BackgroundAdolescence is characterized by an increase in the rate of sleep problems, which might be even more pronounced in adolescents with ADHD. This systematic review with meta‐analysis aimed to compare sleep in adolescents with and without ADHD, including sleep parameters, both subjectively and objectively measured, sleep problems and sleep hygiene.MethodsMedline, CINAHL, PsycINFO, EMBASE, ERIC, Web of Science, and PubMed databases were searched for studies with case‐control designs (published between 1980 and 2022) directly comparing sleep in adolescents (12–25 years) with ADHD to typically developing controls. Standardized mean differences were calculated and a random‐effects model was implemented using RevMan.ResultsOverall, 6974 titles/abstracts and 205 full texts were screened, resulting in 13 eligible studies. The sample sizes range from 35 to 9846 with in total 2465 adolescents with ADHD and 18,417 controls. The data suggests that adolescents with ADHD report significantly more disturbed subjective sleep parameters (e.g., total sleep time; n = 7, SMD = 0.47, p < .001) and experience more sleep problems compared to typically developing peers (e.g., daytime sleepiness; n = 5, SMD = 0.54, p = .01). Only few studies objectively measured sleep and no significant differences were found between both groups (n = 3) in any parameter. Differences in sleep hygiene could not be examined due to a limited number of studies.ConclusionsAdolescents with ADHD report significantly worsened subjectively sleep parameters and more sleep problems compared to controls. These findings are still preliminary as a limited number of studies was identified. Nevertheless, it is advised to routinely include sleep assessment in the ADHD diagnostic process. More research is needed with a focus on objective measurement and sleep hygiene in ADHD.

Restrictions related to the COVID-19 pandemic may have significantly impacted adolescents’ sleep, possibly even more so in adolescents with attention-deficit/hyperactivity disorder (ADHD). The current study examines the sleep of adolescents without ADHD (TD) and a homogeneous group of adolescents with ADHD and comorbid sleep problems using a multi-method objective and subjective assessment of sleep outcomes, during few and multiple COVID-19 restrictions. Four groups (2 TD and 2 ADHD) of in total 100 adolescents (50 TD and 50 ADHD) were included. One ADHD group was tested during numerous COVID-19 restrictions, the other during few. The same was done with the two TD groups. All participants were between 13 and 17 years old. Three two-way MANCOVAs were implemented with ADHD diagnosis and level of COVID-19 restrictions as independent and sleep outcomes (sleep hygiene, sleep deprivation, and objective and subjective total sleep time (TST) and sleep onset latency (SOL)) as dependent variables. As expected, adolescents with ADHD and comorbid sleep problems had significantly more subjective and objective sleep problems. Additionally, COVID-19 restrictions were related to sleep outcomes in both TD and ADHD groups, with both objective TST and subjective SOL being shorter when there were numerous COVID-19 restrictions. However, the shorter SOL was only found in the ADHD group. COVID-19 restrictions are related to sleep in adolescents, and more so in the ADHD group. Future research should focus on mechanisms underlying these relations.

IntroductionAdolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment—Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)—that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD.Methods and analysisA randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13–17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach.Ethics and disseminationThe study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards.Trial registration numberNCT04723719.

Introduction During the past years, an increasing number of articles has focused on comparing sleep in youths with and without ADHD. However, so far no meta-analysis has been conducted summarizing the findings. Therefore, the current study assesses sleep architecture (i.e. the basic sleep structure), sleep problems, and sleep hygiene. Sleep was assessed both subjectively and objectively and the two groups were compared on multiple variables. Methods Two researchers independently performed a literature search (1980–2020). Studies using a case-control design comparing sleep in youths (12–25 years) with and without ADHD were included. Study quality was evaluated using the Newcastle-Ottawa Scale. Standardized mean differences were calculated for each outcome domain being reported by at least two studies. Results 10379 publications were screened, resulting in 11 studies and 52 effect sizes (nADHD=2377, ncontrol=21687). These effect sizes were summarized into 7 objective and 11 subjective variables measuring sleep. Two objective sleep variables were significantly worse in the ADHD group; total sleep time (z=2.16, p=.03) and sleep onset latency (z=2.39, p=.02). The two groups did not differ on sleep efficiency, sleep onset/offset time, and time in bed. Comparing the groups on subjective variables resulted in the same pattern, with total sleep time (z=21.27, p&lt;.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p&lt;.001) and wake after sleep onset (z=13.50, p&lt;.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p&lt;.001) and subjective sleep satisfaction (z=3.50, p&lt;.001). Wake time and number of awakenings during the night were not significant. Youths with ADHD also reported significantly more sleep problems, including insomnia (z=6.38, p&lt;.001), daytime sleepiness (z=26.68, p&lt;.001) and sleep disturbances (z=8.00, p&lt;.001). Due to only two studies measuring it, with a focus on different variables, sleep hygiene could not be included. Conclusion In general, youths with ADHD have a disrupted sleep architecture and experience more sleep problems compared to their typically developing peers. Consequently, sleep assessment should become a routine part during the diagnostic process of ADHD. Additionally, more research is needed focusing on sleep architecture and sleep hygiene, and on the development of a sleep intervention for youths with ADHD. Support (if any):

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