Background: Sleep problems are highly prevalent in adults with ADHD. Sleep problems and ADHD symptoms can cause, amplify, and maintain each other. We studied the effects of additive treatment for sleep problems on self-reported symptoms of ADHD as primary outcome, with subscales of inattention and hyperactivity-impulsivity, objective, performance-based ADHD symptoms, sleep quality, fatigue, and depressive symptoms as secondary outcomes.
Methods: Preliminary open-label randomized controlled trial of adult patients diagnosed with ADHD and a positive screening for at least one sleep disorder. Participants were recruited between March, 2020 and May, 2023, during the COVID-19 pandemic. Seventy patients (60% female, mean age 27.9 years [SD = 8.2]) were randomized to a 12-week period of: (1) ADHD treatment as usual (TAU, n = 25), (2) ADHD TAU + sleep treatment (n = 22), or (3) stand-alone sleep treatment (n = 33). Outcome measures were assessed at baseline, and after 6 and 12 weeks of treatment. A total of 20% of participants did not complete the post-treatment assessment. Primary analyses compared changes between groups 1 and 2. Exploratory within-group analyses were conducted to assess improvements in the stand-alone sleep treatment group. All performed analyses were pre-specified.
Results: Primary analysis showed no significant difference in the reduction of subjective ADHD symptoms between the ADHD TAU + sleep treatment group and the ADHD TAU group (β = -1.30, 95% CI [-5.57, 2.96], d = 0.21). The ADHD TAU + sleep treatment group did show significantly larger improvements in subjective sleep quality (β = -1.98, 95% CI [-3.65, -0.30], d = 0.42) and fatigue (β = -6.52, 95% CI [-12.33, -0.70], d = 1.59) compared to the ADHD TAU group. Pre-specified, exploratory within-group analysis showed a significant reduction in subjective ADHD symptoms in the stand-alone sleep treatment group (β = -4.80, 95% CI [-7.60, -2.01], d = 0.62).
Conclusion: Adding sleep treatment to standard ADHD treatment did not lead to significantly greater reductions in subjective or objective, performance based ADHD symptoms. However, combined treatment showed the largest improvements in sleep quality and fatigue, suggesting that such an approach may offer additional benefits. Subjective ADHD symptoms improved in the stand-alone sleep treatment group, but to a lesser extent than the other groups. Future studies with greater statistical power are needed, with long-term effects and quality of life as important outcomes.
Keywords: ADHD symptoms; CBT-I; adult ADHD; chronotherapy; clinical trial.