Table 3.
Studies utilizing objective measures of sleep in ADHD
| Study | Sample size (n) | Age (years) | Study design | Medication | Measurement | Major findings |
|---|---|---|---|---|---|---|
| ADHD symptoms | ||||||
| Paavonen et al45 | 280 children | 7–8 | Cross-sectional, community-based | NA | Actigraph | Children’s short sleep duration measured by actigraphs increase the risk for behavioral symptoms of ADHD. |
| O’Brien et al31 | 44 significant ADHD symptoms 53 mild ADHD symptoms 39 controls |
5–7 | Cross-sectional, Community-based | NA | PSG | REM latency and proportion of REM sleep (%TST) were more likely to be affected in the group with significant ADHD symptoms. |
| ADHD diagnosis | ||||||
| Gruber et al39 | 38 ADHD boys 64 normal boys |
6–14 | Cross-sectional, community-based | Medication-naive | Actigraphy and Sleep diaries | No significant differences were found in SOL, WASO, SE, and TST between the ADHD and control groups. |
| Gruber and Sadeh40 | 24 ADHD boys 25 normal boys |
7–11 | Cross-sectional, community-based | Medication-naive | Actigraphs | No significant differences were found between the ADHD and control groups on SOL, WASO, SE, and TST. |
| Dagan et al41 | 12 ADHD 12 controls |
6–12 | Cross-sectional, clinic-based | Medicated | Actigraph | SOL and sleep duration were not significantly different between the two groups. However, quiet sleep percentage and SE were found to be significantly lower in ADHD children than in controls. |
| Gruber et al46 | 15 ADHD 23 controls |
7–11 | Cross-sectional, community-based | Unmedicated | PSG | Children with ADHD had significantly shorter sleep and REM sleep durations, and a smaller percentage of REM sleep of total sleep time compared with controls. |
| Kirov et al12 | 22 healthy controls 25 ADHD 32 TD 24 ADHD + TD |
8–16 | Cross–sectional, clinic-based | Unmedicated | PSG | Children with ADHD had significant longer TST, shorter REM sleep, increased REM sleep percentage, and higher number of sleep cycles than children without ADHD. |
| O’Brien et al47 | 47 ADHD clinic 53 ADHD community 49 controls |
5–9 | Cross-sectional, clinic-based and community-based | Medicated | PSG | ADHD clinic group showed significantly lower spontaneous arousals, longer REM sleep latency, and lower REM sleep percentage than both ADHD community group and controls. |
| Picchietti et al48 | 14 ADHD 10 controls |
5–12 | Cross-sectional, clinic-based | Unmedicated | PSG | Duration of deep sleep (Stage 3 and 4), and REM sleep was decreased in ADHD compared with control group. |
| Prihodova et al16 | 31 ADHD 26 controls |
6–12 | Cross-sectional, clinic-based | Unmedicated | PSG | Basic sleep macrostructure parameters revealed no differences between control and ADHD groups either the first or the second night. |
| Lecendreux et al18 | 33 ADHD boys 23 learning disorder boys |
5–10 | Cross-sectional, clinic-based | Unmedicated | PSG | No significant differences in TST, SOL, number of awakenings, and percentage of different stages were found between children with ADHD and controls. |
| Konofal et al49 | 30 ADHD boys 19 learning disorder boys |
5–10 | Cross-sectional, clinic-based | Unmedicated | PSG | TST, SOL, number of awakenings, and percentage of different stages in PSG did not differ significantly between the two groups. |
| Cooper et al50 | 18 ADHD 20 normal controls |
4–16 | Cross-sectional, clinic-based | Unmedicated | PSG | PSG showed normal arousal indexes, and AHI for the ADHD group and normal control group. The sleep architecture was not significantly different between groups. |
| ADHD comorbid with other diagnosis | ||||||
| Corkum et al35 | 25 ADHD 25 normal controls |
7–11 | Cross-sectional, clinic-based | Medication-naive | Actigraphy and sleep diary | There were no group differences on TST, WASO, SOL, and night-time awakenings. |
| Hvolby et al42 | 45 ADHD 64 psychiatric control group 97 health reference group |
5–12 | Cross-sectional, clinic-based | Medicated | Actigraphy | There was a significant difference in SOL between the three groups. There were no group differences for TST, WASO, and night-time awakenings. |
| Wiggs et al43 | 71 ADHD 23 healthy controls |
3–15 | Cross-sectional, clinic-based | Medication-free | Actigraphy and sleep diary | The results suggested no significant differences between the groups for wake time, wake episodes, and sleep schedule. |
| Owens et al44 | 80 ADHD 45 healthy controls |
6–14 | Cross-sectional, community-based | Unmedicated | Actigraphy and sleep diary | Compared with the control group, the ADHD group experienced shorter actual sleep time of all epochs scored as sleep, significantly fewer sleep interruptions, but more total interrupted sleep time. |
| Golan et al17 | 34 ADHD 32 healthy controls |
7–17 | Cross-sectional, clinic-based | Unmedicated | PSG | Sleep architecture did not differ significantly between the groups, with the exception of higher percentage of REM sleep in the ADHD group. |
| O’Brien et al47 | 47 ADHD clinic 53 ADHD community 49 controls |
5–7 | Cross sectional, clinic-based and community-based | Medicated | PSG | There were statistically significant differences between the ADHD community group and the control group in REM sleep latency and percentage of REM. |
| Miano et al51 | 20 ADHD 20 normal controls |
6–13 | Cross-sectional, clinic-based | Medication-naive | PSG | Children with ADHD showed significantly reduced sleep duration, increased rate of stage shifts, lower REM sleep percentage, and lower sleep efficiency. |
| Silvestri et al52 | 55 ADHD 20 healthy controls |
6–11 | Cross-sectional, clinic-based | NA | PSG | Significant difference in percentage of REM, N2%, N3%, SE, TST, and REM latency between ADHD children and controls. |
| Kirov et al53 | 17 ADHD boys (12 with comorbid disease) 17 normal boys |
8–14 | Cross-sectional, clinic-based | Unmedicated | PSG | PSG data showed a significant increase in the duration of the absolute REM sleep and the number of sleep cycles in ADHD group when compared with controls. |
Abbreviations: ADHD, attention deficit/hyperactivity disorder; TD, tic disorder; PSG, polysomnography; REM, rapid eye movement; SOL, sleep onset latency; WASO, wake after sleep onset; SE, sleep efficiency; TST, total sleep time; N2, sleep stage 2; N3, merged the third and fourth stage of sleep; NA, not applicable.