Main Article Content
Attention Deficit Hyperactivity Disorder (ADHD) is a quite common neuropsychiatric ailment affecting all ages. The diagnosis is based on clinical judgement without a biological diagnostic marker. Thus, both over – and – underdiagnoses are not a rarity. Since it is a developmental disorder the clinical features are altered with age but the classical “triad” of inattention, hyperactivity and impulsivity remain in the majority of the patients throughout their life span. A number of comorbidities are associated with the disorder and in many patients their presence imposes a negative effect on life quality which may be more prominent than that caused directly by the classical "triad". Although cases with the triad have been reported during the last 200 years, the concept of ADHD was solidified in 1987. Sleep impairment as an important comorbidity of ADHD has been slowly unrevealed. Surprisingly, even in DSM-5, any form of sleep impairment was not mentioned in ADHD. This paper is a review of the prevalence, characteristics and possible aetiology of sleep impairment in youngsters and adults with ADHD. Also, the bidirectional association between impaired sleep quality and ADHD is discussed in an attempt to clarify whether impaired sleep is an additional symptom of “pure” ADHD, is the sole result of associated comorbidities or is the result of both.
The Medical Research Archives grants authors the right to publish and reproduce the unrevised contribution in whole or in part at any time and in any form for any scholarly non-commercial purpose with the condition that all publications of the contribution include a full citation to the journal as published by the Medical Research Archives.
2. Cortese S, Coghill D.Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evid Based Ment Health. 2018; 21(4):173-6.
3. NICE. Attention deficit hyperactivity disorder: diagnosis and management of ADHD in children, young people and adults. Clinical Guideline 72. London: National Institute for Health and Care Excellence, 2008.
4. Sayal K, Prasad V, Daley D, Ford T, Coghill D. ADHD in children and young people: prevalence, care pathways, and service provision. Lancet Psychiatry 2018; 5(2):175-86.
5. Faraone SV, Sergeant J, Gillberg C, Biederman J. The worldwide prevalence of ADHD: is it an American condition? World Psychiatry 2003; 2: 104-13.
6. Solanto MV. The Prevalence of "Late-Onset" ADHD in a Clinically Referred Adult Sample. J Atten Disord 2019; 23(9):1026-34.
7. Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of followup studies. Psychol Med 2006; 36(2):159–65.
8. Fayyad J, Sampson NA, Hwang I, Adamowski T, Aguilar-Gaxiola S, AlHamzawi A, et al. The descriptive epidemiology of DSM-IV adult ADHD in the world health organization world mental health surveys. Atten Defic Hyperact Disord 2017; 9(1):47–65.
9. Gillberg C, Gillberg IC, Rasmussen P, Kadesjö B, Söderström H, Råstam M, et al. Co-existing disorders in ADHD - implications for diagnosis and intervention. Eur Child Adolesc Psychiatry 2004; 13 Suppl 1: I80-92.
10. Biederman J, Faraone SV, Spencer T, Wilens T, Norman D, Lapey KA, et al. Patterns of psychiatric comorbidity, cognition, and psychosocial functioning in adults with attention deficit hyperactivity disorder. Am J Psychiatry 1993; 150: 1792-8.
11. Smaldone A, Honig JC, Byrne MW. Sleepless in America: inadequate sleep and relationships to health and well-being of our nation’s children. Pediatrics 2007; 119:s29–37.
12. Steinsbekk S, Berg-Nielsen TS, Wichstrøm L. Sleep disorders in pre-schoolers: prevalence and comorbidity with psychiatric symptoms. J Dev Behav Pediatr 2013; 34:633–41.
13. Stephens RJ, Chung SA, Jovanovic D, Guerra R, Stephens B, Sandor P, et al. Relationship between polysomnographic sleep architecture and behavior in medication-free children with TS, ADHD, TS and ADHD, and controls. J Dev Behav Pediatr 2013; 34:688–96.
14. Friman PC, Schnoes, CJ. Pediatric Prevention: Sleep Dysfunction. Pediatr Clin North Am 2020; 67(3):559-71.
15. Owens J. Classification and epidemiology of childhood sleep disorders. Prim Care 2008; 35(3):533-46.
16. Owens JA, Spirito A, McGuinn M, Nobile C. Sleep habits and sleep disturbance in elementary school-aged children. J Dev Behav Pediatr 2000; 21(1):27-36.
17. Pagel JF, Forister N, Kwiatkowki C. Adolescent sleep disturbance and school performance: the confounding variable of socioeconomics J Clin Sleep Med 2007; 3(1):19-23.
