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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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a, b Polysomnographic, c parent-rated subjective and d actigraphic outcomes from a double-blind, randomized, parallel-group study of the effects of LDX treatment on sleep in 24 children with ADHD (Giblin and Strobel 2011). *p < 0.0001 versus baseline. ADHD attention-deficit/hyperactivity disorder, CSHQ Children’s Sleep Habits Questionnaire, LDX lisdexamfetamine
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Fig2: a, b Polysomnographic, c parent-rated subjective and d actigraphic outcomes from a double-blind, randomized, parallel-group study of the effects of LDX treatment on sleep in 24 children with ADHD (Giblin and Strobel 2011). *p < 0.0001 versus baseline. ADHD attention-deficit/hyperactivity disorder, CSHQ Children’s Sleep Habits Questionnaire, LDX lisdexamfetamine

Mentions: LDX is the only stimulant prodrug. After oral administration, rate-limiting enzymatic hydrolysis of LDX in the bloodstream releases the pharmacologically active d-amfetamine moiety from the lysine conjugate (Steer et al. 2012). LDX treatment was not associated with impairments in sleep quality or quantity in clinical trials using objective sleep measures in adults with ADHD (Adler et al. 2009a; Surman and Roth 2011) and children with ADHD (Giblin and Strobel 2011) (Fig. 2). Table 2 shows a summary of the proportions of patients experiencing TEAEs of insomnia in randomized, double-blind, placebo-controlled, parallel-group clinical studies of LDX.Fig. 2


Associations of sleep disturbance with ADHD: implications for treatment.

Hvolby A - Atten Defic Hyperact Disord (2014)

a, b Polysomnographic, c parent-rated subjective and d actigraphic outcomes from a double-blind, randomized, parallel-group study of the effects of LDX treatment on sleep in 24 children with ADHD (Giblin and Strobel 2011). *p < 0.0001 versus baseline. ADHD attention-deficit/hyperactivity disorder, CSHQ Children’s Sleep Habits Questionnaire, LDX lisdexamfetamine
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

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

Fig2: a, b Polysomnographic, c parent-rated subjective and d actigraphic outcomes from a double-blind, randomized, parallel-group study of the effects of LDX treatment on sleep in 24 children with ADHD (Giblin and Strobel 2011). *p < 0.0001 versus baseline. ADHD attention-deficit/hyperactivity disorder, CSHQ Children’s Sleep Habits Questionnaire, LDX lisdexamfetamine
Mentions: LDX is the only stimulant prodrug. After oral administration, rate-limiting enzymatic hydrolysis of LDX in the bloodstream releases the pharmacologically active d-amfetamine moiety from the lysine conjugate (Steer et al. 2012). LDX treatment was not associated with impairments in sleep quality or quantity in clinical trials using objective sleep measures in adults with ADHD (Adler et al. 2009a; Surman and Roth 2011) and children with ADHD (Giblin and Strobel 2011) (Fig. 2). Table 2 shows a summary of the proportions of patients experiencing TEAEs of insomnia in randomized, double-blind, placebo-controlled, parallel-group clinical studies of LDX.Fig. 2

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