Sleep phenotypes in attention deficit hyperactivity disorder

• Published in: Sleep medicine Vol. 60; pp. 123 - 131
• Main Authors: Miano, Silvia, Amato, Ninfa, Foderaro, Giuseppe, Pezzoli, Valdo, Ramelli, Gian Paolo, Toffolet, Lorenzo, Manconi, Mauro
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.08.2019
• Subjects: ADHD; Epilepsy; Narcolepsy; Pediatrics – Insomnia; Pediatrics – Sleep apnea; ADHD; Pediatrics – Insomnia; Narcolepsy; Pediatrics – Sleep apnea; Epilepsy
• ISSN: 1389-9457; 1878-5506; 1878-5506
• DOI: 10.1016/j.sleep.2018.08.026

A case-control study was performed to test the hypothesis that children with attention deficit hyperactivity disorder (ADHD) have chronic sleep deprivation and may be classified into specific sleep-related phenotypes. Thirty outpatients with ADHD (nine females, mean age 10.1 ± 2.1 years) were recruited consecutively, and given a comprehensive sleep assessment, including blood exams, sleep questionnaires, laboratory video-polysomnographic recordings (v-PSG), multiple sleep latency tests, and one-week actigraphy. The PSG parameters were compared to those of 25 age-matched controls (12 females, mean age 10.34 ± 1.54 years) who underwent only the v-PSG. ADHD children were classified as follows: a narcolepsy-like phenotype was found in four; delayed sleep onset insomnia in five; obstructive sleep apnea (OSA) in 15; periodic limb movements in eight, and sleep epileptiform discharges in 10 children. All subjects had a total sleep time shorter than 9 h at actigraphy, ferritin levels lower than 60 mcg/L, and a history of sleep problems (mainly OSA and insomnia). Compared to controls, the ADHD group had a higher apnea-hypopnea index at PSG. A full sleep assessment in children with ADHD confirmed the validity of the sleep phenotypes hypothesis, and revealed a much higher percentage of sleep problems than that found in the literature. Beyond the sleep phenotypes, all children reported a history of sleep problems and slept less than 9 h per night, indicating chronic sleep deprivation that should be evaluated as a possible unifying marker of ADHD. •A full sleep assessment in ADHD enables the diagnosis of specific sleep phenotypes.•Children with ADHD have a history of sleep problems and low ferritin levels.•Chronic sleep deprivation is a possible unifying marker of ADHD.