18. Kahn A, Van de Merckt C, Rebuffat E, Mozin MJ, Sottiaux M, Blum D, et al. Sleep problems in healthy preadolescents.Pediatrics 1989 ;84(3):542-6.
19. Preety R, Gayatri Devi R, Jothi Priya A. Sleep deprivation and cell phone usage among teenagers. Drug Intervention Today 2018; 10(10), 2073-5.
20. Rodríguez-García AM, Moreno-Guerrero AJ, López Belmonte J. Nomophobia: An Individual's Growing Fear of Being without a Smartphone-A Systematic Literature Review. Int J Environ Res Public Health 2020; 17(2):580.
21. Green A, Cohen-Zion M, Haim A, Dagan Y. Evening light exposure to computer screens disrupts human sleep, biological rhythms, and attention abilities, Chronobiol Int 2017; 34 (7), 855-65.
22. Roenneberg T, Kuehnle T, Pramstaller PP, Ricken J, Havel M, Guth A, et al. A marker for the end of adolescence. Curr Biol 2004; 14(24):R1038-9.
23. Dolsen MR, Wyatt JK, Harvey AG. Sleep, Circadian Rhythms, and Risk Across Health Domains in Adolescents With an Evening Circadian Preference. J Clin Child Adolesc Psychol 2019; 48 (3):480-90.
24. Cohen-Zion M, Shiloh E. Evening chronotype and sleepiness predict impairment in executive abilities and academic performance of adolescents. Chronobiol Int 2018; 35 (1): 137–45.
25. Vignau J, Bailly D, Duhamel A, Vervaecke P, Beuscart R, Collinet C. Epidemiologic study of sleep quality and troubles in French secondary school adolescents. J Adolesc Health 1997; 21(5):343-50.
26. Levy D, Gray-Donald K, Leech J, Zvagulis I, Pless IB. Sleep patterns and problems in adolescents. J Adolesc Health Care 1986; 7(6):386-9.
27. Becker SP, Cusick CN, Sidol CA, Epstein JN, Tamm L. The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. Eur Child Adolesc Psychiatry 2018; 27(3):353-65.
28. Sung V, Hiscock H, Sciberras E, Efron D. Sleep problems in children with attention-deficit/hyperactivity disorder: prevalence and the effect on the child and family. Arch Pediatr Adolesc Med 2008; 162(4):336-42.
29. Chiang HL, Gau SS, Ni HC, Chiu YN, Shang CY, Wu YY, et al. Association between symptoms and subtypes of attention-deficit hyperactivity disorder and sleep problems/disorders .J Sleep Res 2010; 19(4):535-45.
30. Chervin, RD, Archbold KH. Hyperactivity and polysomnographic findings in children evaluated for sleep-disordered breathing. Sleep 2001; 24(3):313-20.
31. Hill CM, Hogan AM, Karmiloff-Smith A. To sleep, perchance to enrich learning? Arch Dis Child 2007; 92(7): 637–43.
32. Schechter MS. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002; 109:e69.
33. Huang YS, Guilleminault C, Li HY, Yang CN, Wu YY, Chen NH. Attention deficit/hyperactivity disorder with obstructive sleep apnea: a treatment outcome study. Sleep Med 2007; 8(1): 18–30.
34. Wu J, Gu M, Chen S, Chen W, Ni K, Xu H, et al. Factors related to pediatric obstructive sleep apnea-hypopnea syndrome in children with attention deficit hyperactivity disorder in different age groups. Medicine 2017; 96(42): e8281.
35. Vogel SWN, Bijlenga D, Benjamins JS, Beekman ATF, Kooij JJS, van Someren EJW. Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry. Sleep Med 2017; 40:94–102.
36. Hesselbacher S, Aiyer AA, Surani SR, Suleman AA, Varon J. A Study to Assess the Relationship between Attention Deficit Hyperactivity Disorder and Obstructive Sleep Apnea in Adults. Cureus 2019: 24; 11(10):e5979.
37. Sedky K, Bennett DS, Carvalho KS .Attention deficit hyperactivity disorder and sleep disordered breathing in paediatric populations: a meta-analysis. Sleep Med Rev 2014; 18(4):349-56.
38. Marcus CL, Traylor J, Gallagher PR, Brooks LJ, Huang J, Koren D, et al .Prevalence of periodic limb movements during sleep in normal children.Sleep 2014;37(8):1349-52.
39. Gingras JL, Gaultney JF, Picchietti D. Pediatric periodic limb movement disorder: sleep symptom and polysomnographic correlates compared to obstructive sleep apnea. J Clin Sleep Med 2011; 7(6):603-609.
