Table A2.
Subjective and objective sleep parameters in attention deficit hyperactivity disorder.
| Author | Description of Study | Demographics | Measures | Significant Results | Additional Comments |
|---|---|---|---|---|---|
| Hvolby et al., 2008 [52] | Cross-sectional evaluation of objective sleep in children with ADHD, psychiatric disorders and healthy controls. | ADHD (M:F) = 37:8 Age = 5 years 9 months–10 years 11 months Psychiatric control (M:F) = 55:9 Age = 6 years 2 months–12 years 4 months Healthy Controls, (M:F) = 61:36 Age = 6 years–11 years 1 months |
Actigraphy | Long sleep onset latency, greater day to day variability in sleep onset latency in children with ADHD when compared to healthy children and psychiatric controls. | |
| Owens et al., 2009 [54] | Cross-sectional evaluation of subjective and objective sleep patterns of children with ADHD and healthy controls. | ADHD (M:F) = 82:25 Age 10.2 ± 2.0 years Control (M:F) = 23:23 Age = 10.3 ± 2.6 years |
Electronic sleep diaries | Children with ADHD report less sleep, more difficulty waking up in the morning, and more daytime sleepiness. Parental reports suggest more reports of sleep difficulties such as difficulty getting out of bed, difficulty getting ready for bed, and difficulty falling asleep than healthy children. |
|
| Actigraphy | Lower sleep efficiency, shorter total sleep time in children with ADHD. | ||||
| Mullin et al., 2011 [58] | Cross-sectional study of children and adolescents with ADHD, Bipolar disorder and healthy controls. | ADHD combined (M:F) = 11:3 Age = 15.1 ± 2.1 years Bipolar Disorder (M:F) = 6:7 Age = 14.4 ± 2.1 years Healthy controls (M:F) = 11:10 Age = 14.1 ± 2.0 years |
Sleep diary | Children with ADHD did not differ from the controls in any of the subjective sleep parameters. | Children with ADHD on medication. |
| actigraphy | No differences in sleep between adolescents with ADHD and controls. | ||||
| Moreau et al., 2014 [53] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD | ADHD (M:F) = 24:17 Age = 9.7 ± 1.6 years Healthy controls (M:F) = 24:17 Age = 9.5 ± 1.6 years |
Children’s Sleep Habits Questionnaire Insomnia severity index and Sleep Diary |
Sleep onset delay, sleep anxiety, daytime sleepiness and high insomnia score in children with ADHD | Three fourths of the children with ADHD children were taking stimulants. Having a medication on board or comorbidity was not associated with differences in sleep disturbances in ADHD. |
| Actigraphy for 5 days | Total sleep time, and sleep efficiency were lower and sleep onset latency significantly higher in children with ADHD. Mean activity was higher in children with ADHD. Higher deviation of sleep onset latency and higher deviation In mean activity in children with ADHD than controls. |
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| Jeong et al., 2014 [59] | Cross-sectional study of objective sleep patterns in children with ADHD and healthy controls | ADHD (M:F) = 37:0 Age = 8.7 ± 2.1 years Healthy controls (M:F) = 32:0 Age = 9.3 ± 1.9 years |
Actigraphy for 3 days | Children with ADHD had longer sleep latency, wake after sleep and greater sleep fragmentation than healthy controls. | |
| Bergwerff et al., 2016 [60] | Cross-sectional study of objective sleep patterns in children with ADHD and healthy controls | ADHD (M:F) = 47:16 Age = 9.7 ± 1.6 years Healthy controls (M:F) = 32:29 Age = 10.1 ± 1.6 years |
Actigraphy | No differences of measured sleep patterns in children with ADHD and controls. No significant night-to-night variability in children with ADHD when compared to controls. |
Long duration in bed, high nocturnal activity, and high average wake bout duration in children with ADHD but did not reach significance. |
