The sleep of children with attention deficit hyperactivity disorder on and off methylphenidate: a matched case-control study

Abstract

SUMMARYIn the present study, we assessed the effects of regular use of methylphenidate medication in children diagnosed with attention deficit hyperactivity disorder (ADHD) on sleep timing, duration and sleep architecture. Twenty-seven children aged 6-12 years meeting diagnostic criteria for Diagnostic and Statistical Manual version IV ADHD and 27 control children matched for age (±3 months) and gender. Two nights of standard polysomnographic (PSG) recordings were conducted. ADHD children were allocated randomly to an on-or 48 h off-methylphenidate protocol for first or second recordings. Control childrenÕs recordings were matched for night, but no medication was used.Mixed modelling was employed in the analyses so that the full data set was used to determine the degree of medication effects. Methylphenidate in ADHD children prolonged sleep onset by an average of 29 min [confidence interval (CI) 11.6, 46.7], reduced sleep efficiency by 6.5% (CI 2.6, 10.3) and shortened sleep by 1.2 h (CI 0.65, 1.9). Arousal indices were preserved. Relative amounts of stages 1, 2 and slow wave sleep were unchanged by medication. Rapid eye movement sleep was reduced ()2.4%) on the medication night, an effect that became non-significant when control data were incorporated in the analyses. PSG data from ADHD children off-medication were similar to control data. Our findings suggest that methylphenidate reduces sleep quantity but does not alter sleep architecture in children diagnosed with ADHD.

Methylphenidate Modifies the Motion of the Circadian Clock

“…Methylphenidate delayed the onset of the main sleep bout at the beginning of the light period and reduced the amount of sleep over 24 h, matching findings reported in humans (Galland et al, 2010). Both effects were mainly found in NREM sleep whereas REM sleep was not changed significantly.…”

“…Some studies suggest that methylphenidate, a common pharmacotherapy for ADHD, may exacerbate these sleep problems (Corkum et al, 2008;Galland et al, 2010;Ironside et al, 2010;Sangal et al, 2006;Schwartz et al, 2004). We show here that in healthy adult mice, methylphenidate alone can alter both sleep and circadian rhythmicity.…”

“…The change in phase angle is also consistent with findings from placebocontrolled and baseline-comparison human studies examining the effects of methylphenidate on various sleep and circadian markers. Longer sleep latency and decreased total sleep time were observed in people given methylphenidate (Boonstra et al, 2007;Corkum et al, 2008;Galland et al, 2010;Sangal et al, 2006;Schwartz et al, 2004). A phase delay in circadian locomotor rhythms has also been noted (Ironside et al, 2010).…”

“…While methylphenidate is quite effective at managing the inattention, impulsiveness, and hyperactivity associated with ADHD, it may not help the co-morbid sleep problems, and in fact methylphenidate may exacerbate these symptoms. In children, placebo-controlled studies have demonstrated that methylphenidate leads to longer sleep latency, lower sleep efficiency, decreased total sleep time (Corkum et al, 2008;Galland et al, 2010;Sangal et al, 2006;Schwartz et al, 2004), increased motor activity at sleep onset, decreased circadian amplitude, and phase delayed daily rhythms (Ironside et al, 2010). Many of these symptoms are consistent with either a phase delayed circadian clock or a circadian clock with a lengthened period.…”

ADHD and Sleep Problems in Children

“…Some have suggested that stimulant medication causes sleep disturbances in children and adolescents with ADHD. Some studies of stimulant medication have supported this, but others have shown no change or improvements in sleep in children and adolescents treated with psychostimulant medication, (Galland et al, 2010;Mick, 2000;Barkley et al, 1990;O'Brien, 2003;Kim, 2010;Giblin & Strobel, 2010).…”