Abstract
Objectives: To conduct a first detailed analysis of the pattern of leg movement (LM) activity during sleep in adult subjects with Attention-Deficit/Hyperactivity Disorder (ADHD) compared to healthy controls.Methods: Fifteen ADHD patients and 18 control subjects underwent an in-lab polysomnographic sleep study. The periodic character of LMs was evaluated with established markers of “periodicity,” i.e., the periodicity index, intermovement intervals, and time distribution of LM during sleep, in addition to standard parameters such as the periodic leg movement during sleep index (PLMSI) and the periodic leg movement during sleep arousal index (PLMSAI). Subjective sleep and psychiatric symptoms were assessed using several, self-administered, screening questionnaires.Results: Objective sleep parameters from the baseline night did not significantly differ between ADHD and control subjects, except for a longer sleep latency (SL), a longer duration of the periodic leg movements during sleep (PLMS) in REM sleep and a higher PLMSI also in REM sleep. Data from the sleep questionnaires showed perception of poor sleep quality in ADHD patients.Conclusions: Leg movements during sleep in ADHD adults are not significantly more frequent than in healthy controls and the nocturnal motor events do not show an increased periodicity in these patients. The non-periodic character of LMs in ADHD has already been shown in children and seems to differentiate ADHD from other pathophysiological related conditions like restless legs syndrome (RLS) or periodic limb movement disorder (PLMD). The reduced subjective sleep quality reported by ADHD adults contrasted with the normal objective polysomnographic parameters, which could suggest a sleep-state misperception in these individuals or more subtle sleep abnormalities not picked up by the traditional sleep staging.
Highlights
The complex relationship between sleep and attentiondeficit/hyperactivity disorder (ADHD) has been widely investigated, especially in children [1, 2]
Some authors have hypothesized that the typical daytime hyperactivity observed in ADHD may be mirrored by an increased motor activity during the night, which in turn may cause sleep disruption and explain the reduced sleep quality mostly experienced by these patients
It has been suggested that sleep disruption associated with these disorders and the motor restlessness of restless legs syndrome (RLS) while awake could contribute to the typical symptoms of inattention and hyperactivity seen in ADHD children [16]
Summary
The complex relationship between sleep and attentiondeficit/hyperactivity disorder (ADHD) has been widely investigated, especially in children [1, 2]. Some authors have hypothesized that the typical daytime hyperactivity observed in ADHD may be mirrored by an increased motor activity during the night, which in turn may cause sleep disruption and explain the reduced sleep quality mostly experienced by these patients. ADHD is often associated with sleep-related movement disorders, such as restless legs syndrome (RLS) and periodic limb movement disorder (PLMD) [15,16,17,18,19]. It has been suggested that sleep disruption associated with these disorders and the motor restlessness of RLS while awake could contribute to the typical symptoms of inattention and hyperactivity seen in ADHD children [16]. Some authors pointed out that all these conditions may share a similar pattern of periodic leg movements during sleep (PLMS), and even a possible common pathophysiology related to a central dopaminergic dysfunction [20, 21] or brain iron deficiency [22,23,24]
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