Sleep phenotypes in attention deficit hyperactivity disorder

Sleep Med. 2019 Aug;60:123-131. doi: 10.1016/j.sleep.2018.08.026. Epub 2018 Sep 20.


Objective: A case-control study was performed to test the hypothesis that children with attention deficit hyperactivity disorder (ADHD) have chronic sleep deprivation and may be classified into specific sleep-related phenotypes.

Methods: Thirty outpatients with ADHD (nine females, mean age 10.1 ± 2.1 years) were recruited consecutively, and given a comprehensive sleep assessment, including blood exams, sleep questionnaires, laboratory video-polysomnographic recordings (v-PSG), multiple sleep latency tests, and one-week actigraphy. The PSG parameters were compared to those of 25 age-matched controls (12 females, mean age 10.34 ± 1.54 years) who underwent only the v-PSG.

Results: ADHD children were classified as follows: a narcolepsy-like phenotype was found in four; delayed sleep onset insomnia in five; obstructive sleep apnea (OSA) in 15; periodic limb movements in eight, and sleep epileptiform discharges in 10 children. All subjects had a total sleep time shorter than 9 h at actigraphy, ferritin levels lower than 60 mcg/L, and a history of sleep problems (mainly OSA and insomnia). Compared to controls, the ADHD group had a higher apnea-hypopnea index at PSG.

Conclusions: A full sleep assessment in children with ADHD confirmed the validity of the sleep phenotypes hypothesis, and revealed a much higher percentage of sleep problems than that found in the literature. Beyond the sleep phenotypes, all children reported a history of sleep problems and slept less than 9 h per night, indicating chronic sleep deprivation that should be evaluated as a possible unifying marker of ADHD.

Keywords: ADHD; Epilepsy; Narcolepsy; Pediatrics – Insomnia; Pediatrics – Sleep apnea.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Actigraphy / statistics & numerical data*
  • Attention Deficit Disorder with Hyperactivity / complications*
  • Case-Control Studies
  • Child
  • Female
  • Humans
  • Male
  • Narcolepsy / epidemiology
  • Phenotype*
  • Polysomnography / statistics & numerical data
  • Sleep / physiology*
  • Sleep Apnea, Obstructive / epidemiology
  • Sleep Initiation and Maintenance Disorders / epidemiology
  • Surveys and Questionnaires