Sleep among presentations of Attention-Deficit/Hyperactivity Disorder: Analysis of objective and subjective measures

Characterizing rest-activity rhythms and sleep for children with and without tactile sensitivities: An observational study

STUDY OBJECTIVES

This cross-sectional, observational study aimed to characterize and compare movement-based rest-activity rhythms (RARs) and sleep period variables of children with tactile hypersensitivities (SS) and non-sensitive peers (NSS) to expand the understanding of experienced differences in sleep.

METHODS

Children (ages 6-10) wore Actigraph GT9X watches for 2 weeks and caregivers completed daily sleep diaries. RARs and sleep period variables (e.g., sleep efficiency, duration, wake after sleep onset) were analyzed and localized means were plotted to visualize average rhythms for each group. Groups were compared using Student's t tests, or non-parametric alternatives, and Hedge's g effect sizes.

RESULTS

Fifty-three children and their families participated in this study (nSS = 21 nNSS = 32). The groups had similar RARs and sleep period variables. In both groups, sleep efficiency was low (SESS = 78%, SENSS = 77%) and total sleep time was short (TSTSS = 7 hrs 26 mins, TSTNSS- 7 h, 33 min) compared to national recommendations. Despite these similarities, children with SS took noticeably longer to settle down and fall asleep (53 min) than children with NSS (26 min, p = .075, g = 0.95).

CONCLUSION

This study provides preliminary data describing RAR and sleep period variables in children with and without tactile hypersensitivities. While overall RAR and sleep variables were similar between groups, there is evidence that children with SS spend a longer time transitioning to sleep. Evidence is provided that wrist-worn actigraphy is tolerable and acceptable for children with tactile sensitivities. Actigraphy provides important, movement-based data that should be used in tandem with other measures of sleep health for future studies.

Links between excessive daytime sleepiness and EEG power and activation in two subtypes of ADHD

OBJECTIVES

This study aimed to replicate previously reported EEG characteristics between typically developing (TD) children and two subtypes of Attention Deficit Hyperactivity Disorder (ADHD) using a frontal, single-channel, dry-sensor portable EEG device, and explore whether differences are moderated by excessive daytime sleepiness (EDS).

METHODS

Children with ADHD Inattentive (ADHD-I) and ADHD Combined presentation (ADHD-C) and typically-developing (TD) children (N = 34 in each group) had frontal EEG recorded during eyes-closed resting, eyes-open resting, and focus tasks. Participants also completed the Children's Self-Report Sleep Patterns - Sleepiness Scale as a measure of EDS.

RESULTS

Consistent with previous literature, there were increases in frontal delta and theta power in the ADHD-C compared to ADHD-I and TD groups, in all conditions. Novel power and activation effects in ADHD subtypes, as well as significant group and EDS interactions for alpha and beta power were also found.

CONCLUSIONS

These findings highlight the importance of considering ADHD subtypes and EDS when exploring EEG characteristics, and have important implications for the diagnosis and treatment of children with ADHD.

Analysis of Daily Sleep Diary Measures From Multilayer Extended-Release Methylphenidate (PRC-063) Studies in Children and Adults With ADHD

OBJECTIVE

To compare the effect of a once-daily extended-release methylphenidate formulation (PRC-063) versus placebo on sleep, measured via daily electronic diary in two clinical trials in pediatric (6-12 years) and adult (≥18 years) patients with attention deficit hyperactivity disorder (ADHD).

METHOD

A diary was completed by adult patients or parents/caregivers of pediatric patients during two randomized, double-blind, placebo-controlled laboratory classroom studies. Following dose optimization of PRC-063, patients were randomized to 1 week of double-blind treatment with PRC-063 or placebo before attending a full-day laboratory classroom session.

RESULTS

In the studies, 148 pediatric patients and 239 adult patients were randomized to either PRC-063 or placebo. When compared with the diaries of placebo patients, the sleep diaries in both pediatric and adult patients showed no statistical difference in total sleep time, efficiency, or latency.

