Sleep disruption can lead to symptoms of attention-deficit hyperactivity disorder (ADHD) in children. Since periodic limb movement disorder and/or restless legs syndrome can cause sleep disruption, we assessed whether these two specific sleep disorders are likely to occur in children with ADHD. We asked a series of 69 consecutive parents of children with ADHD questions about the symptoms of periodic limb movement disorder. Based on a positive response to these periodic limb movement disorder queries, 27 children underwent all-night polysomnography. Eighteen children (aged 2 to 15 years) of the 27 (26% of the 69 children with ADHD) had 5 or more periodic leg movements in sleep per hour of sleep and had complaints of sleep disruption, thus fulfilling the criteria for periodic limb movement disorder. A comparably age- and sex-matched group of children referred to a sleep laboratory for sleep complaints but without ADHD showed only a 5% prevalence (2 of 38 subjects) of periodic leg movements in sleep (P=.017). Eight of the 18 children with ADHD and periodic limb movement disorder and one of the two control patients with periodic limb movement disorder had both a personal and parental history of restless legs syndrome symptomatology. This study further documents the occurrence of periodic limb movement disorder and restless legs syndrome in children and is the first large-scale study establishing a possible comorbidity between ADHD and periodic limb movement disorder. We propose that the sleep disruption associated with periodic limb movement disorder and restless legs syndrome and the motor restlessness of restless legs syndrome while awake could contribute to the inattention and hyperactivity seen in a subgroup of ADHD-diagnosed children.

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The pattern of respiratory movements of the vocal cords in relation to airflow and respiratory system resistance was assessed in healthy human volunteers during quiet breathing. Motion pictures of the vocal cords were obtained through a fiber-optic laryngoscope inserted transnasally under topical anesthesia. A simultaneous estimate of lung volume was obtained using either rib cage and abdominal magnetometer coils or an integrated pneumotachograph signal. The vocal cords separated during inspiration and moved closer together during the expiratory phase of each breath. The extent of these movements varied greatly among the subjects. Total respiratory system resistance, assessed by the forced oscillation technique, was negatively correlated with distance between the vocal cords when measured at isoflow points in inspiration and expiration. Analysis of breath-by-breath variations in expiratory airflow and vocal cord position revealed that decreases in airflow accompanied decreases in the distance between the vocal cords. The results of this study indicate that the human larynx participates in the regulation of respiratory airflow by providing a variable, controlled resistance.