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Sleep Med. 2018 Sep 20. pii: S1389-9457(18)30294-6. doi: 10.1016/j.sleep.2018.08.026. [Epub ahead of print]

Sleep phenotypes in attention deficit hyperactivity disorder.

Author information

1
Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), via Tesserete 46, Lugano, 6903, Switzerland. Electronic address: silvia.miano@eoc.ch.
2
Sleep and Epilepsy Center, Neurocenter of Southern Switzerland, Civic Hospital of Lugano (EOC), via Tesserete 46, Lugano, 6903, Switzerland.
3
Department of Pediatrics, Civic Hospital of Lugano, Lugano, Switzerland.
4
Department of Pediatrics, San Giovanni Hospital, Bellinzona, Switzerland.

Abstract

OBJECTIVE:

A case-control study was performed to test the hypothesis that children with attention deficit hyperactivity disorder (ADHD) have chronic sleep deprivation and may be classified into specific sleep-related phenotypes.

METHODS:

Thirty outpatients with ADHD (nine females, mean age 10.1 ± 2.1 years) were recruited consecutively, and given a comprehensive sleep assessment, including blood exams, sleep questionnaires, laboratory video-polysomnographic recordings (v-PSG), multiple sleep latency tests, and one-week actigraphy. The PSG parameters were compared to those of 25 age-matched controls (12 females, mean age 10.34 ± 1.54 years) who underwent only the v-PSG.

RESULTS:

ADHD children were classified as follows: a narcolepsy-like phenotype was found in four; delayed sleep onset insomnia in five; obstructive sleep apnea (OSA) in 15; periodic limb movements in eight, and sleep epileptiform discharges in 10 children. All subjects had a total sleep time shorter than 9 h at actigraphy, ferritin levels lower than 60 mcg/L, and a history of sleep problems (mainly OSA and insomnia). Compared to controls, the ADHD group had a higher apnea-hypopnea index at PSG.

CONCLUSIONS:

A full sleep assessment in children with ADHD confirmed the validity of the sleep phenotypes hypothesis, and revealed a much higher percentage of sleep problems than that found in the literature. Beyond the sleep phenotypes, all children reported a history of sleep problems and slept less than 9 h per night, indicating chronic sleep deprivation that should be evaluated as a possible unifying marker of ADHD.

KEYWORDS:

ADHD; Epilepsy; Narcolepsy; Pediatrics – Insomnia; Pediatrics – Sleep apnea

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