Variable sleep schedules and outcomes in children with psychopathological problems: preliminary observations

Abstract

BackgroundNight-to-night variability in sleep of children with attention deficit hyperactivity disorder (ADHD) may be a mediator of behavioral phenotype. We examined the potential association between alertness, sleep, and eating behaviors in children with ADHD and comorbid problems.MethodsSleep was monitored by actigraphy for 7 days. Questionnaires were used to assess sleep complaints, habits and food patterns by parental report, and sleep complaints and sleepiness by child report.ResultsThe group comprised 18 children, including 15 boys, aged 9.4 ± 1.7 years, 88.9% Caucasian, who took one or multiple medications. Children slept on average for 6 hours and 58 minutes with a variability of 1 hour 3 minutes relative to the mean, and their sleepiness scores were highly variable from day to day. Most children had a normal body mass index (BMI). Sleepiness and BMI were associated with sleep schedules and food patterns, such that they accounted for 76% of variance, predominantly by the association of BMI with mean wake after sleep onset and by bedtime sleepiness, with wake after sleep onset variability. Similarly, 97% of variance was shared with eating behaviors, such as desserts and snacks, and fast food meals were associated with morning sleepiness.ConclusionDisrupted sleep and sleepiness appears to favor unhealthy food patterns and may place children with ADHD at increased risk for obesity.

Intraindividual variability of sleep/wake patterns in relation to child and adolescent functioning: A systematic review

“…Separate studies indicate that duration IIV is approximately 1 hour in school-aged children [30,31] and approximately 1.5 hours in adolescence [32,33]. …”

“…No relation was found between sleep IIV with BMI in three studies conducted with school-aged children [31,45,56]. In contrast, in a community sample of adolescents greater duration IIV was significantly associated with higher BMI, and this association remained significant when controlling for a range of other variables associated with BMI [40].…”

Less Efficient Neural Processing Related to Irregular Sleep and Less Sustained Attention in Toddlers

“…Durmer & Dinges, 2005; Lim & Dinges, 2008) and older children (e.g Chervin, Bassetti, Ganoczy, & Pituch, 1997; Fallone, Acebo, Arnedt, Seifer, & Carskadon, 2001; Gruber et al, 2011), as well as differences in the ERPs thought to reflect attention processes including the MMN, the novelty P3, and the P3 elicited during active oddball tasks (Gumenyuk et al, 2011; Trujillo et al, 2009), the findings from this study provide evidence that these associations may be present in very early childhood. Irregular sleep from night to night has been shown to be a distinguishing feature of the sleep patterns of children with ADHD (Spruyt, Raubuck, Grogan, Gozal, & Stein, 2012), suggesting that this particular aspect of sleep may be especially related to attentional capacities. The association between target P3 latencies and irregular sleep, in conjunction with the finding that longer P3 latencies are associated with poorer ability to sustain attention, suggests a potential candidate process by which sleep difficulties affect attentional abilities.…”

ADHD Treatments, Sleep, and Sleep Problems: Complex Associations

“…Sleep problems are also common in children treated with psychosocial treatments. A recent study of children attending a summer treatment program and receiving comprehensive behavioral therapy, parent training, and medication management demonstrated 61 % reported sleep onset difficulties, short duration of sleep was evident (i.e., mean sleep time of 6 hours, 58 minutes), and considerable night-to-night variability was displayed [9]. Thus, sleep problems are common in both untreated and pharmacologically and behaviorally treated children with ADHD.…”