Abstract
The relationship between attention-deficit/hyperactivity disorder (ADHD) and sleep is complex and poses many challenges in clinical practice. Recent studies have helped to elucidate the nature of the neuromodulator systems underlying the associations among sleepiness, arousal, and attention. Studies of sleep disturbances in children with academic and behavioral problems have also underscored the role that primary sleep disorders play in the clinical presentation of symptoms of inattention and behavioral dysregulation. Recent research has shed further light on the prevalence, type, risk factors for, and impact of sleep disturbances on children with ADHD. The following discussion of the multilevel and bidirectional relationships among sleep, neurobehavioral functioning, and the clinical syndrome of ADHD synthesizes current knowledge about the interaction of sleep and attention/arousal in these children. Guidelines are provided to outline a clinical approach to evaluating and managing children with ADHD and sleep problems.
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References and Recommended Reading
Owens JA: The ADHD and sleep conundrum: a review. J Dev Behav Pediatr 2005, 26:312–322.
Fallone G, Owens JA, Deane J: Sleepiness in children and adolescents: clinical implications. Sleep Med Rev 2002, 6:287–306.
Dahl RE: The regulation of sleep and arousal: development and psychopathology. Dev Psychopathol 1996, 8:3–27.
Biederman J, Spencer T: Attention-deficit/hyperactivity disorder (ADHD) as a noradrenergic disorder. Biol Psychiatry 1999, 46:1234–1242.
Horne JA: Human sleep, sleep loss and behaviour. Implications for the prefrontal cortex and psychiatric disorder. Br J Psychiatry 1993, 162:413–419.
van der Heijden KB, Smits MG, van Someren EJ, Boudewijn Gunning W: Prediction of melatonin efficacy by pretreatment dim light melatonin onset in children with idiopathic chronic sleep onset insomnia. J Sleep Res 2005, 14:187–194.
Golan N, Shahar E, Ravid S, Pillar G: Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. Sleep 2004, 27:261–266.
Lecendreux M, Konofal E, Bouvard M, et al.: Sleep and alertness in children with ADHD. J Child Psychol Psychiatry 2000, 41:803–812.
Corkum P, Tannock R, Moldofsky H: Sleep disturbances in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 1998, 37:637–646.
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, 8:379–402.
Sadeh A, Pergamin L, Bar-Heim Y: Sleep in children with attention-deficit hyperactivity disorder: a meta-analysis of polysomnographic studies. Sleep Med Rev 2006, 10:381–398.
Miano S, Donfrancesco R, Bruni O, et al.: NREM sleep instability is reduced in children with attention-deficit/hyperactivity disorder. Sleep 2006, 29:797–803.
Cortese S, Konofal E, Yateman N, et al.: Sleep and alertness in children with attention-deficit/hyperactivity disorder: a systematic review of the literature. Sleep 2006, 29:504–511.
Gruber R, Sadeh A, Raviv A: Instability of sleep patterns in children with attention-deficit/hyperactivity disorder. J Am Acad Child Adolesc Psychiatry 2000, 39:495–501.
Ring A, Stein D, Barak Y, et al.: Sleep disturbances in children with attention-deficit/hyperactivity disorder: a comparative study with healthy siblings. J Learn Disabil 1998, 31:572–578.
Marcotte AC, Thacher PV, Butters M, et al.: Parental report of sleep problems in children with attentional and learning disorders. J Dev Behav Pediatr 1998, 19:178–186.
O’Brien LM, Ivanenko A, Crabtree VM, et al.: Sleep disturbances in children with attention deficit hyperactivity disorder. Pediatr Res 2003, 54:237–243.
O’Brien LM, Ivanenko A, Crabtree VM, et al.: The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder. Sleep Med 2003, 4:309–316.
Mick E, Biederman J, Jetton J, Faraone SV: Sleep disturbances associated with attention deficit hyperactivity disorder: the impact of psychiatric comorbidity and pharmacotherapy. J Child Adolesc Psychopharmacol 2000, 10:223–231.
Stein MA: Unravelling sleep problems in treated and untreated children with ADHD. J Child Adolesc Psychopharmacol 1999, 9:157–168.
Tirosh E, Sadeh A, Munvez R, Lavie P: Effects of methylphenidate on sleep in children with attention-deficient hyperactivity disorder. An activity monitor study. Am J Dis Child 1993, 147:1313–1315.
