Attention deficit hyperactivity disorder symptom severity and sleep problems in adult participants of the Netherlands sleep registry

Highlights

• Overall ADHD symptom severity was associated with several current sleep problems.

• Severe ADHD symptoms were associated with a history of persistent sleep problems.

• In particular, the severity of hyperactivity was associated with current sleep problems.

Abstract

Background

We examined whether current overall attention deficit hyperactivity disorder (ADHD), inattention, or hyperactivity symptom severities are associated with the current presence and persistent history of sleep problems.

Methods

N = 942 participants of the Netherlands Sleep Registry filled out online several validated questionnaires. Regression analyses were performed to assess the association between (1) current overall ADHD symptom severity and the current presence of sleep problems, (2) current ADHD symptom-severity groups and the persistent history of sleep problems, and (3) current inattention or hyperactivity symptom severities and the current presence of sleep problems.

Results

(1) Current overall ADHD symptom severity was associated with the odds of suffering from probable obstructive sleep apnea syndrome (OSAS), restless legs syndrome (RLS), periodic limb movement disorder (PLMD), insomnia disorder (ID) with predominant difficulties initiating sleep (DIS) and maintaining sleep (DMS), but not with the odds of suffering from narcolepsy or ID with predominant early-morning awakening (EMA). Current overall ADHD symptom severity was also associated with an extreme evening chronotype but not with short sleep. (2) The group with the most severe current ADHD symptoms was more likely to have a history of persistent OSAS, RLS, and ID. (3) The severity of symptoms of hyperactivity, but not of inattention, was specifically associated with probable RLS, PLMD, ID with DIS or DMS, and short sleep. Inattention symptom severity was only related to the probability of being an extreme evening chronotype.

Conclusion

ADHD severity, especially the severity of hyperactivity, is associated with the current presence and persistent history of sleep problems.

Introduction

Sleep disturbances have a considerable impact on quality of life [1] and constitute a risk factor for serious health issues in the long term, such as obesity, diabetes, cardiovascular disease, and cancer [2], [3], [4]. Sleep disturbances are frequently comorbid with mental disorders, including attention deficit hyperactivity disorder (ADHD) [5]. ADHD is characterized by symptoms of hyperactivity, impulsivity, and/or inattention [6] and also affects quality of life [7]. Although the direction of the relationship between ADHD and sleep disturbances remains unknown, the association seems reciprocal: disturbed sleep can aggravate or mimic features of ADHD, and vice versa, ADHD can contribute to sleep problems [8]. For instance, hyperactivity may result in difficulty falling asleep, which is the most frequently occurring sleep disturbance as reported by parents of children with ADHD [9]. Research among adults on the association between ADHD symptoms and sleep problems is scarce. Studies reported frequent sleep-onset difficulties also in adults with ADHD [10]. Another report suggests that the prevalence of sleep problems may even be higher in adults (60–80%) than in children and adolescents with ADHD (25–50%) [8].

One aspect of the association between ADHD symptoms and sleep problems that needs further investigation, is the persistence of the sleep problems. Most previous longitudinal studies [11] revealed that sleep problems, such as short sleep duration due to later bedtimes and frequent awakenings, were stable over time among children with ADHD. Two studies in adolescents indicate that sleep problems are more persistent in the presence of ADHD [12], [13]. No studies addressed how current ADHD symptom severity in adulthood is related to the persistent history of sleep problems. Analogous to the core symptoms of hyperactivity and inattention that persist into adulthood and old age [14], [15], we hypothesize that sleep disturbances are chronic across the lifespan in ADHD patients. Since specifically chronic sleep problems are associated with serious health consequences [2], [3], [4], it is important to study whether ADHD symptom severities in adulthood are associated with a persistent history of sleep problems.

Among the many ADHD-sleep studies in children, relatively few studies addressed whether sleep problems might differentially be associated with the severities of either inattention or hyperactivity symptoms. Moreover, this has been rarely studied in adults. Some sleep problems, such as periodic limb movement disorder (PLMD), seem particularly associated with hyperactivity [16], [17]. Conflicting differential associations with inattention versus hyperactivity symptom severity have been reported for other sleep problems, including restless legs syndrome (RLS) [17], [18], [19], [20], sleep-disordered breathing [21], [22], [23], [24], insomnia [25], [26], [27], [28], [29], extreme evening chronotype [30], [31], [32], [33], and short sleep duration [26], [31], [34], [35], [36]. Altogether, the relationship between inattention and hyperactivity symptom severities and sleep disturbances needs to be further explored. If any prominent patterns across symptom severities are found, this is an important indication of the type of sleep problems that are co-occurring, causing, or the result of the severity of specific ADHD symptoms. This could guide assessment and treatment of sleep problems among those with more severe specific ADHD symptoms.

Using data from adult participants of the Netherlands Sleep Registry, we examined whether current overall ADHD, inattention, or hyperactivity symptom severities are associated with the history and current presence of sleep problems.