Sleep in attention-deficit/hyperactivity disorder in children and adults: Past, present, and future

Sun Young Rosalia Yoona, b, , , , Umesh Jainb, e, , Colin Shapiroa, c, d, f, a Institute of Medical Sciences, University of Toronto, Canadab Child, Youth and Family Service, Centre for Addiction and Mental Health, 352-250 College Street, Toronto, ON, M5T 1R8, Canadac Division of Patient Based Clinical Research, Toronto Western Research Institute, Canadad Youthdale Child and Adolescent Sleep Centre, CanadaReceived 5 April 2011. Revised 1 July 2011. Accepted 5 July 2011. Available online 26 October 2011.View full text The understanding that sleep can give rise to, or exacerbate symptoms of attention-deficit/hyperactivity disorder (ADHD), and that good sleep hygiene improves attention and concentration tasks has sparked interest in the investigation of possible etiological relationships between sleep disorders and ADHD.

Studies indicate that 30% of children and 60–80% of adults with ADHD have symptoms of sleep disorders such as daytime sleepiness, insomnia, delayed sleep phase syndrome, fractured sleep, restless legs syndrome, and sleep disordered breathing. The range and diversity of findings by different researchers have posed challenges in establishing whether sleep disturbances are intrinsic to ADHD or whether disturbances occur due to co-morbid sleep disorders. As a result, understanding of the nature of the relationship between sleep disturbances/disorders and ADHD remains unclear.

In this review, we present a comprehensive and critical account of the research that has been carried out to investigate the association between sleep and ADHD, as well as discuss mechanisms that have been proposed to account for the elusive relationship between sleep disturbances, sleep disorders, and ADHD.

prs.rt("abs_end");Sleep architecture; Sleep disturbances; Sleep disordered breathing; Restless legs; Periodic limb movements; ADHD; Circadian cycle

Figures and tables from this article:

Table 1. Studies of sleep disturbances in children with ADHD with subjective methods.

ADHD = Attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, BD = bipolar disorder, CD = conduct disorder, DEP = major depressive episode, C(P/T)RS-R:S = Conner’s (parent/teacher) rating scale-revised: short forms, GAD = generalized anxiety disorder, IQ = intelligence quotient, LD = learning disability, MPH = methylphenidate, OCD = obsessive compulsive disorder, ODD = oppositional defiant disorder, PTSD = post-traumatic stress disorder, SAD = separation anxiety disorder, SD = standard deviation.

View Within ArticleTable 2. Studies of sleep disturbances in children with ADHD with objective methods.

AHI = Apnea hypopnea index, BD = bipolar disorder, CD = conduct disorder, DEX = dextro-amphetamine, DLMO = dim light melatonin onset, GAD = generalized anxiety disorder, LD = learning disability, MD = major depression, MPH = methylphenidate, MSLT = multiple sleep latency test, ODD = oppositional defiant disorder, PLMI = periodic limb movement index, RDI = respiratory disturbance index, REM = rapid eye movement, S1 = stage 1 sleep, SAD = separation anxiety disorder, SDB = sleep disordered breathing, SE = sleep efficiency, SOL = sleep onset latency, SOT = sleep onset time,TSP = total sleep period.

View Within ArticleTable 3. Studies of sleep disturbances in adults with ADHD with subjective methods.

ADHD = attention-deficit/hyperactivity disorder, ADHD-C = ADHD of the combined subtype, ADHD-H/I = ADHD of the hyperactive/impulsive subtype, ADHD-I = ADHD of the inattentive subtype, ASRS = adult self report scale, CSM = composite scale of morningness, EDS = excessive daytime sleepiness, ESS - Epworth sleepiness scale, IH = idiopathic hypersomnia, GAD = generalized anxiety disorder, MDD = major depressive disorder, MPH = methylphenidate, OCD = obsessive compulsive disorder, PTSD = post-traumatic stress disorder.

View Within ArticleTable 4. Studies of sleep disturbances in adults with ADHD with objective methods.

DEX = dextro-amphetamine, BRD = brief recurrent depression, MDD = major depressive disorder, MPH = methylphenidate, PSG = polysomnography, REM = rapid eye movement, SE = sleep efficiency, SOL = sleep onset latency.

View Within ArticleCopyright © 2011 Elsevier Ltd. Published by Elsevier Ltd. All rights reserved.

prs.rt('data_end');

View the original article here