NREM sleep instability is reduced in children with attention-deficit/hyperactivity disorder.

STUDY OBJECTIVES To evaluate non-rapid eye movement sleep instability (NREM), as measured by the cyclic alternating pattern (CAP), in a cohort of children with attention-deficit/hyperactivity disorder (ADHD) and normal controls. DESIGN Prospective study. SETTINGS Sleep laboratory. PARTICIPANTS Twenty consecutive outpatients with ADHD (18 boys and 2 girls; age range 6-13 years, mean age 9.3 years) and 20 normal children matched for age and socioeconomic status underwent polysomnographic recordings for 2 consecutive nights in a standard laboratory setting. Sleep was visually scored for sleep macrostructure and CAP, according to standard criteria. MEASUREMENTS AND RESULTS Children with ADHD showed significantly reduced sleep duration and increased rate of stage shifts. All children with ADHD had an apnea-hypopnea index less than 1. Those with ADHD presented lower total CAP rates and lower CAP rates during sleep stage 2 than did normal controls. Moreover, in children with ADHD, we found a lower number of CAP sequences and a reduced total A1 index, mainly in light sleep (sleep stages 1 and 2). We did not find differences in A subtype percentages, but there was a longer duration of A1 subtypes in children with ADHD. CONCLUSIONS Children with ADHD showed a lower CAP rate and a lower number of CAP sequences; this supports the hypothesis of the existence of a hypoarousal state in these patients.

[1]  Liborio Parrino,et al.  Origin and Significance of the Cyclic Alternating Pattern (CAP). REVIEW ARTICLE. , 2000, Sleep medicine reviews.

[2]  C. Harper,et al.  Vigilance and its disorders. , 1993, Neurologic clinics.

[3]  A. MacDonald,et al.  Prevalence of ADHD and comorbid disorders among elementary school children screened for disruptive behavior , 1996, Journal of abnormal child psychology.

[4]  E. Shahar,et al.  Sleep disorders and daytime sleepiness in children with attention-deficit/hyperactive disorder. , 2004, Sleep.

[5]  G. Plazzi,et al.  NREM sleep alterations in narcolepsy/cataplexy , 2005, Clinical Neurophysiology.

[6]  H. Feldman,et al.  Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings. , 2001, Pediatrics.

[7]  P. Halász,et al.  Micro-arousals during nocturnal sleep. , 1979, Acta physiologica Academiae Scientiarum Hungaricae.

[8]  D. Gozal,et al.  Sleep Disturbances in Children with Attention Deficit Hyperactivity Disorder , 2003, Pediatric Research.

[9]  C. Guilleminault,et al.  Non-REM-sleep instability in recurrent sleepwalking in pre-pubertal children. , 2005, Sleep medicine.

[10]  C. Guilleminault,et al.  Upper airway resistance syndrome in children: a clinical review. , 2001, Seminars in pediatric neurology.

[11]  C L Marcus,et al.  Normal polysomnographic values for children and adolescents. , 1992, The American review of respiratory disease.

[12]  M. Terzano,et al.  Atlas, rules, and recording techniques for the scoring of cyclic alternating pattern (CAP) in human sleep. , 2002, Sleep medicine.

[13]  O. Bruni,et al.  Sleep cyclic alternating pattern in normal school-age children , 2002, Clinical Neurophysiology.

[14]  D Mancia,et al.  Is the EEG cyclic alternating pattern a true autonomous entity? Analytic study in a case of post-traumatic coma with good prognosis. , 1982, European neurology.

[15]  J. Owens,et al.  Patients with attention-deficit/hyperactivity disorder without observed apneic episodes in sleep or daytime sleepiness have normal sleep on polysomnography. , 2005, Sleep.

[16]  L Parrino,et al.  Polysomnographic analysis of arousal responses in obstructive sleep apnea syndrome by means of the cyclic alternating pattern. , 1996, Journal of clinical neurophysiology : official publication of the American Electroencephalographic Society.

[17]  J. Epstein,et al.  Conners Rating Scales-Revised. , 1999 .

[18]  A. Rechtschaffen,et al.  A manual of standardized terminology, technique and scoring system for sleep stages of human subjects , 1968 .

[19]  D. Elmqvist,et al.  Sleep and wakefulness in preadolescent children with deficits in attention, motor control and perception , 1992, Acta paediatrica.

