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Associations of sleep disturbance with ADHD: implications for treatment.

Hvolby A - Atten Defic Hyperact Disord (2014)

Bottom Line: Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Child and Adolescent Psychiatry, Psychiatry of Southern Denmark, Gl. Vardevej 101, 6715, Esbjerg N, Denmark, allan.hvolby@rsyd.dk.

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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Sleep onset latency assessed by parental estimation and actigraphy (Hvolby et al. 2008). Data are shown as means ± standard deviations. Differences between the three groups were statistically significant for both the actigraphic measure (p < 0.01) and the parental measure (p < 0.001), as was the difference between the two measures (p < 0.001) across all groups (three-way analysis of variance, adjusted for sex and family type) (Hvolby et al. 2008). ADHD attention-deficit/hyperactivity disorder
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Fig1: Sleep onset latency assessed by parental estimation and actigraphy (Hvolby et al. 2008). Data are shown as means ± standard deviations. Differences between the three groups were statistically significant for both the actigraphic measure (p < 0.01) and the parental measure (p < 0.001), as was the difference between the two measures (p < 0.001) across all groups (three-way analysis of variance, adjusted for sex and family type) (Hvolby et al. 2008). ADHD attention-deficit/hyperactivity disorder

Mentions: A meta-analysis of four actigraphic studies reported statistically significantly longer mean sleep onset latency and shorter true sleep time in non-medicated children with ADHD than in typically developing controls (Cortese et al. 2009). Figure 1 illustrates data from one of these studies and shows that mean actigraphic sleep onset latency was longer in children with ADHD than in community controls and children with other psychiatric conditions (Hvolby et al. 2008). Mean longest sleep latency was also highest in children with ADHD, but total sleep time did not significantly differ among the three groups (Hvolby et al. 2008).Fig. 1


Associations of sleep disturbance with ADHD: implications for treatment.

Hvolby A - Atten Defic Hyperact Disord (2014)

Sleep onset latency assessed by parental estimation and actigraphy (Hvolby et al. 2008). Data are shown as means ± standard deviations. Differences between the three groups were statistically significant for both the actigraphic measure (p < 0.01) and the parental measure (p < 0.001), as was the difference between the two measures (p < 0.001) across all groups (three-way analysis of variance, adjusted for sex and family type) (Hvolby et al. 2008). ADHD attention-deficit/hyperactivity disorder
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4340974&req=5

Fig1: Sleep onset latency assessed by parental estimation and actigraphy (Hvolby et al. 2008). Data are shown as means ± standard deviations. Differences between the three groups were statistically significant for both the actigraphic measure (p < 0.01) and the parental measure (p < 0.001), as was the difference between the two measures (p < 0.001) across all groups (three-way analysis of variance, adjusted for sex and family type) (Hvolby et al. 2008). ADHD attention-deficit/hyperactivity disorder
Mentions: A meta-analysis of four actigraphic studies reported statistically significantly longer mean sleep onset latency and shorter true sleep time in non-medicated children with ADHD than in typically developing controls (Cortese et al. 2009). Figure 1 illustrates data from one of these studies and shows that mean actigraphic sleep onset latency was longer in children with ADHD than in community controls and children with other psychiatric conditions (Hvolby et al. 2008). Mean longest sleep latency was also highest in children with ADHD, but total sleep time did not significantly differ among the three groups (Hvolby et al. 2008).Fig. 1

Bottom Line: Attention-deficit/hyperactivity disorder (ADHD) is commonly associated with disordered or disturbed sleep.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.

View Article: PubMed Central - PubMed

Affiliation: Department of Child and Adolescent Psychiatry, Psychiatry of Southern Denmark, Gl. Vardevej 101, 6715, Esbjerg N, Denmark, allan.hvolby@rsyd.dk.

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.

Show MeSH
Related in: MedlinePlus