Polysomnographic Findings in Children with Attention-Deficit//Hyperactivity Disorder Investigated for Sleep Disturbances
I. Příhodová; D. Kemlink; S. Nevšímalová
Authors‘ workplace: Neurologická klinika a Centrum klinických neurověd, 1. LF UK a VFN v Praze
Published in: Cesk Slov Neurol N 2012; 75/108(2): 191-196
Category: Original Paper
A retrospective assessment of sleep disorders in patients with attention--deficit/hyperactivity disorder (ADHD) referred to nocturnal polysomnography.
Patients and methods:
Our cohort included 80 children, 60 males, age range 4−18 years, mean age 10 ±4.2). We evaluated presenting complaints, subjective sleep problems, polysomnographic findings and final diagnosis.
Presenting complaints were parasomnia − sleep terrors, somnambulism (28% patients), insomnia with difficulty in falling asleep (25%), obstructive sleep apnea − OSA (13%) and excessive daytime sleepiness (11%). The most frequent polysomnographic findings were periodic limb movements in sleep − PLMS (25%), parasomnia – disorders of arousal from NREM sleep (24%), OSA (18%) and delayed sleep phase disorder (11%). 10% of patients had normal polysomnography. Comparison of sleep parameters of the entire ADHD group and subgroups with various sleep disorders did not reveal any statistically significant changes in polysomnographic results. 70% of patients presenting with insomnia had a diagnosis of various sleep disorders (delayed sleep phase disorder – 8 patients, periodic limb movement disorder − 4 patients, restless legs syndrome − 2 patients).
Sleep disorders (PLMS, parasomnia, OSA) are to be considered among comorbidities found in children with ADHD, whereas nocturnal polysomnography plays an important role in their diagnostics. Sleep phase delay, periodic limb movement disorder or restless legs syndrome all may manifest as ADHD-associated insomnia.
attention-deficit hyperactivity disorder – nocturnal polysomnography – parasomnia – insomnia – periodic limb movements in sleep – delayed sleep phase disorder
1. Biederman J. Faraone SV. Attention-deficit hyperactivity disorder. Lancet 2005; 366(9481): 237−248.
2. Corkum P, Tannock R, Moldofsky H. Sleep disturbances in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1998; 37(6): 637−646.
3. Owens JA, Maxim R, Nobile C, McGuinn M, Msall M. Parental and self-report of sleep in children with attention deficit/hyperactivity disorder. Arch Pediatr Adolesc Med 2000; 154(6): 549−555.
4. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Washington: American Psychiatric Association 1980.
5. O’Brien LM, Gozal D. Sleep in children with attention deficit/hyperactivity disorder. Minerva Pediatr 2004; 56(6): 585−601.
6. Cohen-Zion M, Ancoli-Israel S. Sleep in children with attention-deficit hyperactivity disorder (ADHD): a review of naturalistic and stimulant intervention studies. Sleep Med Rev 2004; 8(5): 379−402.
7. Sadeh A, Pergamin L, Bar-Haim Y. Sleep in children with attention-deficit hyperactivity disorder: a meta--analysis of polysomnographic studies. Sleep Med Rev 2006; 10(6): 381−398.
8. Cortese S, Konofal E, Yateman N, Mouren M, Lecendreux M. Sleep and alertness in children with attention-deficit/hyperactivity disorder: a systematic review of the literature. Sleep 2006; 29(6): 504−511.
9. Cortese S, Faraone SV, Konofal E, Lecendreux M. Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. J Am Acad Child Adolesc Psychiatry 2009; 48(9): 894−908.
10. van der Heijden KB, Smits MG, Gunning WB. Sleep-related disorders in ADHD: a review. Clin Pediatr 2005; 44(3): 201−210.
11. Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997; 20(12): 1185−1192.
12. Chervin RD, Archbold KH, Dillon JE, Panahi P, Pituch KJ, Dahl RE et al. Inattention, hyperactivity, and symptoms of sleep-disordered breathing. Pediatrics 2002; 109(3): 449−456.
13. Huang YS, Chen NH, Li HY, Wu YY, Chao CC, Guilleminault C. Sleep disorders in Taiwanese children with attention deficit/hyperactivity disorder. J Sleep Res 2004; 13(3): 269−277.
14. Pichietti DL, Walter AS. Restless legs syndrome and periodic limb movement disorder in children and adolescents: comorbidity with attention-deficit hyperactivity disorder. Child Adolesc Psychiatr Clin N Am 1996; 5: 729−740.
15. Picchietti DL, England SJ, Walters AS, Willis K, Verrico T. Periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. J Child Neurol 1998; 13(12): 588−594.
16. Picchietti DL, Underwood DJ, Farris WA, Walters AS, Shah MM, Dahl RE et al. Further studies on periodic limb movement disorder and restless legs syndrome in children with attention-deficit hyperactivity disorder. Mov Disord 1999; 14(6): 1000−1007.
17. Chervin RD, Archbold KH, Dillon JE, Pituch KJ, Panahi P, Dahl RE et al. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep 2002; 25(2): 213−218.
