Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder

O’Brien, Louise M.; Holbrook, Cheryl R.; Mervis, Carolyn Β.; Klaus, Carrie J; Bruner, Jennifer L.; Raffield, Troy J.; Rutherford, Jennifer; Mehl, Rochelle C.; Wang, Mei; Tuell, Andrew; Hume, Brittany C; Gozal, David

doi:10.1542/peds.111.3.554

Cited by 455 publications

(367 citation statements)

References 43 publications

Supporting

Mentioning

302

Contrasting

Unclassified

Order By: Relevance

“…This agrees with O'Brien et al [37]. They found that 77% of ADHD children had problems with bedtime and experienced unsettled sleep compared with only 43% within the healthy control group.…”

Section: Discussionsupporting

confidence: 91%

Parental rating of sleep in children with attention deficit/hyperactivity disorder

Hvolby¹,

Jørgensen

Bilenberg

2009

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

Objective: Sleep problems have often been associated with attention deficit/hyperactivity disorder (ADHD). Parents of those with ADHD and children with ADHD report sleep difficulties more frequently than healthy children and their parents. The primary objective of this paper is to describe sleep patterns and problems of 5 to 11-year-old children suffering from ADHD as described by parental reports and sleep questionnaires. Method: The study included 321 children aged 5–11 years (average age 8.4 years); 45 were diagnosed with ADHD, 64 had other psychiatric diagnoses, and 212 were healthy. One hundred and ninety-six of the test subjects were boys and 125 were girls. A semi-structured interview (Kiddie-SADS-PL) was used to DSM-IV diagnose ADHD and comorbidity in the clinical group. Sleep difficulties were rated using a structured sleep questionnaire (Children Sleep Behaviour Scale). Results: Children diagnosed with ADHD had a significantly increased occurrence of sleep problems. Difficulties relating to bedtime and unsettled sleep were significantly more frequent in the ADHD group than in the other groups. Children with ADHD showed prolonged sleep onset latency, but no difference was shown regarding numbers of awakenings per night and total sleep time per night. Comorbid oppositional defiant disorder appeared not to have an added effect on problematic behaviour around bedtime. Conclusion: Parents of children with ADHD report that their children do not sleep properly more often than other parents. The ADHD group report problems with bedtime resistance, problems with sleep onset latency, unsettled sleep and nightmares more often than the control groups. It may therefore be relevant for clinicians to initiate a closer examination of those cases reporting sleep difficulties

show abstract

Section: Discussionsupporting

confidence: 91%

Parental rating of sleep in children with attention deficit/hyperactivity disorder

Hvolby¹,

Jørgensen

Bilenberg

2009

Eur Child Adolesc Psychiatry

View full text Add to dashboard Cite

show abstract

Section: Discussionsupporting

confidence: 57%

“…In 2 studies, the SAT min was used to qualify nocturnal hypoxemia, and associations with impaired intelligence, attention, and behavior were observed. 5,6 These and our data suggest that the SAT min is an accurate predictor for neurocognitive impairment in children and may be used as a standard variable in the evaluation of children.Little is known about mild hypoxemia and its impact on cognition in children. Although associations between neurobehavioral impairments and saturation levels of Ͻ90% Spo 2 have been reported, 1,14 the clinical significance of Spo 2 levels between 90% and 95% is unknown.…”

supporting

confidence: 57%

“…Although associations between neurobehavioral impairments and saturation levels of Ͻ90% Spo 2 have been reported, 1,14 the clinical significance of Spo 2 levels between 90% and 95% is unknown. The 2 studies mentioned above observed impaired outcome in children with SAT min values in the lower 90s (90.7% and 90.9%), 5,6 and a recent study found associations between mean SAT min values of 94.1% and neurocognitive impairments in children with primary snoring. 18 We included children with a SAT min in the upper quartile in a "normoxic" reference group.…”

