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Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies

Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies
Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies
Objective: to perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using poly-somnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.

Method: we searched for subjective and objective sleep studies (1987–2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.

Results: sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p < .001), more sleep onset difficulties (z = 9.38, p < .001), night awakenings (z = 2.15, p = .031), difficulties with morning awakenings (z = 5.19, p < .001), sleep disordered breathing (z = 2.05, p = .040), and daytime sleepiness (z = 1.96, p = .050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p = .001; z = 2.43, p = .015; z = 3.47, p = .001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p = .024), true sleep time on actigraphy (z = 2.85, p = .004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p < .001) than the controls.

Conclusions: the children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADHD
1527-5418
894-908
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Faraone, Stephen V.
bd307516-e8db-4d38-b649-9d7d7caafe93
Konofal, Eric
6328bf1a-74f1-4438-8c14-333ccc8931eb
Lecendreux, Michel
51135545-1b33-4540-8ba9-1e8a1cc57173
Cortese, Samuele
53d4bf2c-4e0e-4c77-9385-218350560fdb
Faraone, Stephen V.
bd307516-e8db-4d38-b649-9d7d7caafe93
Konofal, Eric
6328bf1a-74f1-4438-8c14-333ccc8931eb
Lecendreux, Michel
51135545-1b33-4540-8ba9-1e8a1cc57173

Cortese, Samuele, Faraone, Stephen V., Konofal, Eric and Lecendreux, Michel (2009) Sleep in children with attention-deficit/hyperactivity disorder: meta-analysis of subjective and objective studies. Journal of the American Academy of Child and Adolescent Psychiatry, 48 (9), 894-908. (doi:10.1097/CHI.0b013e3181ac09c9). (PMID:19625983)

Record type: Article

Abstract

Objective: to perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using poly-somnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.

Method: we searched for subjective and objective sleep studies (1987–2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.

Results: sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p < .001), more sleep onset difficulties (z = 9.38, p < .001), night awakenings (z = 2.15, p = .031), difficulties with morning awakenings (z = 5.19, p < .001), sleep disordered breathing (z = 2.05, p = .040), and daytime sleepiness (z = 1.96, p = .050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p = .001; z = 2.43, p = .015; z = 3.47, p = .001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p = .024), true sleep time on actigraphy (z = 2.85, p = .004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p < .001) than the controls.

Conclusions: the children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADHD

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More information

Published date: September 2009
Organisations: Clinical Neuroscience

Identifiers

Local EPrints ID: 380443
URI: http://eprints.soton.ac.uk/id/eprint/380443
ISSN: 1527-5418
PURE UUID: 62904e77-e0c6-425c-9f08-563bbf57091a
ORCID for Samuele Cortese: ORCID iD orcid.org/0000-0001-5877-8075

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Date deposited: 10 Sep 2015 09:57
Last modified: 17 Dec 2019 01:34

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Contributors

Author: Samuele Cortese ORCID iD
Author: Stephen V. Faraone
Author: Eric Konofal
Author: Michel Lecendreux

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