Sleep disorders in children with Attention-Deficit/Hyperactivity Disorder (ADHD) recorded overnight by video-polysomnography

Silvestri, Rosalia; Gagliano, Antonella; Aricò, Irene; Calarese, Tiziana; Cedro, Clemente; Bruni, Oliviero; Condurso, Rosaria; Germanò, Eva; Gervasi, Giuseppe; Siracusano, Rosamaria; Vita, Giuseppe; Bramanti, Placido

doi:10.1016/j.sleep.2009.04.003

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Volume 10, Issue 10 , Pages 1132-1138, December 2009

Sleep disorders in children with Attention-Deficit/Hyperactivity Disorder (ADHD) recorded overnight by video-polysomnography

Rosalia Silvestri
- Sleep Medicine Centre, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Via Consolare Valeria n1, Messina, Italy
- Corresponding author. Tel.: +39 0902212289; fax: +39 0902923847.
Antonella Gagliano
- Division of Child Neurology and Psychiatry, University of Messina, Messina, Italy
Irene Aricò
- Sleep Medicine Centre, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Via Consolare Valeria n1, Messina, Italy
Tiziana Calarese
- Division of Child Neurology and Psychiatry, University of Messina, Messina, Italy
Clemente Cedro
- Sleep Medicine Centre, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Via Consolare Valeria n1, Messina, Italy
Oliviero Bruni
- Department of Developmental Neurology and Psychiatry, Center for Pediatric Sleep Disorders, Roma, Italy
Rosaria Condurso
- Sleep Medicine Centre, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Via Consolare Valeria n1, Messina, Italy
Eva Germanò
- Division of Child Neurology and Psychiatry, University of Messina, Messina, Italy
Giuseppe Gervasi
- Sleep Medicine Centre, Department of Neurosciences, Psychiatric and Anaesthesiological Sciences, University of Messina, Via Consolare Valeria n1, Messina, Italy
Rosamaria Siracusano
- Division of Child Neurology and Psychiatry, University of Messina, Messina, Italy
Giuseppe Vita
- Department of Pathology and Experimental Microbiology, University of Messina, Messina, Italy
Placido Bramanti
- IRCCS, Centro Neurolesi “Bonino Pulejo”, Messina, Italy

Received 5 October 2008; received in revised form 27 March 2009; accepted 14 April 2009.

Abstract

Objective

To outline specific sleep disturbances in different clinical subsets of Attention Deficit/Hyperactivity Disorder (ADHD) and to confirm, by means of nocturnal video-polysomnography (video-PSG), a variety of sleep disorders in ADHD besides the classically described periodic leg movement disorder (PLMD), restless legs syndrome (RLS) and sleep related breathing disorder (SRBD).

Methods

Fifty-five ADHD children (47 M, 8F; mean age=8.9y) were included: 16 had Inattentive and 39 Hyperactive/Impulsive or Combined ADHD subtype. Behavior assessment by Conners and SNAP-IV Scales, a structured sleep interview and a nocturnal video-PSG were administered.

Results

Most children/parents reported disturbed, fragmentary sleep at night; complaints were motor restlessness (50%), sleep walking (47.6%), night terrors (38%), confusional arousals (28.5%), snoring (21.4%), and leg discomfort at night associated with RLS (11.9%). There is a significant difference (p value <0.05 or <0.001) in almost all the studied sleep variables between ADHD children and controls. International RLS Rating Scale scoring, Periodic Limb Movements during Sleep (PLMS) and Wake (PLMW) indexes, hyperactivity and opposition scores and ADHD subtype appear related. Different sleep disorders seem to address specific ADHD phenotypes and correlate with severity of symptoms as in sleep related movement disorders occurring in Hyperactive/Impulsive and Combined ADHD subtypes. Besides, an abnormality of the arousal process in slow wave sleep with consequent abnormal prevalence of disorders of arousal possibly enhanced by SRBD has also been detected in 52% of our sample.

Conclusions

This study underlines the opportunity to propose and promote the inclusion of sleep studies, possibly by video-PSG, as part of the diagnostic screening for ADHD. This strategy could address the diagnosis and treatment of different specific ADHD phenotypic expressions that might be relevant to children’s symptoms and contribute to ADHD severity.

Keywords: Sleep disorders, ADHD, Children, Video-polysomnography, Restless legs syndrome (RLS), Disorders of arousal (DOA)