40. Gaultney JF, Merchant K, Gingras JL. Parents of children with periodic limb movement disorder versus sleep-disordered breathing report greater daytime mood and behavior difficulties in their child: the importance of using ICSD-2nd Edition criteria to define a PLMD study group. Behav Sleep Med 2009; 7:119-35.
41. Begum E, Goodday A, Spurr K, Malgorzata R , Corkum P. Periodic Limb Movements of Sleep in Children with Attention-Deficit/Hyperactivity Disorder: Baseline Frequency and Impact of Psycho-Stimulant Medication. SM J Sleep Disord 2018; 4(1): 1019.
42. Virring A, Lambek R, Thomsen PH, Møller LR, Jennum PJ .Disturbed sleep in attention-deficit hyperactivity disorder (ADHD) is not a question of psychiatric comorbidity or ADHD presentation. J Sleep Res 2016; 25:333-40.
43. Scarpelli S, Gorgoni M, D'Atri A, Reda F, De Gennaro L .Advances in Understanding the Relationship between Sleep and Attention Deficit-Hyperactivity Disorder (ADHD). J Clin Med 2019; 8(10):1737.
44. Kirov R , Kinkelbur J, Heipke S, Kostanecka-Endress T, Westho M, Cohrs S, et al. Is there a specific polysomnographic sleep pattern in children with attention deficit/hyperactivity disorder? J Sleep Res 2004; 13, 87–93. Zhang DW, Roodenrys S, Li H, Barry RJ, Clarke AR, Wu Z, et al. Atypical interference control in children with AD/HD with elevated theta/beta ratio.Biol Psychol 2017;128:82-8 .
45. Cremone A, Lugo-Candelas CI, Harvey EA, McDermott JM, Spencer RMC. REM theta activity enhances inhibitory control in typically developing children but not children with ADHD symptoms. Exp Brain Res 2017; 235, 1491–500.
46. Zhang DW, Li H, Wu Z, Zhao Q, Song Y, Liu L, et al . Electroencephalogram Theta/Beta Ratio and Spectral Power Correlates of Executive Functions in Children and Adolescents With AD/HD. J Atten Disord 2019; 23(7):721-32.
47. Larson K, Russ SA, Kahn RS, Halfon N. Patterns of comorbidity, functioning, and service use for US children with ADHD, 2007. Pediatrics 2011; 127, 462–70.
48. Mayes SD, Calhoun SL, Crowell EW. Learning disabilities and ADHD: overlapping spectrum disorders. J Learn Disabil 2000; 33:417–24.
49. Barkley RA, Russell A. (2014), Attention-deficit hyperactivity disorder: A handbook for diagnosis and treatment. Guilford Publications, New York.
50. DuPaul GJ, Gormley MJ, Laracy SD. Comorbidity of LD and ADHD: implications of DSM-5 for assessment and treatment. J Learn Disabil 2013; 46(1):43–51.
51. Gnanavel S, Sharma P, Kaushal P, Hussain S. Attention deficit hyperactivity disorder and comorbidity: A review of literature.World J Clin Cases 2019 ;7(17):2420-6.
52. Mokobane M, Pillay BJ, Meyer A. Fine motor deficits and attention deficit hyperactivity disorder in primary school children. S Afr J Psychiatr 2019; 25:1232.
53. Takeda T, Ambrosini PJ, deBerardinis R, Elia J.What can ADHD without comorbidity teach us about comorbidity?. Res Dev Disabil 2012; 33(2):419-25.
54. Reale L, Bartoli B, Cartabia M, Zanetti M, Costantino MA, Canevini MP, et al. Lombardy ADHD Group.Comorbidity prevalence and treatment outcome in children and adolescents with ADHD. Eur Child Adolesc Psychiatry 2017; 26(12):1443-57.
55. Lindgren, SD, Koeppl, GK. Assessing child behavior problems in a medical setting: Development of the Pediatric Behavior Scale. In R. J. Prinz (Ed.), Advances in behavioral assessment of children and families Greenwich, CT: JAI press, Vol. 3, 1987, pp. 57-90.
56. Mayes SD, Calhoun SL, Bixler EO, Vgontzas AN, Mahr F, Hillwig-Garcia J, et al. ADHD subtypes and comorbid anxiety, depression, and oppositional-defiant disorder: differences in sleep problems. J Pediatr Psychol 2009; 34(3):328-37.
57. de Carvalho LB, do Prado LB, Ferrreira VR, da Rocha Figueiredo MB, Jung A, et al. Symptoms of sleep disorders and objective academic performance. Sleep Med 2013; 14(9):872-6.
