Abstract
Objective: To compare the occurrence of a spectrum of different self-reported sleep problems in adults with ADHD and a control group, and to study the impact of current ADHD medication use and clinical ADHD subtype.Method: Cross-sectional study of 268 clinically ascertained adult ADHD patients (DSM-IV criteria) and 202 randomly selected controls. Sleep problems were self-reported using validated questions, partly from Global Sleep Assessment Questionnaire.Results: ADHD patients reported more sleep problems than controls: Lifetime occurrence of sleep problems (82.6 vs. 36.5%), hypnotics use (61.4 vs. 20.2%), current sleep duration below 6 h (26.6 vs. 7.6%), and symptoms/signs during the past 4 weeks of excessive daytime sleepiness, cataplexy, loud snoring, breathing pauses during sleep, restless legs, and periodic limb movements in sleep (significant odds ratios ranged from 1.82 to 14.55). Current ADHD medication use was associated with less cataplexy compared with not using medication. Patients with inattentive subtype reported better sleep quality and less restless legs than patients with hyperactive/impulsive subtypes.Conclusions: Adults with ADHD reported a very high occurrence of many different self-reported sleep problems, underlining the importance of screening for sleep disorders. Among the ADHD patients, medication use was not associated with more sleep-related symptoms, but in fact less cataplexy. When comparing ADHD subtypes, the inattentive subtype was associated with less sleep problems.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder
The first patients were recruited from regional expert committees on ADHD (n = 57), subsequent patients were recruited from clinical psychologists and psychiatrists in out-patient clinics nationwide (n = 211)
Having used hypnotics were reported by 61.4% compared to 20.2% in the ADHD and control groups, respectively
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder. In a recent systematic literature review, sleep problems were reported to be among the most common co-morbidities associated with ADHD (Instanes et al, 2016). It has been suggested that some patients may have been misdiagnosed with ADHD instead of a primary sleep disorder (Philipsen et al, 2006; Yoon et al, 2012; Bioulac et al, 2015). Some patients may have co-morbid ADHD and sleep disorder (Bioulac et al, 2015). The distinction between having ADHD with sleep problems, having a sleep disorder with ADHD-like symptoms, or having co-morbid ADHD and sleep disorder is blurred and needs more systematic exploration (Oosterloo et al, 2006; Yoon et al, 2012; Bioulac et al, 2015; Hvolby, 2015)
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