P, Laureys S, Peigneux P, et al. Experience-dependent changes in cerebral activation during human REM sleep. Nat Neurosci. 2000;3(8):831–836. doi:10.1038/77744 [CrossRef]
  9. Diekelmann S, Born J. The memory function of sleep. Nat Rev Neurosci. 2010;11:114–126.
  10. Owens J, Gruber R, Brown T, et al. Future research directions in sleep and ADHD: report of a consensus working group. J Atten Disord. 2013;17(7):550–564. doi:10.1177/1087054712457992 [CrossRef]
  11. Sciberras E, DePetro A, Mensah F, Hiscock H. Associations between sleep and working memory in children with ADHD: a cross-sectional study. Sleep Med. 2015;16(10):1192–1197. doi:10.1016/j.sleep.2015.06.006 [CrossRef]
  12. Yoon SYR, Jain U, Shapiro C. Sleep in attention-deficity/hyperactivity disorder in children and adults: past, present and future. Sleep Med Rev. 2012;16:371–388. doi:10.1016/j.smrv.2011.07.001 [CrossRef]
  13. Lecendreux M, Konofal E. Sleep and alertness in children with ADHD. J Child Psychol Psychiatry. 2000;41(6):803–812. doi:10.1111/1469-7610.00667 [CrossRef]
  14. Owens J, Sangal RB, Sutton VK, Bakken R, Allen AJ, Kelsey D. Subjective and objective measures of sleep in children with attention-deficit/hyperactivity disorder. Sleep Med. 2009;10(4):446–456. doi:10.1016/j.sleep.2008.03.013 [CrossRef]
  15. Goraya JS, Cruz M, Valencia I, et al. Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatr Neurol. 2009;40(1):42–46. doi:10.1016/j.pediatrneurol.2008.09.007 [CrossRef]
  16. Corkum P, Davidson F, MacPherson M. A framework for the assessment and treatment of sleep problems in children with attention-deficit-hyperactivity disorder. Pediatr Clin North Am. 2011;58:667–683. doi:10.1016/j.pcl.2011.03.004 [CrossRef]
  17. Rodopman-Arman A, Perdahli-Fis N, Ekinci O, Berkem M. Sleep habits, parasomnias and associated behaviors in children with attention deficit hyperactivity disorder (ADHD). Turk J Pediatr. 2011;53(4):397–403.
  18. Sedky K, Bennett DS, Carvalho KS. Attention deficit hyperactivity disorder and sleep disordered breathing in pediatric populations: a meta-analysis. Sleep Med Rev. 2014;18(4):349–356. doi:10.1016/j.smrv.2013.12.003 [CrossRef]
  19. Chervin RD, Archbold KH, Dillon JE, et al. Inattention, hyperactivity and symptoms of sleep-disordered breathing. Pediatrics. 2002;109(3):449–456. doi:10.1542/peds.109.3.449 [CrossRef]
  20. Bioulac S, Micolaud-Franchi JA, Philip P. Excessive daytime sleepiness in patients with ADHD--diagnostic and management strategies. Curr Psychiatry Rep. 2015;17(8):608. doi:10.1007/s11920-015-0608-7 [CrossRef]
  21. Silvestri R, Gagliano A, Arico I, et al. Sleep disorders in children with attention-deficit/hyperactivity disorder (ADHD) recorded overnight by video-polysomnography. Sleep Med. 2009;10:1132–1138. doi:10.1016/j.sleep.2009.04.003 [CrossRef]
  22. Chervin RD, Archbold KH, Dillon JE, et al. Associations between symptoms of inattention, hyperactivity, restless legs and periodic leg movements. Sleep. 2002;25(2):213–218.
  23. Lahat E, Heyman E, Livne A, Goldman M, Berkovitch M, Zachor D. Iron deficiency in children with attention deficit hyperactivity disorder. Isr Med Assoc J. 2011;13:530–533.
  24. Crabtree VM, Ivanenko A, O'Brien LM, Gozal D. Periodic limb movement disorder of sleep in children. J Sleep Res. 2003;12:73–81. doi:10.1046/j.1365-2869.2003.00332.x [CrossRef]
  25. van der Heijden KB, Smits MG, van Someren EJ, Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int. 2005;22(3):559–570. doi:10.1081/CBI-200062410 [CrossRef]
  26. van der Heijden KB, Smits MG, van Someren EJ, Boudewijn Gunning W. Prediction of melatonin efficacy by pretreatment dim light melatonin onset in children with idiopathic chronic sleep onset insomnia. J Sleep Res. 2005;14:187–194. doi:10.1111/j.1365-2869.2005.00451.x [CrossRef]
  27. Imeraj L, Sonuga-Barke E, Anthrop I, et al. Altered circadian profiles in inattentivehyperactivity disorder: an integrative review and theoretical framework for future studies. Neurosci Biobehav Rev. 2012;36:1897–1919. doi:10.1016/j.neubiorev.2012.04.007 [CrossRef]
  28. Caci H, Bouchez J, Bayle FJ. Inattentive symptoms of ADHD are related to evening orientation. J Atten Disord. 2009;13(1):36–41. doi:10.1177/1087054708320439 [CrossRef]
  29. Lecendreux M, Lavault S, Lopez R, et al. Attention-deficit/hyperactivity disorder (ADHD) symptoms in pediatric narcolepsy: a cross-sectional study. Sleep. 2015;38(8):1285–1295.
  30. Ironside S, Davidson F, Corckum P. Circadian motor activity affected by stimulant medication in children with attention-deficit/hyperactivity disorder. J Sleep Res. 2010;19:546–551. doi:10.1111/j.1365-2869.2010.00845.x [CrossRef]
  31. Boonstra AM, Kooij JJ, Oosterlaan J, Sergeant JA, Buitelaar JK, Van Someren EJ. Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep. 2007;30(4):433–442.
  32. Hvolby A. Associations for sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015;7(1):1–18. doi:10.1007/s12402-014-0151-0 [CrossRef]
  33. Efron D, Lycett K, Sciberras E. Use of sleep medication in children with ADHD. Sleep Med. 2014;15(4):472–475. doi:10.1016/j.sleep.2013.10.018 [CrossRef]
  34. Kendall T, Taylor E, Perez A, Taylor CGuideline Development Group. Diagnosis and management of attention-deficit/hyperactivity disorder in children, young people and adults: summary of NICE guidance. BMJ. 2008;337:a1239. doi:10.1136/bmj.a1239 [CrossRef]
  35. Sciberras E, Fulton M, Efron D, Oberklaid F, Hiscock H. Managing sleep problems in school aged children with ADHD: a pilot randomized controlled trial. Sleep Med. 2011;12(9):932–935. doi:10.1016/j.sleep.2011.02.006 [CrossRef]

