Evaluation of sleep disorders with video-polysomnography in children with attention deficit/hyperactivity disorder

Objective: It is not rare in daily practice that children with attention-deficit/hyperactivity disorder (ADHD) suffer from sleep related symptoms. In this study, we aimed to evaluate sleep macrostructure, sleep disturbance and daytime sleepiness in children with ADHD.Materials and Methods: Thirty newly diagnosed, drug naïve ADHD children (22 male, 8 female; median age: 9.93 years; 9 with inattentive and 21 with hyperactive or combined ADHD subtype) and 15 age and sex matched healthy controls (9 male, 6 female; median age: 11.33 years) were included. Structured sleep interview, Pittsburgh sleep quality questionnaire, Epworth sleepiness scale and nocturnal video-polysomnography (PSG) were performed.Results: Significantly more children/parents reported disturbed, fragmentary sleep at night in the ADHD group compared to the control group. Complaints were sleep talking (60% vs. 6.7%, p=0.001), chronic sleep onset insomnia (56.7% vs. 0.0%, p<0.001), confusional arousal (26.7% vs. 0.0%, p=0.038) and leg discomfort at night associated with restless leg syndrome (RLS) (33.3% vs. 6.7%, p=0.05). Patients with ADHD had higher Epworth sleepiness score (p=0.011) and higher total Pittsburgh sleep quality index (p=0.001), which were correlated with daytime sleepiness and worse sleep quality respectively. PSG data analysis showed decreased REM % and increased REM latency in the ADHD group (p=0.017 and p=0.046, respectively). Although we were not able to show any significant difference in apne-hipopne index (AHI) between two groups, a positive correlation was detected between Epworth sleepiness score and AHI (r=0.32, p=0.032).Conclusion: Children with ADHD, independent of any previous or current drug use, had altered sleep structure and impaired sleep quality compared to healthy controls. Increased RLS, daytime sleepiness and worse quality of sleep might be responsible for some ADHD symptoms, and they may share the same pathophysiologic mechanisms. Altered REM % and REM latency in ADHD children might be associated with neurobehavioral disturbances. The management of sleep related problems would help to alleviate neurobehavioral symptoms and to improve the life quality in affected children with ADHD and their families.