Pharmacological Treatment of ADHD and the Short and Long Term Effects on Sleep

Abstract

There is growing research focusing on the sleep problems of children with attention-deficit/hyperactivity disorder (ADHD) in recent years. High incidence of sleep disorders in children with ADHD may be associated with a substantial impact on their quality of life and exacerbation of ADHD symptoms. The core symptoms of ADHD can be effectively treated by various medications, including methylphenidate (MPH), amphetamine, pemoline, and the newly FDA-approved extended-release α2 adrenergic agonists. However, most of them are known to affect patients' sleep because of their pharmacological actions on dopaminergic and/or noradrenergic release in the central nervous system. Previous studies have found increased incidence of insomnia and sleep disturbances in ADHD children treated with CNS (central nervous system) stimulants. In contrast, recent prospective, double-blind, placebo-controlled trials concluded that MPH, by objective polysomnographic or actigraphic measurements, did not cause significant sleep problems in children or adolescents with ADHD. Given the fact that sleep quality and core symptoms of ADHD are highly correlated, it is imperative that we understand the effects of ADHD medications on sleep while prescribing either CNS stimulants or non-CNS stimulants. Here we will concisely review the pharmacological treatments of ADHD, and provide the relevant data discussing their short- and long-term effects on sleep.

Sleep disorder investigation might be considered to be mandatory in attention deficit/hyperactivity disorder guideline

“…Even if not for differential diagnosis, OSA must be considered as, at least, an attention and working memory disorder along with behavioural disturbance. Our findings reinforce the advice from Huang et al 30 , which states that clinicians should become familiar with sleep apnea as a life-threatening condition with overlapping symptoms including ADHD. Given this scenario, sleep disorder investigation might be considered to be mandatory in ADHD guidelines, as OSA or snoring can act as a cause or contributing factor needing to be investigated.…”

“…These factors are important intervention targets as they determine the degree of impairment and predict outcome. Treatments such as tonsillectomy or adenotonsillectomy seem to drastically reduce aggressive, inattentive, and hyperactive behaviours, improving attention and vigilance in children with OSA and even in children with ADHD and OSA compared to those treated only with methylphenidate, but these need to be validated in more accurate studies 16,30 . The need for continued treatment and effective follow-up should be emphasized as it has been shown that results of pharmacological and psychosocial interventions are generally short lived 30 .…”

“…Treatments such as tonsillectomy or adenotonsillectomy seem to drastically reduce aggressive, inattentive, and hyperactive behaviours, improving attention and vigilance in children with OSA and even in children with ADHD and OSA compared to those treated only with methylphenidate, but these need to be validated in more accurate studies 16,30 . The need for continued treatment and effective follow-up should be emphasized as it has been shown that results of pharmacological and psychosocial interventions are generally short lived 30 . This study indicates that the association between attention deficit disorder and obstructive sleep apnea may be included as a risk factor for major changes, both in latency Values are mean ± standard deviation of the mean; n: number of participants; ±: standard deviation; OSA:obstructive sleep apnea ; ADHD:attention deficit hiperactivity disorder ;REM: rapid eye movement; TST: total sleep time; AHI: obstructive apnea/hypopnea index; AI: obstructive apnea index; Spo 2 : peripheral capillary oxygen saturation; NS: non significant.…”

To Sleep or Not To Sleep: A Systematic Review of the Literature of Pharmacological Treatments of Insomnia in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder

“…We can hypothesize that sleep disturbances in ADHD may be either an adverse effect of pharmacological treatment (Sangal et al 2006;Faraone et al 2009;Giblin and Strobel 2011;Huang et al 2011), an alternative epiphenomenon stemming from core ADHD symptoms (Weiss and Salpekar 2010), a psychiatric comorbidity (Lecendreux and Cortese 2007;Tsai and Huang 2010), or a combination of them. Shorter total sleep time and increased sleep latency are common side effects of stimulant medication (Weiss and Salpekar 2010) because of the pharmacological disruption of dopaminergic and noradrenergic release in the central nervous system (Huang et al 2011).…”

“…Shorter total sleep time and increased sleep latency are common side effects of stimulant medication (Weiss and Salpekar 2010) because of the pharmacological disruption of dopaminergic and noradrenergic release in the central nervous system (Huang et al 2011). The importance of noradrenaline as a key neurotransmitter implicated in arousal is discussed in Mitchell and Weinshenker (2010) who note that stimulant medications promote the synaptic release of dopamine and noradrenaline, and to a lesser extent, serotonin, while also blocking their reuptake, thus increasing the synaptic levels of these monoamines, which all play a role in the arousal pathway.…”