Stimulant Medications and Sleep for Youth With ADHD: A Meta-analysis

Abstract

CONTEXT: Mixed findings exist on whether stimulant medications alter youth sleep. OBJECTIVE:To determine the effect of stimulant medications on sleep.DATA STUDIES: Studies published through March 2015 were collected via CINAHL, PsycINFO, and PubMed. References of retrieved articles were reviewed.STUDY SELECTION: Eligibility criteria included studies with children/adolescents who had attention-deficit/hyperactivity disorder (ADHD), random assignment to stimulants, and objective sleep measurement. Studies that did not include information about key variables were excluded. DATA EXTRACTION: Study-level, child-level, and sleep data were extracted by 2 independent coders. Effect sizes were calculated by using random effects models. Potential moderators were examined by using mixed effect models.RESULTS: A total of 9 articles (N = 246) were included. For sleep latency, the adjusted effect size (0.54) was significant, indicating that stimulants produce longer sleep latencies. Frequency of dose per day was a significant moderator. For sleep efficiency, the adjusted effect size (20.32) was significant. Significant moderators included length of time on medication, number of nights of sleep assessed, polysomnography/actigraphy, and gender. Specifically, the effect of medication was less evident when youth were taking medication longer. For total sleep time, the effect size (20.59) was significant, such that stimulants led to shorter sleep duration. LIMITATIONS:Limitations include few studies, limited methodologic variability, and lack of unpublished studies.CONCLUSIONS: Stimulant medication led to longer sleep latency, worse sleep efficiency, and shorter sleep duration. Overall, youth had worse sleep on stimulant medications. It is recommended that pediatricians carefully monitor sleep problems and adjust treatment to promote optimal sleep.Department of Psychology, University of Nebraska-Lincoln, Lincoln, NebraskaMs Kidwell contributed to the conceptualization of the study, organized literature searches, coded the original studies, and drafted the introduction and discussion sections; Ms Van Dyk contributed to the conceptualization of the study, coded the original studies for reliability analyses, and reviewed and revised the manuscript; Ms Lundahl contributed to the conceptualization of the study, conducted the meta-analyses, and drafted the methods and results sections; Dr Nelson contributed to the conceptualization of the study and provided critical editing of the manuscript; and all authors approved the final manuscript as submitted.www.pediatrics.org/cgi

Safety, Tolerability and Efficacy of Drugs for Treating Behavioural Insomnia in Children with Attention-Deficit/Hyperactivity Disorder: A Systematic Review with Methodological Quality Assessment

“…Against this background it is not surprising that a drug that is effective in treating ADHD in one child may be ineffective in another; similarly, it would not be surprising if a drug that was effective in treating sleep in one child with ADHD was ineffective in another. In particular, there is a subgroup of children with ADHD in whom sleep onset is improved with an evening dose of methylphenidate whereas, in most children, an evening dose of methylphenidate would delay sleep onset 68 .…”

Difficult to Bed and Difficult to Rise: Complex Interplay Among ADHD, Sleep, and Adolescence

“…This type of information is needed before intervention development can begin. It is also important to note that while stimulant medication may exacerbate some sleep difficulties (e.g., sleep onset latency) in youth with ADHD (Kidwell, Van Dyk, Lundahl, & Nelson, 2015), the high prevalence of sleep problems in youth with ADHD cannot be wholly-or even primarily-attributed to stimulant medication use. Indeed, the Cortese and colleagues (2009) metaanalysis documenting more sleep problems in youth with ADHD compared to youth without ADHD excluded studies that had pharmacologically treated participants.…”

Effect of Aptensio XR (Methylphenidate HCl Extended-Release) Capsules on Sleep in Children with Attention-Deficit/Hyperactivity Disorder

“…C hildren, adolescents , and adults with attention-deficit/hyperactivity disorder (ADHD) frequently present with a variety of sleep-related difficulties before receiving ADHD medications (Stein et al 2012; Kidwell et al 2015). The impact of ADHD medications on sleep has been debated, with some studies showing deleterious effects on sleep, some studies showing minimal effects on sleep, and other studies showing improvement in sleep parameters after treatment with ADHD medications (Kidwell et al 2015).…”

“…The impact of ADHD medications on sleep has been debated, with some studies showing deleterious effects on sleep, some studies showing minimal effects on sleep, and other studies showing improvement in sleep parameters after treatment with ADHD medications (Kidwell et al 2015). The potential for different ADHD medications with varying pharmacokinetic profiles to have different impacts on sleep parameters also has been a topic of research and clinical discussion.…”

“…A recent meta-analysis of articles in which stimulants were used for ADHD found that worsening sleep latency was seen in some patients receiving stimulants and that this finding was more common in patients receiving more frequent stimulant dosing (Kidwell et al 2015). Extended-release stimulant formulations given once daily had less impact on sleep latency than thrice-daily immediate-release dosing.…”