Cheryl R. Holbrook

Sleep Disturbances in Children with Attention Deficit Hyperactivity Disorder

The objective of the study was to compare polysomnographic patterns in two groups of preadolescent children with attention deficit hyperactivity disorder (ADHD) (a sleep clinic referral sample and a community sample) with control children. A prospective and observational study in the sleep clinic and the community was undertaken. Forty-seven ADHD children referred to the sleep clinic (ADHDcl), 53 ADHD children from a community survey (ADHDcom), and 49 control children underwent overnight polysomnography. Significant differences between the groups were observed for rapid-eye-movement (REM) sleep latency and percentage, and periodic limb movement index with associated arousals (PLMa). REM sleep latency was shorter in controls than ADHDcl and ADHDcom (p < 0.01) and REM% was highest in controls and lowest in ADHDcl (p < 0.001). PLMa was higher in ADHDcl than the other groups (p < 0.001), but there were no differences in PLMa between ADHDcom and controls. ADHD children display significant alterations in their sleep patterns, and ADHDcl are more likely to have an elevated PLMa than ADHDcom. In addition, REM sleep is affected by ADHD. We postulate that ADHDcl may represent a subset of children with ADHD at high risk for hyperactivity during sleep.

The effect of stimulants on sleep characteristics in children with attention deficit/hyperactivity disorder

OBJECTIVE To investigate the effects of stimulant medications on subjective and objective sleep characteristics of children with attention deficit/hyperactivity disorder (ADHD) compared with control children. METHODS An observational study in the sleep clinic and the community. Children with characteristics of ADHD, both stimulant-medicated (n=53), and non-medicated (n=34), together with control children (n=53) completed a sleep habits questionnaire prior to undergoing full overnight polysomnographic assessment. RESULTS Medicated and non-medicated ADHD subjects were reported to have more sleep disturbances compared with controls. Both groups of ADHD children also demonstrated decreased REM sleep percentage compared with controls (P=0.006 for ADHDmed; P=0.02 for ADHDnon). However, the use of stimulant medication (n=53) was not associated with differences in subjective sleep quality or objective sleep measures, compared to ADHD children not taking any medication (n=34; P=n.s.). CONCLUSIONS Despite the high prevalence of reported sleep disturbance in children with ADHD, stimulant medication appears to have minimal effects on subjective and objective sleep characteristics in children with reported ADHD.

380 RACIAL DIFFERENCES IN SLEEP HYGIENE

Purpose Many epidemiological studies have reported that sleep problems are frequent in children. A common sleep disturbance, sleep disordered breathing, is also known to vary by ethnicity, but little is known about other sleep problems that may be affected by racial background. The objective of this study was to assess the prevalence of sleep disturbances in community children and determine if racial differences exist. Methods A detailed questionnaire related to sleep habits and sleep quality was mailed to parents of children enrolled in the community public school system. Children, aged 5 to 6 years of age, and who self-identified as Caucasian (C) or African American (AA) were eligible to participate. Results 2000 questionnaires were eligible for analysis. Demographic data were as follows: 6 year olds, 1119 (56%); males, 1059 (53%); C, 1582 (79%). The average hours of nighttime sleep was 9.2 ± 1.4 hours. The parents of C children reported more sleep hours than their AA counterparts (C, 9.4 ± 1.3 hours vs. AA, 8.5 ± 1.6 hours). Only 180 (9%) of parents reported no concerns with sleep issues, but of the remaining parents, racial differences did exist. More C parents reported that their children willingly went to bed (C, 60% vs. AA, 48%, p < .001) and were easy to arouse in the morning (C, 59% vs. AA, 52%, p = .007) than parents of AA children. Parents of AA children felt their children talked more during sleep (C, 12% vs. AA 29%, p < .001), had a higher frequency of sleepwalking (C, 1.9% vs. AA, 3.8%, p = .03), more nightmares (C, 1.9% vs. AA, 7.0%, p < .001), snored more frequently (C, 25% vs. AA, 45%, p < .001), and exhibited daytime somnolence more often (C, 8.9% vs. AA 13.2%, p < .001). Conclusion Racial differences do exist in sleep habits and sleep quality. This study suggests AA children are more at risk for sleep disturbances than their C counterparts.