Abstract
Recent studies suggest a role for sleep and sleep problems in the etiology of attention deficit hyperactivity disorder (ADHD) and a recent model about the working mechanism of sensori-motor rhythm (SMR) neurofeedback, proposed that this intervention normalizes sleep and thus improves ADHD symptoms such as inattention and hyperactivity/impulsivity. In this study we compared adult ADHD patients (N = 19) to a control group (N = 28) and investigated if differences existed in sleep parameters such as Sleep Onset Latency (SOL), Sleep Duration (DUR) and overall reported sleep problems (PSQI) and if there is an association between sleep-parameters and ADHD symptoms. Secondly, in 37 ADHD patients we investigated the effects of SMR and Theta/Beta (TBR) neurofeedback on ADHD symptoms and sleep parameters and if these sleep parameters may mediate treatment outcome to SMR and TBR neurofeedback. In this study we found a clear continuous relationship between self-reported sleep problems (PSQI) and inattention in adults with- and without-ADHD. TBR neurofeedback resulted in a small reduction of SOL, this change in SOL did not correlate with the change in ADHD symptoms and the reduction in SOL only happened in the last half of treatment, suggesting this is an effect of symptom improvement not specifically related to TBR neurofeedback. SMR neurofeedback specifically reduced the SOL and PSQI score, and the change in SOL and change in PSQI correlated strongly with the change in inattention, and the reduction in SOL was achieved in the first half of treatment, suggesting the reduction in SOL mediated treatment response to SMR neurofeedback. Clinically, TBR and SMR neurofeedback had similar effects on symptom reduction in ADHD (inattention and hyperactivity/impulsivity). These results suggest differential effects and different working mechanisms for TBR and SMR neurofeedback in the treatment of ADHD.
Highlights
Humans spend about one third of their lives in a sleeping state, yet the function and implications of this “inactive state” are to date not fully understood, especially in relation to psychiatric problems such as depression and attention deficit hyperactivity disorder (ADHD)
In this study we found that adults with ADHD, reported more sleep problems (PSQI score), a shorter sleep duration (36 min less sleep on average) and a longer sleep onset latency (SOL: 23 min more to fall asleep) than adults without ADHD
When www.frontiersin.org using a cut-off of 30 min for SOL (Smits et al, 2001; Rybak et al, 2007) we found that 57% of the ADHD adults and children had sleep-onset insomnia (SOI) as compared to 18% of the control group, which is in line with previous studies that reported 72–78% of sleep-onset insomnia” (SOI) in ADHD adults and children (Van der Heijden et al, 2005; Van Veen et al, 2010)
Summary
Humans spend about one third of their lives in a sleeping state, yet the function and implications of this “inactive state” are to date not fully understood, especially in relation to psychiatric problems such as depression and attention deficit hyperactivity disorder (ADHD). Process-S can be quantified by the build-up of Electroencephalogram (EEG) slow activity (delta and theta) during the day, often referred to as sleep homeostatic drive, and is a function of duration of prior waking (Achermann et al, 1993) This slow EEG activity is considered the hallmark of drowsiness (Arns et al, 2010), and shows a gradual decline with subsequent sleep stages. Process-C can be quantified by assessing the different circadian measures such as melatonin (using the Dim Light Melatonin Onset (DLMO: Van der Heijden et al, 2005) or core-body temperature Both Process-S and Process-C, and especially their interaction, play a crucial role in sleep-wake regulation and optimal vigilance regulation. We will focus mainly on the role of sleep in ADHD (subgroups)
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