Journal of the American Academy of Child & Adolescent Psychiatry
Volume 48, Issue 9 , Pages 894-908, September 2009

Sleep in Children With Attention-Deficit/Hyperactivity Disorder: Meta-Analysis of Subjective and Objective Studies

Drs. Cortese, Konofal, and Lecendreux are with the Robert Debré Hospital. Dr. Faraone is with SUNY Upstate Medical University. Dr. Cortese is also with Verona University, and Dr. Konofal is also with Pitié-Salpêtrière Hospital

Accepted 20 April 2009.

Disclosure: Dr. Cortese has received financial support to attend medical meetings from Eli Lilly & Company and Shire Pharmaceuticals, and has been co-investigator in studies sponsored by GlaxoSmithKline, Eli Lilly & Company, and Genopharm. Dr. Faraone has received consulting fees from, has been on the advisory boards and speakers' bureaus of, or received research support from the National Institutes of Health, Shire, Pfizer, and Eli Lilly. Dr. Konofal has served on the advisory boards for Shire and UCB. He has consulted for Shire. He has served as a medical writer for Remidica and Janssen-Cilag. He has served on the speakers_bureau of UCB and served as a principal investigator in clinical trials for Eli Lilly & Company and Janssen-Cilag. Dr. Lecendreux has received industry research funding from Shire. He has served as a consultant for UCB and Shire. He has served as an investigator for Eli Lilly & Company and Shire.

Abstract 

Objective

To perform a meta-analysis of subjective (i.e., based on questionnaires) and objective (i.e., using poly-somnography or actigraphy) studies comparing sleep in children with attention-deficit/hyperactivity disorder (ADHD) versus controls.

Method

We searched for subjective and objective sleep studies (1987–2008) in children with ADHD (diagnosed according to standardized criteria). Studies including subjects pharmacologically treated or with comorbid anxiety/depressive disorders were excluded.

Results

Sixteen studies, providing 9 subjective and 15 objective parameters and including a total pooled sample of 722 children with ADHD versus 638 controls, were retained. With regard to subjective items, the meta-analysis indicated that children with ADHD had significantly higher bedtime resistance (z = 6.94, p < .001), more sleep onset difficulties (z = 9.38, p < .001), night awakenings (z = 2.15, p = .031), difficulties with morning awakenings (z = 5.19, p < .001), sleep disordered breathing (z = 2.05, p = .040), and daytime sleepiness (z = 1.96, p = .050) compared with the controls. As for objective parameters, sleep onset latency (on actigraphy), the number of stage shifts/hour sleep, and the apnea-hypopnea index were significantly higher in the children with ADHD compared with the controls (z = 3.44, p = .001; z = 2.43, p = .015; z = 3.47, p = .001, respectively). The children with ADHD also had significantly lower sleep efficiency on polysomnography (z = 2.26, p = .024), true sleep time on actigraphy (z = 2.85, p = .004), and average times to fall asleep for the Multiple Sleep Latency Test (z = 6.37, p < .001) than the controls.

Conclusions

The children with ADHD are significantly more impaired than the controls in most of the subjective and some of the objective sleep measures. These results lay the groundwork for future evidence-based guidelines on the management of sleep disturbances in children with ADHD.

Key Words:  ADHD , sleep , polysomnography , actigraphy , meta-analysis

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 This article was reviewed under and accepted by Ad Hoc Editor Garry Walter, M.D., Ph.D.The authors thank Drs. R. Gruber, R. Kirov, S. Mayes, and S. Miano for having provided supplemental data from their studies to be included in the present meta-analysis.This article is the subject of an editorial by Dr. Eric Taylor in this issue.

PII: S0890-8567(09)60145-3

doi:10.1097/CHI.0b013e3181ac09c9

Journal of the American Academy of Child & Adolescent Psychiatry
Volume 48, Issue 9 , Pages 894-908, September 2009

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