Abstract
Background
This study aims to study prospectively specific sleep patterns and risk of ADHD after adjusting for potential confounders such as obstructive sleep apnoea (OSA) and methylphenidate use.
Methods
A population-representative sample of 514 Chinese preschool children was recruited when in kindergarten (K3). Parents reported on their socioeconomic status and children’s sleep duration. The cohort was reassessed 3 years later when the children were in Grade 3 (P3). Parents reported on children’s sleep patterns and ADHD symptoms. Information on OSA diagnosis and methylphenidate use was retrieved from health records.
Results
Among the 514 parent–child dyads (mean [SD] age, 5.52 [0.33] years), 411 were reassessed (80.0% retention; 9.35 [0.33] years) at follow-up. There were no significant baseline differences between follow-up and drop-out groups. A gradient relationship was observed between probable ADHD in P3 and sleep duration in K3. The risk of probable ADHD was 15.5 per 100 for children with <8 h of sleep in K3, whereas it was 1.1 per 100 for children with 11–12 h of sleep in K3. The adjusted risk ratio was 14.19 (p = 0.02).
Conclusions
Sleep deprivation in early childhood is associated with higher risk of ADHD in middle childhood.
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Acknowledgments
We thank the schools, children, and their parents for participating in this study. The cohort study was fully supported by two research grants from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project Nos. 743413 and 746111).
Author contributions
W.T. interpreted the data and wrote the first draft of the manuscript. F.K.W.H. analysed the data, drafted a part of the manuscript, and critically revised the manuscript. M.C., K.L.C., A.M.L., A.T., Y.K.W., I.C.K.W., B.V.V., S.L.L. and W.H.S.G. interpreted the data and critically revised the manuscript. P.I. and N.R. conceptualised and designed the study, interpreted the data, and critically revised the manuscript. All authors have read and approved the final version of the manuscript.
Funding disclosure
The cohort study was supported by two research grants from the Research Grants Council of the Hong Kong Special Administrative Region, China (Project Nos. 743413 and 746111). The funder has no role in (1) study design; (2) the collection, analysis, and interpretation of data; (3) the writing of the report; and (4) the decision to submit the paper for publication.
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Co-first authors: Winnie Tso, Meanne Chan.
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Tso, W., Chan, M., Ho, F.K. et al. Early sleep deprivation and attention-deficit/hyperactivity disorder. Pediatr Res 85, 449–455 (2019). https://doi.org/10.1038/s41390-019-0280-4
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DOI: https://doi.org/10.1038/s41390-019-0280-4
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