Polygraphic sleep recordings in children with attention deficit hyperactivity disorder (ADHD) [Polysomnographie bei aufmerksamkeitsgestorten und hyperaktiven kindern (attention deficit hyperactivity disorder, ADHD)]

Disturbed onset and maintenance of their children's sleep is frequently reported by parents of inattentive and hyperactive children. We performed polygraphic sleep recordings in children with and without attention deficit hyperactivity disorder in order to compare objective sleep parameters of these groups. From October 1996 to October 1998 polygraphic sleep recordings were carded out in 22 patients with ADHD (20 boys, 2 girls, age 8 ± 2 years) and 11 peer children without ADHD (8 boys, 3 girls, age 7.2 ±3.5 years). Six ADHD patients were treated with methylphenidate. The peer group consisted of children with parasomnias. The polygraphic sleep recordings included cardiorespiratory and neurophysiologic parameters. Based on EEG, EOG and EMG recordings sleep stages were visually classified according to Rechtschaffen and Kales. ADHD patients without methylphenidat therapy were found to have a variety of patterns of disturbed sleep: difficulties of sleep onset and maintenance and alterations of sleep cycles. As a group untreated ADHD patients had a shorter total sleep time and a lower sleep efficiency than their peers. A current pathophysiologic concept of ADHD postulates alterations of neurotransmitter metabolism with respect to a system controlling limited capacity of attention. Failure of this system is manifest in the awake state and can be improved by drugs increasing sympathetic activity within the CNS. Aminergic and cholinergic neuronal activity of the brain stem plays an important role in the regulation of sleep. This may be disturbed in patients with ADHD leading to a variety of patterns of disturbed sleep. Alterations of objective sleep parameters with a lower quality of sleep are associated with ADHD, but no unique pattern of sleep disturbance can be described. Quality of sleep seems to improve when ADHD patients are treated with central nervous stimulants.