Effects of atomoxetine and methylphenidate on sleep in children with ADHD

Study Objectives: This study compared the effects of atomoxetine and methylphenidate on the sleep of children with attention-deficit/hyperactivity disorder (ADHD). This study also compared the efficacy of these medications for treating ADHD in these children. Design: Randomized, double-blind, crossover trial. Setting: Two sleep disorders centers in the United States; 1 in a private-practice setting and 1 in a hospital setting. Patients: 85 children diagnosed with ADHD. Interventions: Twice-daily atornoxetine and thrice-daily methylphenidate, each for approximately 7 weeks. Measurements and Results: Relative to baseline, the actigraphy data indicated that methylphenidate increased sleep-onset latency significantly more than did atornoxetine (39.2 vs 12.1 minutes, p < .001). These results were consistent with the polysomnography data. Child diaries indicated that it was easier to get up in the morning, it took less time to fall asleep, and the children slept better with atornoxetine, compared with methylphenidate. Parents reported that it was less difficult getting their children up and getting them ready in the morning and that the children were less irritable, had less difficulty getting ready for bed, and had less difficulty falling asleep with atornoxetine, compared with methylphenidate. There were no significant differences between medications using the main measures of efficacy for ADHD treatment. Atomoxetine was superior on some secondary ADHD treatment-efficacy measures, based on parent reports. The only significant differences in treatment-emergent adverse events were greater incidence of decreased appetite and greater incidence of insomnia with methylphenidate. Conclusions: Patients receiving twice-daily atornoxetine had shorter sleep-onset latencies, relative to thrice-daily methylphenidate, based on objective actigraphy and polysomnography data. Although both medications decreased nighttime awakenings, the decrease was greater for methylphenidate.