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Review
. 2015 Mar;7(1):1-18.
doi: 10.1007/s12402-014-0151-0. Epub 2014 Aug 17.

Associations of sleep disturbance with ADHD: implications for treatment

Allan Hvolby  1
Affiliations
Review

Associations of sleep disturbance with ADHD: implications for treatment

Allan Hvolby. Atten Defic Hyperact Disord. 2015 Mar.

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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Figures

Fig. 1
Fig. 1
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
Fig. 2
Fig. 2
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
Fig. 3
Fig. 3
Ball blanket. a Plastic balls, diameter 49 mm and b cotton blanket containing 7 kg of balls and measuring 140 × 200 cm
Fig. 4
Fig. 4
Conceptual model of the modes of interaction between ADHD and sleep. ADHD attention-deficit/hyperactivity disorder
See this image and copyright information in PMC

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