| Gruber et al., 2009 [57] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD and healthy controls | ADHD (M:F) = 10:5 Age = 8.93± 1.39 years Healthy controls (M:F) = 13:10 Age = 8.61 ± 1.27 years |
Children’s Sleep Habits Questionnaire | Parents of children with ADHD report lower sleep time, high sleep anxiety, daytime sleepiness, sleep onset difficulties and high awakenings at night | No medication in the past seven days. Children with ADHD scored high on the internalizing symptoms than healthy controls. |
| In home olysomnography one night | Children with ADHD had shorter sleep duration and shorter Rem sleep duration, total sleep time, and smaller percentage of REM sleep. | ||||
| Kirov et al., 2004 [61] | Cross-sectional study of objective sleep findings in children with ADHD and healthy controls. | ADHD = 17 Age = 11.2 ± 2.0 years Control = 17 Age = 11.2 ± 2.3 years |
Polysomnography | Greater REM sleep duration, high sleep period time identified in children with ADHD. High movements in light sleep stages and high movement related epochs in children with ADHD. |
|
| Miano et al., 2006 [64] | Cross-sectional study of objective sleep patterns in children with ADHD and healthy controls. | ADHD (M:F) = 18:2, Age range = 6–13 years Healthy Controls (M:F) = 11:9, Age range = 6–13 years |
Two-night polysomnography | Children with ADHD have increased sleep period, total sleep time and high sleep stage shifts. Low cyclic alternating patterns in stage 2 sleep observed in ADHD. |
|
| Kirov et al., 2007 [63] | Cross-sectional study of objective sleep patterns in children with co-morbid ADHD and controls. | ADHD and Tic Disorder (M:F) = 18:1 Age 11.0 ± 2.2 years Control (M:F) = 17:2 Age = 11.0 ± 2.2 years |
Polysomnography | High sleep period time, short REM latency and high REM sleep in children with ADHD. High microarousals, increased motor activity during light and REM sleep also observed in children with ADHD. |
|
| Prihodova et al., 2010 [55] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD and healthy controls. | ADHD (M:F) = 26:5 Age = 9.3± 1.7 years Healthy controls (M:F) = 22:4 Age = 9.2 ± 1.5 years |
Pediatric sleep questionnaire | Children with ADHD had restless sleep, difficulty with falling asleep and high leg movements | |
| Two-night polysomnography | Children with ADHD had increased wakefulness, reduced sleep efficiency, and prolonged sleep onset latency on first when compared to second night. No night to night variability in control subjects. Multiple sleep latency test did not show differences. |
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| Choi et al., 2010 [50] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD and healthy controls. | ADHD (M:F) = 24:3 Age = 9.0 ± 2.1 years Healthy controls (M:F) = 23:3 Age = 8.4 ± 1.5 years |
Children’s Sleep Habits Questionnaire | Children with ADHD have more difficulty with sleep onset, less sleep duration, more awakenings at night, more daytime sleepiness, and more parasomnias. Total sleep disturbance scores higher in children with ADHD. | High internalizing, externalizing and affective problems in children with ADHD. |
| Overnight Polysomnography | No significant differences in the PSG sleep characteristics of children with ADHD and controls. | ||||
| Gruber et al., 2012 [51] | In home study of children with ADHD using polysomnography. | ADHD (M:F) = 17:9 Age = 8.46 ± 1.5 years Healthy controls (M:F) = 30:19 Age = 8.6 ± 1.2 years |
Children’s Sleep Habits Questionnaire | High sleep onset latency, high sleep anxiety, daytime sleepiness, awakenings at night, resistance to bedtime and low total sleep time in children with ADHD. | |
| In home Polysomnography | No significant differences on PSG measures in children with ADHD and healthy controls. | ||||
| Imeraj et al., 2012 [65] | Cross-sectional study of cortisol patterns in children with ADHD and healthy controls. | ADHD (M:F) = 9:2 Age = 8.8 ± 1.5 years ADHD + ODD (M:F) = 17:5 Age = 9.0 ± 1.5 years Healthy controls (M:F) = 26:7 Age = 8.8 ± 1.6 years |
