Sleep problems and their effect in ADHD

Abstract

Sleep problems are common in attention-deficit/hyperactivity disorder (ADHD) to the extent that they mimic or exacerbate daytime symptoms expression. In this review, we advocate the need for a better understanding of sleep alterations in youths with ADHD and their impact on neurobehavioral functions including learning, memory and emotional regulation. An in-depth exploration of existing data showed that although extensively studied, the actual nature of sleep problems in ADHD and their effects on daytime behavior are still less well understood. Important issues, among which developmental changes in sleep architecture and role of subtle sleep electroencephalogram signatures, are generally neglected. Future research of sleep effects on behavior in ADHD would benefit from considering developmental aspects and links between brain activation patterns during sleep and wake.

Keywords::

• ADHD
• development
• memory and emotion
• neurobehavioral functions
• rapid eye movement sleep
• sleep architecture
• sleep electroencephalogram signatures
• sleep problems

Acknowledgements

The authors thank A Prehn-Kristensen and R Silvestri for providing original data from their studies to help us in completing missing details.

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• The actual nature of sleep problems in attention-deficit/hyperactivity disorder (ADHD) is still elusive, and accordingly, their effects on neurobehavioral functions are so far not sufficiently conclusive.

• To fill this gap, future trends in this research should address several neglected links.

• Given that ADHD is a neurodevelopmental disorder, and that its route is paralleled by maturational changes in sleep, it is critically important to make a clear distinction between ADHD-specific sleep and behavioral problems and maturational processes.

• Objective longitudinal sleep studies are still missing, and such studies are mandated.

• Targeting links between nocturnal and daily brain activation patterns in ADHD by application of electroencephalographic and neuroimaging methodologies in association with symptom expression and neurobehavioral functioning is critically important.

• Combining sleep and behavioral studies in ADHD with precise ADHD phenotyping and with genetic screening would more productively advance research in the field.

• Tensing the role for rapid eye movement sleep in emotional problems and quality of life in ADHD patients is essential and timely.

• Further pharmacological precision of sleep and behavioral research, in combination with effects of behavioral therapy, also is needed.

Notes