Abstract
The objective of the study was to compare polysomnographic patterns in two groups of preadolescent children with attention deficit hyperactivity disorder (ADHD) (a sleep clinic referral sample and a community sample) with control children. A prospective and observational study in the sleep clinic and the community was undertaken. Forty-seven ADHD children referred to the sleep clinic (ADHDcl), 53 ADHD children from a community survey (ADHDcom), and 49 control children underwent overnight polysomnography. Significant differences between the groups were observed for rapid-eye-movement (REM) sleep latency and percentage, and periodic limb movement index with associated arousals (PLMa). REM sleep latency was shorter in controls than ADHDcl and ADHDcom (p < 0.01) and REM% was highest in controls and lowest in ADHDcl (p < 0.001). PLMa was higher in ADHDcl than the other groups (p < 0.001), but there were no differences in PLMa between ADHDcom and controls. ADHD children display significant alterations in their sleep patterns, and ADHDcl are more likely to have an elevated PLMa than ADHDcom. In addition, REM sleep is affected by ADHD. We postulate that ADHDcl may represent a subset of children with ADHD at high risk for hyperactivity during sleep.
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Abbreviations
- ADHD:
-
attention/deficit hyperactivity disorder
- ADHDcl:
-
clinical sample of children with ADHD
- ADHDcom:
-
community sample of children with ADHD
- AHI:
-
apnea/hypopnea index
- AI:
-
apnea index
- EDS:
-
excessive daytime sleepiness
- EOG:
-
electrooculogram
- EMG:
-
electromyogram
- PLMa:
-
periodic limb movements with arousals
- PLMD:
-
periodic limb movement disorder
- PLMI:
-
periodic limb movement index
- PLMS:
-
periodic leg movements in sleep
- PSG:
-
polysomnography
- REM:
-
rapid eye movement
- REM%:
-
duration of REM sleep as percentage of total sleep time
- SDB:
-
sleep-disordered breathing
- SpO2:
-
oxyhemoglobin saturation
- SWS:
-
slow-wave sleep
- TST:
-
total sleep time
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Acknowledgements
The authors thank the parents and children who participated in this study for their cooperation.
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Additional information
Supported by National Institutes of Health Grant HL-65270, the Department of Education Grant H324E011001, and The Commonwealth of Kentucky Research Challenge Trust Fund.
APPENDIX
APPENDIX
1: The Sleep Questionnaire
Child's demographic information
-
Name:
-
Address:
-
Telephone number:
-
Date of birth:
-
Gender:
-
Ethnicity:
Father's demographic information
-
Profession:
-
Highest level graduated from: junior high/high school/ college/graduate school
-
Snore: yes/no
-
Smoke: yes/no
-
Adenoids or tonsils removed: yes/no
Mother's demographic information
-
Profession:
-
Highest level graduated from: junior high/high school/ college/graduate school
-
Snore: yes/no
-
Smoke: yes/no
-
Adenoids or tonsils removed: yes/no
-
Pregnancy: normal/abnormal
-
Pregnancy: full term/preterm
Child
-
Medical problems:
-
Medications:
-
Allergies:
-
Birth weight:
-
Adenoids or tonsils removed: yes/no
-
Vision problems: yes/no
-
Hearing problems: yes/no
-
Poor appetite: yes/no
-
Poor growth: yes/no
-
Ear infections: yes/no
-
Asthma: yes/no
-
Frequent colds and/or flus: yes/no
-
Constant runny nose: yes/no
-
Does child sleep alone, share with 1, share with 2, share with 3, share with >3
-
Do any of his/her siblings snore? yes/no
-
Does your child have ADHD (also called hyperkinetic/ attention deficit)? yes/no
-
Is your child hyperactive? yes/no
-
Is your child on any ADHD medication? yes/no; which one:
-
How long does your child sleep at night?
-
At what time does your child go to bed?
-
At what time does your child wake up?
The following questions can be answered by “never,” “rare ly,” “occasionally,” frequently,” or “almost always”:
-
Have you seen or heard your child having nightmares that he/she does not remember the next day?
-
Has he/she expressed fear of sleeping in the dark?
-
Is your child easy to wake up in the morning?
-
Does your child go to bed willingly?
-
Is he/she a restless sleeper?
-
Have you seen your child smiling during sleep?
-
Does he/she wake up at night?
-
Have you heard your child talking during his/her sleep?
-
Have you observed him/her sleepwalking?
-
While asleep, does he/she ever sit up in bed?
-
Does he/she grind his/her teeth during sleep?
-
Have you heard your child laugh during sleep?
-
Has your child told you about having a frightening dream?
-
Have you observed repetitive actions such as rocking or head banging during sleep?
-
Does he/she have problems with bed wetting?
-
Have you observed your child having a nightmare during which he/she appeared extremely afraid or terrified?
-
Have you looked in on your child and discovered he/she was crying while asleep?
-
Has he/she told you about having a pleasant dream?
-
Does your child complain about difficulties going to sleep?
-
Does your child get up to go to the bathroom during the night?
-
Does your child stop breathing during sleep?
-
Does your child struggle to breathe while asleep?
-
Does your child fall asleep easily?
-
Do you ever shake your child to make him/her breathe again when asleep?
-
Do your child's lips ever turn blue or purple while asleep?
-
Are you ever concerned about your child's breathing during sleep?
-
How often does your child snore?
-
How loud is the snore? (the responses to this question are “mildly quiet,” “medium loud,” “loud,” “very loud,” and “extremely loud”)
-
How often does your child have a sore throat?
-
Does your child complain of morning headaches?
-
Is your child a daytime mouth breather?
-
Is your child sleepy during the daytime?
-
Does your child fall asleep at school?
-
Does your child fall asleep while watching television?
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O'Brien, L., Ivanenko, A., Crabtree, V. et al. Sleep Disturbances in Children with Attention Deficit Hyperactivity Disorder. Pediatr Res 54, 237–243 (2003). https://doi.org/10.1203/01.PDR.0000072333.11711.9A
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DOI: https://doi.org/10.1203/01.PDR.0000072333.11711.9A
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