Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes

Abstract

The analysis of sleep microstructure in attention deficit hyperactivity disorder (ADHD) revealed an under‐representation of the EEG slow component during NREM sleep. Previous studies either excluded or did not characterize objectively sleep disorders, which notoriously affect sleep architecture. The present study aimed to investigate the cyclic alternating pattern in a real clinical sample of children with ADHD, in whom sleep disorders could be considered. Twenty‐seven consecutively enrolled drug‐naïve children (mean age, 10.53 years; nine females) and 23 controls (mean age, 10.22 years; 11 females) underwent a full sleep investigation, including attended video‐polysomnography. Visual cyclic alternating pattern analysis was performed in a blinded way. Children with ADHD had one or more sleep disorders (a narcolepsy‐like phenotype was found in two cases, sleep onset insomnia in three cases, arousal disorder in one case, movement disorder phenotype in six cases and obstructive sleep apnea in 11 cases, and six children had sleep‐related epileptiform discharges). Children with ADHD and normal controls showed a similar microstructure with a cyclic alternating pattern rate of about 50%. Children with obstructive sleep apnea had a significantly higher cyclic alternating pattern rate during stage N3. Despite not reaching statistical differences, a lower cyclic alternating pattern rate and A1 index were found in children without epileptic abnormalities/obstructive sleep apnea. Our analysis might allow differentiation of the “primary form” of ADHD associated with a decrease of NREM instability from those forms associated with sleep apnea and epileptic activity.

Understanding patient characteristics and medication prescriptions in children with mental health and neurodevelopmental disorders referred to a sleep clinic—A quality improvement/quality assurance analysis

“…The low number of patients in this pilot project precludes our ability to assess correlations between sleep disorders, mental health diagnosis and other comorbidities. Continuing to use the logic model to frame clinical presentations will result in larger patient cohorts that will allow us to phenotype patients referred to our clinic with ADHD, MHNDD and sleep disturbances further, as recently suggested ( 24 , 25 ).…”

The Contribution of Sleep Texture in the Characterization of Sleep Apnea

“…The application of CAP scoring can support the phenotyping of various diseases as demonstrated for Down syndrome, Fragile-X syndrome, and attention deficit hyperactivity disorder, where the evaluation of sleep microstructure can help in the identification of patients suffering between ‘primary disease forms’ (lower amounts of CAP oscillations) from those with coexistent sleep-related breathing disorders (higher CAP rate values) [ 44 , 45 ]. In the latest years, the European Sleep Apnea Database (ESADA) has tried to detail OSA heterogeneity using clustering procedures.…”

Sleep Power Topography in Children with Attention Deficit Hyperactivity Disorder (ADHD)

“…Sleep problems are commonly reported by children-adolescents with ADHD and their parents in clinical settings [ 7 ]. This observation has led to a growing attention towards sleep [ 8 ] and its electroencephalographic (EEG) microstructure in ADHD [ 9 , 10 ]. Few quantitative EEG studies specifically investigated sleep power patterns in children with ADHD [ 9 , 11 ].…”