18. Crabtree VM, Ivanenko A, Gozal D. Clinical and parental assessment of sleep in children with attention-deficit/hyperactivity disorders referred to a pediatric sleep medicine center. Clin Pediatr (Phila) 2003; 42(9): 807−813.
19. Gruber R, Sadeh A. Sleep and neurobehavioral functioning in boys with attention-deficit/hyperactivity disorder and no reported breathing problems. Sleep 2004; 27(2): 188−189.
20. Sangal RB, Owens JA, Sangal J. Patients with attention-deficit/hyperactivity disorder without observed apneic episodes in sleep or daytime sleepiness have normal sleep on polysomnography. Sleep 2005; 28(9): 1143−1148.
21. O’Brien LM, Holbrook CR, Mervis CB, Klaus CJ, Bruner JL, Raffield TJ et al. Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003; 111(3): 554−563.
22. O’Brien LM, Ivanenko A, Crabtree VM, Holbrook CR, Bruner JL, Klaus CJ et al. Sleep disturbances in children with attention deficit hyperactivity disorder. Pediatr Res 2003; 54(2): 237−243.
23. O’Brien LM, Ivanenko A, Crabtree VM, Holbrook CR, Bruner JL, Klaus CJ et al. The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder. Sleep Med 2003; 4(4): 309−316.
24. Rechtschaffen A, Kales A. Manual of Standardised Terminology, Techniques and Scoring System for Sleep Stages of Human Subjects. Washington DC: Government Printing Office 1968.
25. American Thoracic Society. Standards and indications for cardiopulmonary sleep studies in children. Am J Respir Crit Care Med 1996; 153(2): 866−878.
26. The International Classification of Sleep Disorders. Diagnostic and Coding manual. 2nd ed. Westchester, IL: American Academy of Sleep Medicine 2005.
27. Van der Heijden KB, Smits MG, Van Someren EJ, Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int 2005; 22(3): 559−570.
28. Van der Heijden KB, Smits MG, Gunning WB. Sleep hygiene and actigraphically evaluated sleep characteristics in children with ADHD and chronic sleep onset insomnia. J Sleep Res 2006; 15(1): 55−62.
29. Goraya JS, Cruz M, Valencia I, Kaleyias J, Khurana DS, Hardison HH et al. Sleep study abnormalities in children with attention deficit hyperactivity disorder. Pediatr Neurol 2009; 40(1): 42−46.
30. Prihodova I, Paclt I, Kemlink D, Skibova J, Ptacek R, Nevsimalova S. Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactivity disorder: a two-night polysomnographic study with a multiple sleep latency test. Sleep Med 2010; 11(9): 922−928.
31. Silvestri R, Gagliano A, Aricò I, Calarese T, Cedro C, Bruni O et al. Sleep disorders in children with Attention-Deficit/Hyperactivity Disorder (ADHD) recorded overnight by video-polysomnography. Sleep Med 2009; 10(10): 1132−1138.
32. Walters AS, Silvestri R, Zucconi M, Chandrashekariah R, Konofal E. Review of the possible relatioship and hypothetical links between attention deficit hyperactivity disorder (ADHD) and the simple sleep related movement disorders, parasomnias, hypersomnias and circadian rhythm disorders. J Clin Sleep Med 2008; 4(6): 591−600.
33. Kissling C, Retz W, Wiemann S, Coogan AN, Clement RM, Hünnerkopf R et al. A polymorphism at the 3‘-untranslated region of the CLOCK gene is associated with adult attention-deficit hyperactivity disorder. Am J Med Genet B Neuropsychiatr Genet 2008; 147(3): 333−338.
34. Van der Heijden KB, Smits MG, Van Someren EJ, Ridderinkhof KR, Gunning WB. Effect of melatonin on sleep, behavior, and cognition in ADHD and chronic sleep-onset insomnia. J Am Acad Child Adolesc Psychiatry 2007; 46(2): 233−241.
35. Hoebert M, van der Heijden KB, van Geijlswijk IM, Smits MG. Long-term follow-up of melatonin treatment in children with ADHD and chronic sleep onset insomnia. J Pineal Res 2009; 47(1): 1−7.
36. Chervin RD, Hedger KM. Clinical prediction of periodic leg movements during sleep in children. Sleep Med 2001; 2(6): 501−510.
37. Martinez S, Guilleminault C. Periodic leg movements in prepubertal children with sleep disturbance. Dev Med Child Neurol 2004; 46(11): 765−770.
38. Martin BT, Williamson BD, Edwards N, Teng AY. Parental symptom report and periodic limb movements of sleep in children. J Clin Sleep Med 2008; 4(1): 57−61.
39. Walters AS, Mandelbaum DE, Lewin DS, Kugler S, England SJ, Miller M. Dopaminergic therapy in children with restless legs/periodic limb movements in sleep and ADHD. Dopaminergic Therapy Study Group. Pediatr Neurol 2000; 22(3): 182−186.
40. Konofal E, Arnulf I, Lecendreux M, Mouren MC. Ropinirole in a child with attention-deficit hyperactivity disorder and restless legs syndrome. Pediatr Neurol 2005; 32(5): 350−351.
LabelsPaediatric neurology Neurosurgery Neurology
Article was published in
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