Abstract
Starting from the consolidated relationship between sleep and cognition, we reviewed the available literature on the association between Attention Deficit-Hyperactivity Disorder (ADHD) and sleep. This review analyzes the macrostructural and microstructural sleep features, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (PRISMA). We included the polysomnographic studies published in the last 15 years. The results of macrostructural parameters are mixed. Almost half of the 18 selected investigations did not find differences between sleep architecture of children with ADHD and controls. Five studies observed that children with ADHD show a longer Rapid Eye Movement (REM) sleep duration than controls. Eight studies included microstructural measures. Remarkable alterations in sleep microstructure of ADHD are related to slow wave activity (SWA) and theta oscillations, respectively, during Non-REM (NREM) and REM sleep. Specifically, some studies found higher SWA in the ADHD group than controls. Similarly, higher theta activity appears to be detrimental for memory performance and inhibitory control in ADHD. These patterns could be interpreted as a maturational delay in ADHD. Also, the increased amount of these activities would be consistent with the hypothesis that the poor sleep could imply a chronic sleep deprivation in children with ADHD, which in turn could affect their cognitive functioning.
Highlights
Attention Deficit-Hyperactivity disorder (ADHD) is one of the most common early childhood disorders, classified into three subtypes: predominantly inattentive, hyperactive-impulsive, and a combination of these two subtypes [1]
Considering that some neuroanatomical studies highlighted a delay in cortical maturation of children with ADHD [20], we suggest that a better understanding of the relationship between sleep alterations and this neurodevelopmental disorder could be helpful to design protocols aimed to enhance sleep quality and to manipulate sleep EEG oscillations to ameliorate ADHD symptoms
The results were grouped on the basis of the sleep measures obtained in each study: (a) Macrostructural pattern (18 articles) [22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39]; (b) Microstructural pattern (8 articles) [23,26,30,31,33,34,36,37]
Summary
Attention Deficit-Hyperactivity disorder (ADHD) is one of the most common early childhood disorders, classified into three subtypes: predominantly inattentive, hyperactive-impulsive, and a combination of these two subtypes [1]. A high percentage of subjects with ADHD (59–87%) reports psychiatric comorbidities, such as learning disabilities (15–25%), language disorders (30–35%), mood and emotional disorders (15–25%), motor coordination deficits (60%), and conduct disorders (20%) [5,6]. Sleep alterations are significantly observed in 25–55% of children with ADHD compared to 7% among healthy individuals [7]. Subjects with ADHD frequently suffer from the circadian-rhythm disorder and idiopathic sleep-onset insomnia [10]. These disturbances may be due to a delayed endogenous circadian pacemaker, as demonstrated by the alterations observed in the nocturnal pattern of melatonin secretion [10]. Difficulties in sleep offset are reported in children with ADHD [11]
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