Abstract
Introduction: Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). However, the relationship between insomnia disorder and adult ADHD has been neglected in research. The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life.Material and Methods: Two hundred and fifty-two adult patients with ADHD (mean age 37.60 ± 13.22 years; ADHD presentations—combined: 56.7%, inattentive: 39.7%, hyperactive/impulsive: 3.6%) were evaluated with an exhaustive clinical and psychological evaluation protocol including semistructured interviews (for comorbidities and ADHD assessment) and symptom rating scales for ADHD. The diagnosis of ADHD and insomnia disorder was made according to DSM-5 criteria. Furthermore, the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale were administered.Results: Insomnia disorder was found in 44.4% of adult ADHD patients and was more common in combined presentation (64.3%) and in patients with more ADHD severity. Comorbidities (both medical and psychiatric), especially mood disorders (42%), anxiety disorder (26.8%), personality disorder (39.3%), and any substance use disorder (11.6%), were associated with a higher insomnia disorder prevalence. ADHD stimulant treatment was related to lower insomnia disorder compared to patients without medication, as well as ADHD stable treatment. Additionally, worse health-related quality of life was associated with insomnia disorder.Conclusion: Insomnia disorder is highly prevalent in adult ADHD and is related to higher ADHD severity and more psychiatric and medical comorbidities. Some stimulants and stable pharmacological ADHD treatment are associated with better outcomes of insomnia disorder.
Highlights
Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD)
The participants fulfilled the following inclusion criteria: were over 18 years, met ADHD criteria according to DSM-5, accepted to participate, and signed the informed consent. Those patients diagnosed with a sleep disorder other than insomnia disorder, intellectual disability, or any medical condition that could explain the symptoms of ADHD were excluded
44.4% of patients met the criteria for insomnia disorder and 63.9% of the total sample participants had insomnia symptoms
Summary
Several investigations have been performed on insomnia symptoms in adult attention-deficit/hyperactivity disorder (ADHD). The main objective of the current study is to analyze the differences between adult ADHD patients with and without insomnia disorder, in terms of ADHD clinical severity, medical and psychiatric comorbidity, psychopharmacological treatment, and quality of life. The Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM-5) [1] requires for adult ADHD diagnoses five or more symptoms of inattention and/or of hyperactivity/impulsivity. These symptoms should be present before the age of 12, have lasted 6 months, and interfere with daily life activities. According to the DSM-5 [1], the insomnia disorder diagnosis is reached if there is a predominant dissatisfaction in the quantity or quality of sleep for at least three nights a week for at least 3 months in initiating or maintaining sleep or early morning awakening, causing significant discomfort or clinical impairment in any area of the person’s functioning
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