Shooting a high-density electroencephalographic picture on sleep in children with attention-deficit/hyperactivity disorder

Abstract

Study Objectives Sleep-related slow-wave activity (SWA) has been recognized as a marker of synaptic plasticity. In children affected by attention deficit hyperactivity disorder (ADHD), SWA is mainly located in the central rather than frontal regions, reflecting a maturational delay. A detailed subjective and objective sleep investigation, including a full night video-polysomnography (PSG-HD-EEG), was performed on 30 consecutive drug naïve outpatients with a diagnosis of ADHD. They received a diagnosis of sleep disorders in 29/30 cases, and most of them had a past history of sleep problems. They had a higher apnea–hypopnea index at PSG, and slept less than 9 hr at actigraphy. We aimed to describe the SWA behavior in the same group of children with ADHD. Materials and Methods The full-night PSG-HD EEG of children with ADHD was compared with the one of the 25 healthy controls. The scalp SWA mapping, the decrease of SWA during the night, and the EEG source of SWA were analyzed. Results At scalp topography, the focus of SWA was observed over the centro–parietal–occipital regions in participants with ADHD (p < 0.01), which remained significant in the subgroups divided between subgroups according to the sleep diagnosis (p < 0.01). The physiological decrease in SWA was more evident in control participants. The source analysis revealed a greater delta power over the posterior cingulate in participants with ADHD (p < 0.01). Conclusions Our results confirm static and dynamic changes in SWA behavior in children with ADHD, which may reflect a maturational delay occurring at a vulnerable age, as a consequence of chronic sleep deprivation.

Sleep microstructure in attention deficit hyperactivity disorder according to the underlying sleep phenotypes

“…We previously published the results of mapping analysis of SWA performed in the same group of children with ADHD (Miano, Amato, Garbazza, et al, 2019). Children with ADHD, compared to controls, showed an increase of SWA over posterior regions, and the generator of SWA was localized over the posterior cingulate region (Miano et al, 2019). In adults, the topography of A1 and A3 subtypes shows a clear prevalence over the anterior frontal regions for the 0.25–2.5 Hz band and over the parietal–occipital areas for the 7–12 Hz band.…”

“…Because the majority of our sample was composed of the IEDs/OSA phenotype, A1 may be also the expression of arousal, rather than of SWA. The topographic mapping of SWA might reflect an involvement of arousal pathways interfering with the origin of slow waves (Miano et al, 2019). Only a future high‐density EEG mapping and source analysis of CAP subtypes may help to answer this hypothesis in children with ADHD.…”

Sleep Power Topography in Children with Attention Deficit Hyperactivity Disorder (ADHD)

“…Thirty children with a clinical diagnosis of ADHD and 23 healthy control peers were included for analysis. This dataset overlaps with the one described in a recent publication by our group [17]. Demographics and clinical information are summarized in Table 1.…”

“…Spectral analysis was performed using all artifact-free 6-s epochs (Welch's averaged modified periodogram with a Hamming window, 8 segments with 50% of overlap) on the average-referenced signal. For topographic analysis, average signal power (across epochs) was computed for 6 classical frequency ranges [32]: delta/SWA (1-4 Hz), Theta (4-8 Hz), Alpha (8-12 Hz), Sigma (12-16 Hz) Beta (16)(17)(18)(19)(20)(21)(22)(23)(24)(25), low Gamma (25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40). Both topographic maps of absolute average-referenced and normalized data (z-score across channels of the same participant) were examined.…”

“…Older studies, which commonly focused only on one arbitrarily selected EEG channel, showed no abnormalities in the lower frequencies range (0.5–4.5 Hz) during non-rapid eye movement (NREM) sleep [ 12 , 13 , 14 , 15 ]. However, three later studies [ 16 , 17 , 18 ] have been performed in children with ADHD during sleep using high-density EEG (HD-EEG), which allows a higher level of spatial resolution of electrocortical activity in comparison to standard EEG. While two out of three studies found higher slow wave activity (SWA) over a centro-posterior cluster of electrodes [ 16 , 17 ], one found a global decrease in SWA in ADHD children compared to TD peers [ 18 ].…”