Salivary cortisol measured five times a day for five days | Cortisol lower in the morning and higher in the evening. | |
| Prihodova et al., 2012 [62] | Cross-sectional study of subjective and objective sleep of children with ADHD using polysomnography. | ADHD (M:F) = 12:2 Age = 9.6± 1.6 years Healthy controls (M:F) = 8:4 Age = 9.0 ± 1.6 years |
Two-night polysomnography | No significant changes in macro and microstructural differences among ADHD and controls. | Recruited from the clinic by the DSM criteria. Children with ADHD had high internalizing symptoms than healthy controls. |
| Akinci et al., 2015 [49] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD and healthy controls. | ADHD (M:F) = 20:8 Age = 8–12 years Healthy controls (M:F) = 9:6 Age = 9–13 years |
Pittsburgh Sleep Quality Index (PSQI) | On PSQI, low sleep quality, high sleep latency and low sleep efficiency were present in children with ADHD. | Children were free of medication use. |
| Laboratory polysomnography | High REM latency and high REM sleep percentage was present in children with ADHD. Low oxygen saturation at night and awake period and increased leg movements in ADHD. Cyclical alternating patterns (CAP) were low in ADHD. |
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| Virring et al., 2016 [56] | Cross-sectional study of subjective and objective sleep patterns in children with ADHD and healthy controls. | ADHD n = 76 Age = 9.6 ± 1.8 years, 74% male Controls = 25 Age = 9.4 ± 1.5 years 68% male. |
Sleep Diary Children’s Sleep Habits Survey |
Children with ADHD differed from healthy controls in all the measures on the Children’s Sleep Habits Questionnaire Scale Children with ADHD had longer sleep onset latency than the control group on sleep diaries. |
Sleep measures did not differ among the different ADHD subtypes. Children diagnosed with ADHD with and without comorbidity did not differ in sleep measures. |
| Polysomnography | Sleep latency, number of sleep cycles, and REM sleep higher, and total sleep time, Stage 3 and stage 1 sleep lower in children with ADHD than controls. | ||||
| Van der Heijden et al., 2005 [69] | Cross-sectional study of objective sleep patterns in children with ADHD and healthy controls. | ADHD with sleep onset insomnia (M:F) = 66:21, Age = 8.8 ± 1.7 years ADHD without sleep onset insomnia (M:F) = 26:7, Age = 8.2 ± 2.0 years |
Actigraphy and melatonin | Children with ADHD and sleep onset insomnia had significantly longer sleep onset latency, later bedtime and waketime. Melatonin onset significantly later in children with ADHD and sleep onset insomnia. |
|
| Buber et al., 2016 [66] | Cross-sectional study of urinary melatonin in children with ADHD and healthy controls. | ADHD (M:F) = 23:4 Age = 9.3 ± 2.6 years Healthy controls (M:F) = 21:7 Age = 10.5 ± 2.7 years |
24 h urinary melatonin levels measured in the morning and evening | High urinary melatonin levels present daytime, nighttime and 24 h levels in children with ADHD. | |
| Novakova et al., 2011 [67] | Cross-sectional study of salivary melatonin in children with ADHD and healthy controls. | ADHD (M:F) = 30:4 Age = 6–12 years Healthy controls (M:F) = 26:17 Age = 6–12 years |
24 h salivary melatonin | No differences in salivary melatonin levels between ADHD and control subjects. | Duration of the melatonin signal was shortened in 10–12 year old sub sample with ADHD. |
| Doi et al., 2015 [70] | Cross-sectional study of chronotype in children with behavioral problems. | Number (M:F) = 342: 312 Age = 4–6 years |
Munich Chronotype Questionnaire | Chronotype was associated with inattention/hyperactivity problems. |
M: Male; F: female; REM: rapid eye movement; ADHD: Attention Deficit Hyperactivity Disorder.