Sleep disorders and attention-deficit/hyperactivty disorder

Academic General Pediatrics, Rhode Island Hospital, 593 Eddy Street, Providence, RI 02903, USA.
Current Psychiatry Reports (Impact Factor: 3.24). 11/2008; 10(5):439-44. DOI: 10.1007/s11920-008-0070-x
Source: PubMed


The relationship between attention-deficit/hyperactivity disorder (ADHD) and sleep is complex and poses many challenges in clinical practice. Recent studies have helped to elucidate the nature of the neuromodulator systems underlying the associations among sleepiness, arousal, and attention. Studies of sleep disturbances in children with academic and behavioral problems have also underscored the role that primary sleep disorders play in the clinical presentation of symptoms of inattention and behavioral dysregulation. Recent research has shed further light on the prevalence, type, risk factors for, and impact of sleep disturbances on children with ADHD. The following discussion of the multilevel and bidirectional relationships among sleep, neurobehavioral functioning, and the clinical syndrome of ADHD synthesizes current knowledge about the interaction of sleep and attention/arousal in these children. Guidelines are provided to outline a clinical approach to evaluating and managing children with ADHD and sleep problems.

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    • "Furthermore, manifestations of EDS in children are often different when compared to adults, especially in young children . For example, sleepy children can experience not only lapses in attention and concentration or difficulty staying on task, but fidgety or hyperactive behavior and irritability (Calhoun et al., 2012; Fallone, Owens, & Deane, 2002; Mayes, Calhoun, Bixler, & Vgontzas, 2009a; Millman, 2005; Owens, 2008). Nevertheless, subjective definitions in children are typically based on parent or teacher observed behavior and are more likely to grasp the sleep propensity component of EDS (i.e., the child is observed to fall asleep in the car, at school, watching TV, etc., vs a report to the parent of tiredness). "
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    ABSTRACT: Excessive daytime sleepiness (EDS) is a highly prevalent complaint associated with significant negative effects on health, workplace and academic performance, absenteeism, and overall health and safety, such as motor vehicle collisions. Furthermore, EDS represents a substantial cost burden to the health care system. In clinical practice, EDS is not only the cardinal symptom for the diagnosis of disorders of central nervous system origin such as narcolepsy or idiopathic hypersomnia, but it is the most frequent complaint reported in sleep disorders centers. Epidemiological studies have shown that the prevalence of EDS ranges between 4 and 20%, depending on the methods and definitions used. These studies have also shown that the prevalence of EDS is strongly modulated by age, being highest in children, adolescents, and young adults (10–15%), decreasing during middle age (about 6%), and peaking again in the elderly. In this chapter, we review the multifactorial modulation of EDS. First, we clarify the definitions used. Second, we explore each of the most researched factors etiologically linked to EDS. Third, we explore how each potential factor associated with EDS may be modulated by age within each section.
    Full-text · Chapter · Jan 2015
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    • "Problems with sleep may be an intrinsic feature of ADHD, or may both exacerbate and be exacerbated by the symptoms of the disorder. Problems with sleep can, however, also lead to the development of ADHD or ADHD-like symptoms, potentially resulting in misdiagnosis (Cortese et al. 2006b; Owens 2008). The effects of restricted, disordered or disturbed sleep can manifest as symptoms, behaviors or functional impairments that are remarkably similar to those of ADHD (Beebe 2006; Gruber 2009; O'Brien 2009). "
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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.
    Full-text · Article · Aug 2014 · ADHD Attention Deficit and Hyperactivity Disorders
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    • "Sleep problems in children have significant impacts on their health and well-being [1] [2] [3] [4]. Inadequate sleep in children has been shown to be associated with poor academic performance , behavioral problems, poor mental and physical health, obesity and weight gain, alcohol use, accidents, and injuries [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14] [15]. Research also suggests that these adverse health effects vary in relation to the amount or duration of sleep problems [2–6, 12–15]. "
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    ABSTRACT: We examined trends and neighborhood and sociobehavioral determinants of sleep problems in US children aged 6-17 between 2003 and 2012. The 2003, 2007, and 2011-2012 rounds of the National Survey of Children's Health were used to estimate trends and differentials in sleep problems using logistic regression. Prevalence of sleep problems increased significantly over time. The proportion of children with <7 days/week of adequate sleep increased from 31.2% in 2003 to 41.9% in 2011-2012, whereas the prevalence of adequate sleep <5 days/week rose from 12.6% in 2003 to 13.6% in 2011-2012. Prevalence of sleep problems varied in relation to neighborhood socioeconomic and built-environmental characteristics (e.g., safety concerns, poor housing, garbage/litter, vandalism, sidewalks, and parks/playgrounds). Approximately 10% of children in neighborhoods with the most-favorable social environment had serious sleep problems, compared with 16.2% of children in neighborhoods with the least-favorable social environment. Children in neighborhoods with the fewest health-promoting amenities or the greatest social disadvantage had 37%-43% higher adjusted odds of serious sleep problems than children in the most-favorable neighborhoods. Higher levels of screen time, physical inactivity, and secondhand smoke exposure were associated with 20%-47% higher adjusted odds of sleep problems. Neighborhood conditions and behavioral factors are important determinants of sleep problems in children.
    Full-text · Article · May 2013
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