Table 2.
Studies examining sleep as a health outcome
| Study Title | Type of Study | Population | Intervention Framing | Aims | Intervention | Relevant Outcome Measures | Relevant Findings |
|---|---|---|---|---|---|---|---|
| Becker et al., 2022 [57] | Pilot/Feasibility study (pre/post) |
N=14 (50% M), USA 13-17 year oldsa without formal sleep disorder diagnoses who met DSM-V ADHD criteria with evidence of sleep problems (as per Pittsburg Sleep Quality Index (PSQI), or less than recommended sleep, or based on Children’s Morning-Eveningness Preference (CMEP) Scale)). |
Combination of impairments in ADHD and challenges of adolescence may impact on sleep cycle. | The aim was to evaluate a behavioural intervention in adolescents with evidence of sleep problems. | Six ‘TranS-C’ Sessions—psychoeducational intervention around sleep habits | Subjective sleep quality measures were; Pittsburg Sleep Quality Index (PSQI), Adolescent Sleep-Wake Cycle Scale, (self-reported). Children’s Sleep Habits Questionnaire (CSHQ) (parent-reported). The Pediatric Daytime Sleepiness Scale (PDSS) was also used (parent and self-report). Adolescent Dysfunctional Beliefs about Sleep Scale (DBAS-16). |
Significant improvements in PSQI, CSHQ, ASWS and parent-report PDSS scores (p<0.001) between pre and post intervention. Significant improvements on self-report PDSS (p=0.001). Sleep diaries also demonstrated improvements post intervention. No significant improvements on DBAS. Adolescents rated the intervention quality as ‘high’ or ‘very high’. Positive feedback on interventions included responsibility for health, working with a therapist and increased knowledge. |
| Van Andel et al., 2022 [58] |
Secondary analysis of a randomised control trial (within and between group analyses) |
N=49 (34.7% M), The Netherlands. 18-55a year olds with clinically diagnosed ADHD and delayed sleep phase syndrome (DSM-V Criteria) |
Sleep disorders are common in ADHD, and often related to delayed circadian rhythm. | This paper aimed to study the effects of delayed sleep phase (DSPS) interventions on dim-light melatonin onset (DLMO) in ADHD, in relation to ADHD symptoms. |
Melatonin vs Placebo vs Melatonin + BLT All groups received psychoeducation around sleep. |
Sleep actometry. Wake after sleep onset duration (WASO). DLMO-midsleep phase angle difference. Circadian rhythm analysis. Sleep diaries. Sleep Hygiene Questionnaire. | No significant improvements on objective or subjective sleep measures over time in any of the groups, despite significant improvements in the Sleep Hygiene Questionnaire. |
| Jernelov et al., 2019 [59] | Single group interventional study (pre vs post) |
N=19 (32% M), Sweden. 19-57a year olds with clinically diagnosed ADHD and self-reported sleep problems |
Sleep issues are prevalent in ADHD, possibly maintained by executive dysfunction. | The aim was to see if insomnia and ADHD symptoms improve with CBT for insomnia +/- ADHD. | Insomnia and ADHD Cognitive Behavioural Therapy (CBT-i/ADHD) | Insomnia Severity Index (ISI). |
Significant improvements in the Insomnia Severity Index (p=0.002). Subjective positive feedback on the intervention focussed on routines and structure. Mean session attendance; 7.2/10 sessions. |
| Morgensterns et al., 2016 [60] | Single group interventional study (pre vs post) |
N=98 (31.6% M), Sweden. 19-63a year olds with diagnosed ADHD. |
ADHD has broad social and daily functioning implications. There is thus far limited evaluation of psychotherapeutic interventions in ADHD. | The aim was to review the acceptability and feasibility of a structured programme for ADHD. | Structured skills training (adapted from dialectical behavioural therapy), 14 2 hour weekly sessions with 45-60m informal conversation afterwards. | Karolinska Sleep Questionnaire. Sheehan Disability Scale (SDS) and Barkley ADHD Functional Impairment subscale. |
Improvements in Karolinska Sleep Questionnaire noted as secondary outcome (37.1-33.23 at 3 months post follow-up, p-0.003). Significant improvements in functional impairment scales (p<0.001, effect size 0.19 on the Barkley, p=.001 and effect size 0.15 on the SDS). 80% of participants attended at least two thirds of sessions. |
