Published studies have examined the differences between Attention Deficit and Hyperactivity Disorders (ADHD) subtypes and sleep problems, nevertheless revealing inconsistent results. Retrospective description of subjective and objective sleep parameters in children with ADHD subtypes.
MATERIALS AND METHODS
We studied a sample of 25 patients (24 boys and 1 girl), aged 6–17years old, sent for further PSG study for sleep disorders, that were clinically diagnosed ADHD according to the DSM-IV criteria (5 hyperactive-impulsive subtype (ADHD-H-I), 10 inattentive subtype (ADHD-I), and 10 combined subtype (ADHD-C), twelve taking specific medication. The subjective sleep variables were given by parents in a scheduled clinical interview following a sleep questionnaire. The objective variables were obtained by a one night polysomnography (PSG) study performed in our sleep laboratory.
More than 50% of the patients suffered of more than one sleep symptom, the most frequent being: Motor activity during sleep was referred by 60%, somniloquy (56%), bruxism (56%) and awakenings from sleep (56%). Snoring (56%) was reported by parents, observed sleep apnea was in 8% of patients. Other symptoms observed were daytime Sleepiness (24%) and Rest legs Syndrom (RLS) (20%). According to subtypes, the most relevant findings were that the motor activity during sleep was more common in ADHD-H-I (100%), and ADHD-C (60%). Parasomnias were present in the ADHD-H-I (80%). The snoring was more frequent in the ADHD-H-I (60%) and ADHD-I (70%). RLS was more prominent in ADHD-H-I (40%) and daytime sleepiness in ADHD-I (40%). PSG recordings had similar efficiency and the same sleep structure characteristics in all subtypes, except in the ADHD-I, it was found the maximum awakening time from sleep (WASO), more arousals and periodic limb movement, but only in 30% of them the index was higher than 5/hour. Regarding respiratory disorders, we found a pathological respiratory disturbance index (RDS) in 12% of ADHD patients, 8% out of these belonged to ADHD-C.
There are many different subjective complaints about sleep in ADHD patients, but the objective PSG dates showed alterations only in ADHD-I and ADHD-C. The ADHD-I that showed the highest sleep fragmentation and motor activity also had the highest percentage of daytime sleepiness. The percentage of SA cases found in ADHD was scared.
Unidad del Sueño Hospital Universitario y Politécnico La Fe.
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