Abstract
Objective: Recent years saw an increasing interest towards sleep microstructure abnormalities in attention-deficit/hyperactivity disorder (ADHD). However, the existing literature on sleep electroencephalographic (EEG) power in ADHD is still controversial, often based on single electrode recordings, and mainly focused on slow wave activity (SWA) during NREM sleep. This study aimed to systematically investigate sleep power topography in all traditional frequency bands, in all sleep stages and across sleep cycles using high-density EEG (HD-EEG). Method: Thirty drug-naïve children with ADHD (10.5 ± 2.1 years, 21 male) and 23 typically developing (TD) control participants (mean age: 10.2 ± 1.6 years, 13 male) were included in the current analysis. Signal power topography was computed in classical frequency bands during sleep, contrasted between groups and sleep cycles, and correlated with measures of ADHD severity, cognitive functioning and estimated total sleep time. Results: Compared to TD subjects, patients with ADHD consistently displayed a widespread increase in low-frequency activity (between 3 and 10 Hz) during NREM sleep, but not during REM sleep and wake before sleep onset. Such a difference involved a wide centro-posterior cluster of channels in the upper SWA range, in Theta, and low-Alpha. Between-group difference was maximal in sleep stage N3 in the first sleep cycle, and positively correlated with average total sleep time. Conclusions: These results support the concept that children with ADHD, compared to TD peers, have a higher sleep pressure and altered sleep homeostasis, which possibly interfere with (and delay) cortical maturation.
Highlights
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder broadly characterized by daytime symptoms of hyperactivity/impulsivity and inattention [1]
As there was a significant difference between the two groups (ADHD and typically developing (TD)) in the apnea-hypopnea index (AHI), we performed an exploratory analysis within the attention-deficit/hyperactivity disorder (ADHD) group between patients with (n = 15) and without (n = 15) the obstructive hypopneas/apneas phenotype
This study expands our previous findings on normalized sleep power topography in ADHD children, which pointed to a relative increase of slow wave activity (SWA) power over centro–parietal– occipital regions in these subjects compared to TD children 18
Summary
Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder broadly characterized by daytime symptoms of hyperactivity/impulsivity and inattention [1]. ADHD estimated prevalence in children and adolescence is around 5% worldwide [2,3,4,5]. ADHD high individual and societal impact have fueled intensive research over the last decades [2]. Sleep problems are commonly reported by children-adolescents with ADHD and their parents in clinical settings [7]. This observation has led to a growing attention towards sleep [8] and its electroencephalographic (EEG) microstructure in ADHD [9,10]
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