CONCLUSION

PRC-063 did not impact subjective measures of sleep versus placebo in pediatric and adult patients with ADHD.

Characteristics of sleep spindles in school-aged children with attention-deficit/hyperactivity disorder

OBJECTIVE

Attention deficit/hyperactivity disorder (ADHD) is a complex disorder, characterized by different presentations with distinct cognitive and neurobiological characterizations. Here we aimed to investigate whether sleep spindle activity, which has been associated with brain maturation, may be a potential biomarker able to differentiate ADHD presentations in school-aged children (7-11 years).

METHOD

Spindle characteristics were extracted from overnight polysomnography in 74 children (27 ADHD-Inattentive [IQ = 96.04], 25 ADHD-hyperactive/impulsive [IQ = 98.9], and 22 ADHD-combined [IQ = 96.1]). We obtained data of the frontal (Fz) and parietal (Pz) derivations using a validated spindle detection algorithm.

RESULTS

Children with ADHD showed a higher number and density of slow compared to fast spindles which were more frequent in frontal area. No differences were observed among ADHD presentations for any spindle characteristics. Spindle frequency and density increased with age, indicating an age-dependent maturation of different sleep spindles. However, no associations between IQ and spindle characteristics were observed.

CONCLUSIONS

In children with ADHD the spindle characteristics evolve with age but sleep spindle activity does not seem to be a valid biomarker of ADHD phenotypes or general cognitive ability.

Sleep, academic achievement, and cognitive performance in children with attention-deficit hyperactivity disorder: A polysomnographic study

The objective of this study was to examine the influence of parent-reported and polysomnography (PSG)-measured sleep patterns on the academic and cognitive performance of children with attention-deficit hyperactivity disorder (ADHD). We assessed 91 children (18 girls) diagnosed with ADHD aged 7-11 years (29 ADHD-Inattentive, 32 ADHD-Hyperactive/Impulsive, and 31 ADHD-Combined). The Paediatric Sleep Questionnaire (PSQ) and Paediatric Daytime Sleepiness Scale (PDSS) were used to assess subjective sleep quality, as perceived by parents, and objective sleep variables were assessed by PSG. Cognitive performance was evaluated using the Wechsler Intelligence Scale for Children (WISC), and the final average grade of the last school year was used as a measure of academic performance. Academic performance was predicted by the following sleep variables: Sleep time, time in bed, night awakenings, and daytime sleepiness. The best predictors of cognitive performance in children with ADHD were rapid eye movement latency, light sleep, periodic limb movements index (PLMs), awakenings, and daytime sleepiness. In conclusion, sleep parameters are closely associated with the academic and cognitive functioning of children with ADHD.

Normal executive attention but abnormal orienting attention in individuals with sluggish cognitive tempo

Background/objective: Sluggish Cognitive Tempo (SCT) is an attentional disorder characterized by the symptoms of slowness in behavior or thinking, a lack of en.ergy, difficulty initiating and sustaining effort, daydreaming, and drowsiness. The aim of the present study was to investigate the distinctive attentional characteristics of SCT as compared to Attention-Deficit/Hyperactivity Disorder (ADHD). Method: A total of 110 adults were recruited and divided into four groups: SCT+ADHD, SCT, ADHD, and healthy controls. The Revised version of Attention Networks Test was used to investigate each group’s attentional profile. Results: The results revealed that the two SCT groups (SCT+ADHD and SCT) showed a significantly weaker orienting network due to the problems of engaging and disengaging attention than the other two groups. Additionally, the two ADHD groups (SCT+ADHD and ADHD) showed a significantly weaker executive control network than the other two groups. Conclusions: The findings demonstrate an attentional distinction between the SCT and the ADHD groups with a greater dysfunction in the orienting network in the SCT group as compared to the ADHD group. Furthermore, a greater executive control dysfunction was observed in the ADHD group as compared to the SCT group.