| Meyer et al ., 2022 [55] | Multi-centre randomised Controlled Trial (RCT) | N=184 (42.9% M), 15–18-year-oldsa with clinically-diagnosed ADHD from outpatient child psychiatry clinics (Sweden) | Psychosocial rather than pharmacological interventions potentially may be more effective in improving daily functioning in ADHD. Given that adolescents typically may struggle with emotional dysregulation and relational problems as well, adapting a structured skills training group (SSTG) from adults into adolescents may be effective. | The aim was to compare the efficacy and acceptability of an SSTG intervention with psychoeducation. |
SSTG (N=85): 14 weekly 2-hour sessions, blending age-adapted psychoeducation and coping strategies from dialectical behavioural therapy (DBT). Control Psychoeducation (n=79): 3x2 hour sessions on ADHD, related problems, lifestyle advice (Sleep and diet). These participants also received a support book on schoolwork. |
Karolinska Sleep Questionnaire, Impact of ADHD Symptoms (IAS) (sleep problem component) | Average session attendance was 62% for the intervention group vs 76% for the control group A small between-group difference in sleep problems at T2 (2 weeks after) in favour of the control group. This was not preserved in future follow-ups. There were no other reported significant effects on sleep between or within groups. |
| Novik et al., 2020 [61] | RCT Protocol | N=99 adolescents (14-18a years olds) with diagnosed ADHD, on ADHD medication or medication-resistant and with a Clinical Global Impression Severity score >3 Recruited through two outpatient units in Norway, user organisations, GPs and social media/ newspaper advertisement. | ADHD is highly associated with mental illness and pharmacotherapy may not target this effectively. There is little evidence looking at the broader functional impacts of CBT in ADHD in adolescents. | This study aimed to investigate the efficacy of an ADHD CBT group intervention in adolescents, and to look at functional impairment and psychiatric symptoms. | 12 weekly group CBT 90 minute sessions (including a session on sleep), with weekly phone calls and homework, versus treatment as usual (medical treatment with one medical follow-up appointment). | Adolescents’ Sleep Wake Scale | N/A |
| Keuppens et al., 2023 [62] | RCT protocol | N=92 13-17 year oldsa with diagnosed ADHD (verified by Kiddie Schedule for Affective Disorder and Schizophrenia Present and Lifetime (K-SADS-PL) DSM-V interview) and sleep problems determined by interview based on DSM-V and International Classification for Sleep Disorders (Third Edition) criteria), stable on ADHD medication without comorbid disorders affecting sleep. | Adolescents with ADHD have poorer and more disrupted sleep than peers, with lack of specific guidance around this. Whilst reasons for this are unclear, sleep hygiene is an important modifiable risk factor for poor sleep. Furthermore, features of ADHD (impulsivity, executive dysfunction) may lead to poorer sleep hygiene. Thus, ADHD and sleep symptoms likely have reciprocal impact. | This study aimed to evaluate a CBT intervention; Sleep Intervention as Symptom Treatment for ADHD (SIESTA) compared to treatment as usual. | CBT-based intervention consisting of seven adolescent sessions and two parent sessions, focussed around a work book, versus treatment as usual (stimulant medication). | Sleep wrist actigraphy, sleep diaries, School Sleep Habits Survey (self/parent report), Chronic Sleep Reduction Questionnaire (parent report), Adolescent Sleep Hygeine Scale. | Pilot evaluation data from 18 participants have been published, with 8 receiving SIESTA. These show satisfaction with SIESTA from parents and adolescents, and subjective improvement in sleep quality, sleep behaviour and daytime sleepiness. Thematic analysis undertaken generated themes around better understanding and control over sleep. Reliable change indices demonstrate significant improvements for all adolescents in at least one Adolescent Sleep Hygiene Scale subdomain [77]. |
Under population, N denotes sample size, % M denotes the percentage of men in each study
astudies which include an age range broader than 16-25