Sleep Disorders and Attention Deficit: A Consequence of Proinflammatory State?

Abstract

Attention-deficit hyperactivity disorder (ADHD) is common neuropsychiatric disorder in children and adults. Sleep disorders and restless legs are related to the presence of ADHD.Wynchank et al. 1 have recently reported in the Journal of Clinical Sleep Medicine the results of a large survey of adults. The authors found that within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms and 41% reported short sleep duration. A consensus group recently implicated arousal dysregulation in the pathological mechanism of attention in ADHD. 2 In this context, this letter is a plea to investigators in this journal to evaluate the association between enhanced lowgrade inflammation, sleep disorders, and ADHD. This mechanism has been proposed by the investigators of the Turkish Adult Risk Factor (TARF) study to underlie diverse chronic diseases, 3 including type 2 diabetes, coronary heart disease, chronic kidney disease, and rheumatic diseases. It postulates that in individuals with proinflammatory state due to obesity or circulating excess oxidized phospholipid content of lipoprotein [Lp](a), 4 protective plasma proteins such as adiponectin 5 become converted to an inflammatory protein, with concomitant slower clearance of the protein from plasma. Some support for this notion having a potential relevance for ADHD may be derived from Li et al.'s study that reported nondiabetic men with restless legs syndrome (RLS) have a higher risk of early death. 6 Li et al. emphasized that the elevated mortality risk was not associated with the usual known risk factors but rather with endocrine, nutritional/metabolic, and immunological disorders. RLS may be another manifestation of the basic process of enhanced proinflammatory state and autoimmune activation. The TARF cohort revealed that metabolic syndrome, a constellation of proinflammatory state, was associated significantly with obstructive sleep apnea in nondiabetic individuals. 7 In summary, we believe that investigations directed to proinflammatory state may be fruitful to identify mechanisms underlying sleep disorders and ADHD.

Current Pattern of Psychiatric Comorbidity and Psychotropic Drug Prescription in Child and Adolescent Patients

“…In addition, its association has been shown with other systemic disorders, such as restless leg syndrome, sleep disturbance, and neurologic diseases [32]. These associations may be resulted from dopaminergic and norepinephrinergic imbalances that are involved in the pathophysiology and ADHD, and increased proinflammatory response [33,34]. In our study, association of ADHD and SLD, and ADHD diagnosis was established in majority of patients with epilepsy, supporting these opinions.…”

Atomoxetine Induced Obsessive-Compulsive Disorder

“…Previous studies have reported that it coexists with many psychiatric diseases and that this coexistence may be due to common structural and functional disorders. 4,5 One of the most common disorders coexisting with ADHD is special learning disorder. 6 These two disorders have been reported to originate from the same specific gene.…”

“…7 The amount of evidence regarding the coexistence of ADHD and sleep disorder has recently been increasing. 4 Therefore, ADHD should not be considered as a single disease but as a complex disorder associated with other potential psychiatric disorders. Atomoxetine, a nonstimulant drug used in the treatment of ADHD, is the selective blocker of presynaptic norepinephrine carriers in the central nervous system.…”