58. Masi G, Millepiedi S, Mucci M, Poli P, Bertini N. Milantoni L. Generalized anxiety disorder in referred children and adolescents. J Am Acad Child Adolesc Psychiatry 2004; 43: 752–76.
59. Liu X, Buysse DJ, Gentzler AL, Kiss E, Mayer L, Kapornai K, Vetró A, et al. Insomnia and hypersomnia associated with depressive phenomenology and comorbidity in childhood depression. Sleep 2007; 30(1):83-90.
60. Shanahan L, Copeland WE, Angold A, Bondy CL, Costello EJ. Sleep problems predict and are predicted by generalized anxiety/depression and oppositional defiant disorder J Am Acad Child Adolesc Psychiatry 2014; 53(5):550-8.
61. Barnett AL, Wiggs L. Sleep behaviour in children with developmental co-ordination disorder. Child Care Health Dev 2012; 38,403–11.
62. Esposito M, Precenzano F, Bitetti I, Zeno I, Merolla E, Risoleo MC, et al. Sleep Macrostructure and NREM Sleep Instability Analysis in Pediatric Developmental Coordination Disorder. Int J Environ Res Public Health 2019 2; 16(19):3716.
63. Wiggs L. Sparrowhawk M. Barnett AL. Parent Report and Actigraphically Defined Sleep in Children with and without Developmental Coordination Disorder; Links with Fatigue and Sleepiness. Front Pediatr 2016; 4, 81.
64. Takahashi N, Nishimura T, Harada T ,Okumura A, Choi D, Iwabuchi T,et al. Polygenic risk score analysis revealed shared genetic background in attention deficit hyperactivity disorder and narcolepsy. Transl Psychiatry 2020; 17: 10(1):284.
65. Albajara Sáenz A, Villemonteix T, Massat I.Structural and functional neuroimaging in attention-deficit/hyperactivity disorder. Dev Med Child Neurol 2019; 61(4):399-405.
66. Samea F, Soluki S, Nejati V, Zarei M, Cortese S, Eickhoff SB, et al. Brain alterations in children/adolescents with ADHD revisited: A neuroimaging meta-analysis of 96 structural and functional studies. Neurosci Biobehav Rev 2019; 100:1-8.
67. Shen C, Luo Q, Chamberlain SR, Morgan S, Romero-Garcia R, Du J, et al. What Is the Link Between Attention-Deficit/Hyperactivity Disorder and Sleep Disturbance? A multimodal Examination of Longitudinal Relationships and Brain Structure Using Large-Scale Population-Based Cohorts. Biol Psychiatry 2020 15; 88(6):459-469.
68. Saletin JM, Jackvony S, Rodriguez KA, Dickstein DP. A coordinate-based meta-analysis comparing brain activation between attention deficit hyperactivity disorder and total sleep deprivation. Sleep 2019; 42(3):zsy251.
69. Gadoth N. Methylphenidate (Ritalin): What makes it so Widely Prescribed during the Last 60 Years? Curr Drug Therapy 2013; 8:171-80.
70. Cortese, S., Adamo, N., Del Giovane, C. Mohr-Jensen C, Hayes AJ, Carucci S, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents and adults: a systematic review and network meta-analysis. Lancet Psychiatry 2018; 5 (9):727–38.
71. Graham J, Coghill D. Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. CNS Drugs 2008; 22: 213-37.
72. Kirov R, Brand S. Sleep problems and their effect in ADHD. Expert Rev Neurother 2014; 14:287–99.
73. 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: 309-16.
74. Becker SP, Froehlich TE, Epstein JN. Effects of Methylphenidate on Sleep Functioning in Children with Attention-Deficit/Hyperactivity Disorder. J Dev Behav Pediatr 2016;37(5):395-404.
75. Boonstra AM, Kooij JJ, Oosterlaan J, Sergeant JA, Buitelaar JK, Van Someren EJ. Hyperactive night and day? Actigraphy studies in adult ADHD: a baseline comparison and the effect of methylphenidate. Sleep 2007; 30(4):433-42.
76. Sobanski E, Schredl M, Kettler N, Alm B. Sleep in adults with attention deficit hyperactivity disorder (ADHD) before and during treatment with methylphenidate: a controlled polysomnographic study. Sleep 2008; 31(3):375-81.
77. Surman CB, Roth T. Impact of stimulant pharmacotherapy on sleep quality: post hoc analyses of 2 large, double-blind, randomized, placebo-controlled trials. J Clin Psychiatry. 2011; 72(7):903–8.
78. Wynchank D, Bijlenga D, Beekman AT, Kooij JJS, Penninx BW. Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature. Curr Psychiatry Rep 2017; 19(12):98.