mentioning

confidence: 88%

See 1 more Smart Citation

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Urschitz¹,

Wolff²,

Sokollik³

et al. 2005

Pediatrics

View full text Add to dashboard Cite

ABSTRACT. Objective. Hypoxemia, often assessed via pulse oximetry, is associated with neurocognitive deficits in children. The best way to qualify hypoxemia, or which level of hypoxemia already affects cognition, is unknown.Methods. We assessed the association of pulse oximetry-derived variables that qualify hypoxemia with impaired academic performance in mathematics in a population-based cross-section of 995 primary school children who underwent overnight home recordings of motion-resistant new-generation pulse oximeter saturation (SpO 2 ). Impaired academic performance in mathematics was based on the last school report and defined as grade 4 to 6 on a 6-point scale (ie, approximately the lowest quintile grades).Results. Of 10 variables under study, only the nadir of the SpO 2 values was significantly associated with impaired performance. Categories of this variable representing mild (ie, 91%-93% SpO 2 ; odds ratio: 1.65; 95% confidence interval: 1.06 -2.56) and moderate hypoxemia (ie, <90% SpO 2 ; odds ratio: 2.28; 95% confidence interval: 1.30 -4.01) both were associated with impaired performance in mathematics.Conclusions. We suggest using the nadir of the SpO 2 values in an overnight study to qualify hypoxemia in future studies. This variable may predict neurocognitive deficits in school children. Mild hypoxemia, as yet widely considered benign, may already affect cognition in childhood. A dverse impacts of chronic or intermittent hypoxemia on development, behavior, cognition, and academic performance have been reported in many well-designed and controlled studies in children with sleep-disordered breathing 1-6 or congenital heart disease. [7][8][9][10][11] Data for other clinical conditions that result in chronic or intermittent hypoxemia are sparse. In some studies, adverse effects have been noted at even mild levels of oxygen desaturation. 1 Application of pulse oximetry to detect chronic or intermittent hypoxemia is a valid, reliable, and frequently used method. 12 Several variables that qualify chronic and intermittent hypoxemia can be derived from pulse oximetry and reference ranges used to identify abnormal clinical conditions. 13 However, it is yet unclear which pulse oximetry-derived variable best predicts neurocognitive impairments in children and which level of oxygen desaturation is already harmful. The mean and nadir arterial oxygen saturation measured by pulse oximetry (Spo 2 ) have been reported and shown to have some relationship to decreased intelligence, 5 impaired attention, 5 and hyperactive behavior. 1,6 We recently performed a study on the association between sleep-disordered breathing and impaired academic performance in primary school children. 14 As part of this study, children were examined for the presence of nocturnal chronic and intermittent hypoxemia using pulse oximetry. Only a weak association between intermittent hypoxemia and impaired academic performance in mathematics was found. 14 These results, however, were recently challenged: the inclusion of children with perhaps "a...

show abstract

“…Parents were also asked about aggressive behavior (eg, biting, kicking, hair pulling, shoving) and symptoms of ADD (eg, hyperactivity, distractability, poor attention span). 14 …”

Section: Behavioral Assessmentmentioning

confidence: 99%

Sleep Disturbance and Rage Attacks in Opsoclonus-Myoclonus Syndrome: Response to Trazodone

Pranzatelli¹,

Tate²,

Dukart³

et al. 2005

The Journal of Pediatrics

View full text Add to dashboard Cite

Objectives Parents of children with opsoclonus-myoclonus syndrome (OMS) frequently describe poor sleep and rage attacks. We hypothesized that these manifestations are related and could result from underlying monoaminergic dysfunction.Study design We clinically characterized the sleep and behavioral characteristics of 51 young children with OMS; 19 of those with the most disruptive sleep patterns were treated with trazodone, a soporific serotonergic agent.Results Sleep disturbances, including prolonged sleep latency, fragmented sleep, reduced quantity of sleep, snoring, and nonrestorative sleep, were reported in 32 children, and frequent rage attacks were reported in 25. In 59% of the poor sleepers, parents felt that the problem was severe enough to warrant treatment. Children sleeping <10 hours/night had a higher rage frequency than those who slept more. Of the children who required trazodone, 84% were receiving corticosteroids or adrenocorticotropic hormone (corticotrophin), compared with 37% in the subgroup with normal sleep. Trazodone (3.0 ± 0.4 mg/kg/day) improved sleep and behavior in 95% of the children, significantly increasing total sleep time by 72%, decreasing the number of awakenings by 76%, and reducing rage attacks by 33%.Conclusions Children with OMS exhibited multiple types of sleep disturbances, which contributed to rage attacks.Trazodone was effective in improving sleep and decreasing rage attacks and was well tolerated, even in toddlers. (J Pediatr 2005;147:372-8) 0 psoclonus-myoclonus syndrome (OMS) is a neuroblastoma-associated paraneoplastic disorder with serious neuropsychiatric sequelae. Of all of the behavioral symptoms of OMS, such as cognitive impairment, attention deficit disorder (ADD), and obsessive-compulsive disorder, sleep disturbance and rage attacks are the most difficult for the family to cope with. 1 Reduced quality of sleep can also harm the developing child by impairing emotional development, learning, and growth. 2 Multiple pharmacologic interventions have been unsuccessful in children with OMS, because of a lack of efficacy or the propensity for paradoxical reactions to sedatives in this disorder. 3Trazodone hydrochloride, a sedating triazolopyridine derivative with some anxiolytic and hypnotic properties, was first marketed in the United States as an antidepressant in 1983. It is principally a serotonergic agent. 4 In adults, the antidepressant effect occurs at doses of 300 to 600 mg, but in sub-antidepressant doses (50 to 100 mg), it also treats depression-associated sleep disorders. 5 Although understudied in children under 12 years old, it is used in older children to treat migraine headaches, disruptive behavior, depression,8 and sleep disorders. 9We hypothesized a perturbation of monoaminergic neurotransmission to account for sleep disturbances and rage attacks in OMS. Abnormalities of cerebrospinal fluid (CSF) monoamine metabolites have been found in OMS 10 and in disruptive behavioral disorders of children and adolescents." Trazodone, with its serotonergic pro...

show abstract

Sleep and Neurobehavioral Characteristics of 5- to 7-Year-Old Children With Parentally Reported Symptoms of Attention-Deficit/Hyperactivity Disorder

Cited by 455 publications

References 43 publications

Parental rating of sleep in children with attention deficit/hyperactivity disorder

Parental rating of sleep in children with attention deficit/hyperactivity disorder

Nocturnal Arterial Oxygen Saturation and Academic Performance in a Community Sample of Children

Sleep Disturbance and Rage Attacks in Opsoclonus-Myoclonus Syndrome: Response to Trazodone

Contact Info

Product

Resources

About