53: Effects of Dosage on Sleep Duration During Stimulant Treatment of ADHD in Youth

Abstract

Background: Attention-Deficit/Hyperactivity Disorder (ADHD) is characterized by impulsivity, hyperactivity, and inattention, which affects 5% to 10% of school-age children. The first-line treatments for ADHD are stimulant medications, such as methylphenidate and amphetamine. These medications are highly effective, but not always tolerated. Sleep side effects, such as insomnia, can lead to treatment discontinuation. They are reported for both methylphenidate and amphetamine stimulants and are usually, but not always, mild and transitory. Poor tolerability may limit efficacy by compromising the ability to prescribe optimal doses. Few studies have directly compared dose response effects of long-acting methylphenidate and amphetamine formulations in youth with ADHD, and it is unclear if there are differential effects of drug and/or dose on sleep. MAS increase norepinephrine (NE) and dopamine (DA) levels release as well as reuptake, in contrast to d-MPH, and hence could affect sleep differently. Objectives: We sought to determine if there are significant differences in the dose-response effects of ER D-MPH and ER MAS on objective measures of sleep. Design/Methods: Children, aged 10 to 17 (n=37), participated in a double-blind crossover study comparing two stimulants (extended release D-MPH, MAS) at three doses (10 mg, 20 mg, 30 mg) and placebo. Each treatment session lasted one week, for a total protocol duration of eight weeks. Sleep was assessed in all conditions using actigraphy and sleep questionnaires. Results: Sleep duration revealed a significant dose effect on actual sleep duration (F[1, 36]=8.112, P<0.05), with significantly shorter actual sleep duration for subjects receiving 30mg compared to those on placebo (P<0.05). Sleep schedule measures showed a significant effect for dosage on sleep start time (F[1, 36]=6.284; P<0.05), with a significantly later sleep start time when children were on 20mg or 30mg dosages, compared to placebo (P<0.05). No significant differences were found between medications. Conclusions: Increased dosages of stimulants lead to shorter sleep duration and later sleep start times for both ER-MAS and ER D-MPH