767 Sleep architecture and sleep problems in adolescents and young adults with and without ADHD: A systematic review and meta-analysis

Abstract

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<.001) being significantly shorter in the ADHD group, and sleep onset latency (z=15.39, p<.001) and wake after sleep onset (z=13.50, p<.001) being significantly longer. Additionally, the ADHD group reported a significantly lower sleep efficiency (z=20.15, p<.001) and subjective sleep satisfaction (z=3.50, p<.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<.001), daytime sleepiness (z=26.68, p<.001) and sleep disturbances (z=8.00, p<.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):