Sangal RB, Owens J, Allen AJ, et al.: Effects of atomoxetine and methylphenidate on sleep in children with ADHD. Sleep 2006, 29:1573–1585.
Corkum P, Moldofsky H, Hogg-Johnson S, et al.: Sleep problems in children with attention-deficit/hyperactivity disorder: impact of subtype, comorbidity, and stimulant medication. J Am Acad Child Adolesc Psychiatry 1999, 38:1285–1293.
Randazzo AC, Muehlbach MJ, Schweitzer PK, Walsh JK: Cognitive function following acute sleep restriction in children ages 10–14. Sleep 1998, 21:861–868.
Schecter M: AAP technical report: diagnosis and management of childhood obstructive sleep apnea. Pediatrics 2002, 9:704–712.
Redline S, Tishler PV, Schluchter M, et al.: Risk factors for sleep-disordered breathing in children. Associations with obesity, race, and respiratory problems. Am J Respir Crit Care Med 1999, 159:1527–1532.
Chervin RD, Archbold KH: Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing. Sleep 2001, 24:313–320.
Chervin RD, Dillon JE, Bassetti C, et al.: Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997, 20:1185–1192.
Huang YS, Guilleminault C, Li HY, et al.: Attention-defi-cit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med 2007, 8:18–30.
Beebe DW: Neurobehavioral morbidity associated with disordered breathing during sleep in children: a comprehensive review. Sleep 2006, 29:1115–1134.
Gozal D: Sleep-disordered breathing and school performance in children. Pediatrics 1998, 102:616–620.
Ali NJ, Pitson D, Stradling JR: Sleep disordered breathing: effects of adenotonsillectomy on behaviour and psychological functioning. Eur J Pediatr 1996, 155:56–62.
Chervin RD, Ruzicka DL, Giordani BJ, et al.: Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 2006, 117:e769–e778.
O’Brien LM, Holbrook CR, Mervis CB, et al.: Sleep and neurobehavioral characteristics of 5-to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. Pediatrics 2003, 111:554–563.
Picchietti D, Walters A: Restless legs syndrome and period limb movement disorders in children and adolescents. Child Adolesc Psychiatr Clin N Am 1996, 5:729–740.
Walters AS, Mandelbaum DE, Lewin DS, et al.: Dopaminergic therapy in children with restless legs/periodic limb movements in sleep and ADHD. Dopaminergic Therapy Study Group. Pediatr Neurol 2000, 22:182–186.
Cortese S, Konofal E, Lecendreux M, et al.: Restless legs syndrome and attention-deficit/hyperactivity disorder: a review of the literature. Sleep 2005, 28:1007–1013.
Chervin RD, Archbold KH, Dillon JE, et al.: Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep 2002, 25:213–218.
Picchietti D, Allen RP, Walters AS, et al.: Restless legs syndrome: prevalence and impact in children and adolescents—the Peds REST study. Pediatrics 2007, 120:253–266.
Weiss MD, Wasdell MB, Bomben MM, et al.: Sleep hygiene and melatonin treatment for children and adolescents with ADHD and initial insomnia. J Am Acad Child Adolesc Psychiatry 2006, 45:512–519.
Owens JA, Dalzell V: Use of the ‘BEARS’ sleep screening tool in a pediatric residents’ continuity clinic: a pilot study. Sleep Med 2005, 6:63–69.
Owens JA, Spirito A, McGuinn M: The Children’s Sleep Habits Questionnaire (CSHQ): psychometric properties of a survey instrument for school-aged children. Sleep 2000, 23:1043–1051.
Owens JA, Rosen CL, Mindell JA: Medication use in the treatment of pediatric insomnia: results of a survey of community-based pediatricians. Pediatrics 2003, 111:e628–e635.
Owens JA, Babcock D, Blumer J, et al.: The use of pharmacotherapy in the treatment of pediatric insomnia in primary care: rational approaches. A consensus meeting summary. J Clin Sleep Med 2005, 1:49–59.
Mindell J, Owens J: A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems in Children and Adolescents. Philadelphia: Lippincott Williams & Wilkins; 2003
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Owens, J.A. Sleep disorders and attention-deficit/hyperactivity disorder. Curr Psychiatry Rep 10, 439–444 (2008). https://doi.org/10.1007/s11920-008-0070-x
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DOI: https://doi.org/10.1007/s11920-008-0070-x