Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder.

Katia Gagnon,Roger Godbout,Marc-André Gingras,Mélanie Labrosse

doi:10.3390/brainsci11111425

Katia Gagnon, Roger Godbout + Show 2 more

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https://doi.org/10.3390/brainsci11111425

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Abstract

Theoretical models of sleep and attention deficit hyperactivity disorder (ADHD) suggest that symptoms of ADHD are associated with daytime sleepiness, but it has received little support. The present study aimed at testing an alternative model involving the association of attentional instability with sleep instability, i.e., sleep stage transitions and arousals. Twelve ADHD and 15 healthy control (HC) boys aged between 8 and 12 years old underwent polysomnography recording and attentional testing. The microarousal index, the number of awakenings, and the number of stage shifts between stages 1, 2, 3, 4 and REM sleep throughout the night were computed as sleep stability parameters. Attentional functioning was assessed using the Continuous Performance Test-II. We found significantly higher sleep instability in ADHD compared to HC. Sleep arousals and stage transitions (micro arousal index, stage 4/3 and 2/4 transitions) in ADHD significantly correlated with lower attentional scores. No association whatsoever was found between sleep instability and attentional functioning in HC. The results show that sleep instability is associated with lower attentional performance in boys with ADHD, but not in HC. This could be compatible with a model according to which attention and sleep stability share a common neural substrate in ADHD.

Highlights

Compared to healthy control (HC), the attention deficit hyperactivity disorder (ADHD) group displayed significantly higher scores on the Child Behavior Checklist/4-18 (CBCL) total and attention scores, but no significant differences were found on the anxiety/depression scores
These results suggest that sleep instability towards lighter sleep stages of non-REM sleep and lower attentional performance share a common pathophysiological pathway in children with ADHD that is not active in HC
The authors did not report on the direction in which sleep stage transitions occurred, these results suggest that neurodevelopmental defects associated with ADHD could have a negative impact on both sleep stability and attention functioning, but not on daytime sleepiness

Summary

Introduction

ADHD is associated with structural and functional changes in the brain, the neural mechanisms implicated in inattention and impulsivity are still unclear [2,3]. Since neurochemical and anatomical structures that modulate attention are involved in arousal and sleep, a consensus working group of researchers suggested that sleep and attention dysfunction in children with ADHD could be an expression of the alteration of the neural circuitry that regulates both sleep/wake and attention [6]. Acting as a common pathophysiological pathway, defects in neuronal networks in ADHD could lead to both sleep instability, defined here as arousals/microarousals and sleep stage shifts, as well as impaired cognitive performance

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