[20]  R. Brumback,et al.  Primary disorder of vigilance: a novel explanation of inattentiveness, daydreaming, boredom, restlessness, and sleepiness. , 1990, The Journal of pediatrics.

[21]  A. Sadeh,et al.  Instability of sleep patterns in children with attention-deficit/hyperactivity disorder. , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[22]  C. Mervis,et al.  Sleep and neurobehavioral characteristics of 5- to 7-year-old children with parentally reported symptoms of attention-deficit/hyperactivity disorder. , 2003, Pediatrics.

[23]  J. Owens.  The ADHD and Sleep Conundrum: A Review , 2005, Journal of developmental and behavioral pediatrics : JDBP.

[24]  S. Ancoli-Israel,et al.  Sleep in children with attention-deficit hyperactivity disorder (ADHD): a review of naturalistic and stimulant intervention studies. , 2004, Sleep medicine reviews.

[25]  E. Lugaresi,et al.  Some periodic phenomena arising during drowsiness and sleep in man. , 1972, Electroencephalography and clinical neurophysiology.

[26]  L Parrino,et al.  Cyclic alternating pattern (CAP) in normal sleep: polysomnographic parameters in different age groups. , 1998, Electroencephalography and clinical neurophysiology.

[27]  C. Marcus,et al.  Polysomnographic values in children 2–9 years old: Additional data and review of the literature , 2005, Pediatric pulmonology.

[28]  A. Walters,et al.  Further studies on periodic limb movement disorder and restless legs syndrome in children with attention‐deficit hyperactivity disorder , 1999, Movement disorders : official journal of the Movement Disorder Society.

[29]  S. Kales,et al.  Hypnopolygraphic alterations in Attention Deficit Disorder (ADD) children. , 1990, The International journal of neuroscience.

[30]  M. Bouvard,et al.  Sleep and alertness in children with ADHD. , 2000, Journal of child psychology and psychiatry, and allied disciplines.

[31]  D. Lewin,et al.  Sleep disorders and ADHD: shared and common phenotypes. , 2004, Sleep.

[32]  A. Walters,et al.  Periodic Limb Movement Disorder and Restless Legs Syndrome in Children With Attention-deficit Hyperactivity Disorder , 1998, Journal of child neurology.

[33]  G. Marzocchi,et al.  Una scala di facile uso per la rilevazione dei comportamenti problematici dei bambini con Deficit di Attenzione e Iperattività , 2000 .

[34]  D R Ismond,et al.  A naturalistic assessment of the motor activity of hyperactive boys. I. Comparison with normal controls. , 1983, Archives of general psychiatry.

[35]  Gahan Fallone,et al.  Sleepiness in children and adolescents: clinical implications. , 2002, Sleep medicine reviews.

[36]  Liborio Parrino,et al.  Clinical applications of cyclic alternating pattern , 1993, Physiology & Behavior.

[37]  M. Terzano,et al.  Sleep cyclic alternating pattern in normal preschool-aged children. , 2005, Sleep.

[38]  D. Gozal,et al.  Sleep in children with attention deficit/hyperactivity disorder. , 2004, Minerva pediatrica.

[39]  A. Sadeh,et al.  Sleep and neurobehavioral functioning in boys with attention-deficit/hyperactivity disorder and no reported breathing problems. , 2004, Sleep.

[40]  C. Conners.  Conners' rating scales-revised : technical manual , 1997 .

[41]  R Tannock,et al.  Does actigraphy differentiate ADHD subtypes in a clinical research setting? , 2000, Journal of the American Academy of Child and Adolescent Psychiatry.

[42]  R. Chervin.  How many children with ADHD have sleep apnea or periodic leg movements on polysomnography? , 2005, Sleep.

[43]  R. Chervin,et al.  Pediatric sleep questionnaire (PSQ): validity and reliability of scales for sleep-disordered breathing, snoring, sleepiness, and behavioral problems. , 2000, Sleep medicine.

[44]  R. Dahl,et al.  The impact of inadequate sleep on children's daytime cognitive function. , 1996, Seminars in pediatric neurology.

[45]  O. Bruni,et al.  The Sleep Disturbance Scale for Children (SDSC) Construct ion and validation of an instrument to evaluate sleep disturbances in childhood and adolescence , 1996, Journal of sleep research.

[46]  H. Moldofsky,et al.  Sleep disturbances in children with attention-deficit/hyperactivity disorder. , 1998, Journal of the American Academy of Child and Adolescent Psychiatry.