The Relationship Between Sleep-Disordered Breathing and ADHD

Study Design Sample (n) Association Inference
Ganelin-Cohen and Ashkenasi2 Literature review N/A Positive OSA and SDB associated with ADHD
Goraya et al.15 Retrospective study 33 Positive SDB and PLMD linked to ADHD; obesity increases risk
Sedky et al.18 Meta-analysis of literature 30 Positive SDB linked to ADHD; adenotonsillectomy associated with a decrease in ADHD symptoms 2-13 months postoperatively
Chervin et al.19 Cross-sectional survey 866 Positive Pediatric ADHD symptoms linked to SDB symptoms
Bioulac et al.20 Literature review N/A Positive Recommendation to treat SDB prior to treating ADHD

The Relationship Between Sleep-Related Motor Disorders and ADHD

Study Design Sample (n) Association Inference
Ganelin-Cohen and Ashkenasi2 Literature review N/A Positive Motor activity during sleep in ADHD
Silvestri et al.21 Cross-sectional survey 866 Positive Sleep-related motor disturbances and ADHD; bruxisms and SRRMD co-occur with PLMS; low ferritin level and sleep in ADHD
Chervin et al.19 Cross-sectional survey 866 Positive Inattention and hyperactivity in children and symptoms of PLMS and RLS
Bioulac et al.20 Literature review N/A Positive ADHD symptoms associated with RLS and PLMD, with PLMD also occurring frequently with RLS
Lahat et al.23 Prospective study 113 Positive Low ferritin levels and increased severity of ADHD symptoms and cognitive deficits

The Relationship Between Circadian Rhythm Sleep-Wake Disorders and ADHD

Study Design Sample (n) Association Inference
Bioulac et al.20 Literature review N/A Positive ADHD and delayed sleep-phase syndrome
Van der Heijden et al.25 Randomized placebo-controlled trial 176 Positive ADHD and chronic idiopathic sleep-onset insomnia show delayed sleep-phase delay in wake-up time and delayed DLMO
Imeraj et al.27 Systematic literature review N/A Positive ADHD and circadian phase delay
Caci et al.28 Cross-sectional study N/A Positive Being a night owl may constitute an endophenotype of the predominantly ADHD-inattentive type

The Relationship Between Central Disorders of Hypersomnolence (Hypersomnias) and ADHD

Study Design Sample (n) Association Inference
Bioulac et al.20 Literature review N/A Positive ADHD and narcolepsy
Lecendreux et al.29 Cross-sectional survey 108 Positive Pediatric narcolepsy patients with treatment-resistant ADHD symptoms; may need higher doses of methylphenidates
Authors

Lalita D. Ramnaraine, MD, is a second-year Child Fellow. Mariam Rahmani, MD, is an Assistant Professor and Assistant Child Psychiatry Residency Training Director. Khurshid A. Khurshid, MD, FAASM, is an Associate Professor. All contributors are affiliated with the Department of Psychiatry, University of Florida.

Address correspondence to Lalita D. Ramnaraine, MD, 8491 NW 39th Avenue, Gainesville, FL 32606; email: lalita@ufl.edu.

Disclosure: The authors have no relevant financial relationships to disclose.

10.3928/00485713-20160518-01

Sign up to receive

Journal E-contents