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Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study.
J Clin Psychiatry. 2009 Nov; 70(11):1523-9.JC

Abstract

OBJECTIVE

To examine whether sleep impairment is associated with attention-deficit/hyperactivity disorder (ADHD) in adults.

METHOD

In a study conducted from 1998 to 2003, we identified sleep characteristics in a community sample of 182 cases of DSM-IV ADHD or ADHD not otherwise specified and 117 non-ADHD controls aged 18 to 55 years. Attention-deficit/hyperactivity disorder status, current and lifetime psychiatric comorbidity, and pharmacologic treatment of ADHD were identified with the Structured Clinical Interview for DSM-IV and with modules from the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Sleep problems were characterized by self-report. We separately accounted for the contribution of age at ADHD onset, ADHD pharmacotherapy, lifetime bipolar disorder, and the following lifetime and current comorbidities: depression, generalized anxiety, substance abuse, and multiple anxiety disorders.

RESULTS

Adults with ADHD went to bed later than control subjects and had a wider range of bedtimes (mean +/- SD = 18 +/- 92 min vs 54 +/- 69 min before midnight; P < .001), were more likely to take over an hour to fall asleep (OR = 5.22, P = .001), and were more likely (P < .003) to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning. Adults with ADHD experienced daytime sleepiness more often (OR = 2.23, P = .003) and reported more sleep problems (mean +/- SD = 6.7 +/- 2.5 vs 4.3 +/- 2.2; P < .001) than controls. All sleep impairments were significantly associated with ADHD independent of contributions to sleep disruption from ADHD pharmacotherapy, comorbidities likely to contribute to sleep disturbance, and age at ADHD onset.

CONCLUSION

Sleep disturbances that are not attributable to comorbid mental health conditions or ADHD pharmacotherapy are associated with ADHD in adulthood. Clinicians and researchers should consider the potential contribution of sleep disruption to the clinical presentation of adults with ADHD.

Authors+Show Affiliations

Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Cambridge, MA 02138, USA. csurman@partners.orgNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19646365

Citation

Surman, Craig B H., et al. "Association Between Attention-deficit/hyperactivity Disorder and Sleep Impairment in Adulthood: Evidence From a Large Controlled Study." The Journal of Clinical Psychiatry, vol. 70, no. 11, 2009, pp. 1523-9.
Surman CB, Adamson JJ, Petty C, et al. Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. J Clin Psychiatry. 2009;70(11):1523-9.
Surman, C. B., Adamson, J. J., Petty, C., Biederman, J., Kenealy, D. C., Levine, M., Mick, E., & Faraone, S. V. (2009). Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. The Journal of Clinical Psychiatry, 70(11), 1523-9. https://doi.org/10.4088/JCP.08m04514
Surman CB, et al. Association Between Attention-deficit/hyperactivity Disorder and Sleep Impairment in Adulthood: Evidence From a Large Controlled Study. J Clin Psychiatry. 2009;70(11):1523-9. PubMed PMID: 19646365.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study. AU - Surman,Craig B H, AU - Adamson,Joel J, AU - Petty,Carter, AU - Biederman,Joseph, AU - Kenealy,Deborah C, AU - Levine,Madeleine, AU - Mick,Eric, AU - Faraone,Stephen V, Y1 - 2009/07/28/ PY - 2008/06/13/received PY - 2008/11/04/accepted PY - 2009/8/4/entrez PY - 2009/8/4/pubmed PY - 2010/1/6/medline SP - 1523 EP - 9 JF - The Journal of clinical psychiatry JO - J Clin Psychiatry VL - 70 IS - 11 N2 - OBJECTIVE: To examine whether sleep impairment is associated with attention-deficit/hyperactivity disorder (ADHD) in adults. METHOD: In a study conducted from 1998 to 2003, we identified sleep characteristics in a community sample of 182 cases of DSM-IV ADHD or ADHD not otherwise specified and 117 non-ADHD controls aged 18 to 55 years. Attention-deficit/hyperactivity disorder status, current and lifetime psychiatric comorbidity, and pharmacologic treatment of ADHD were identified with the Structured Clinical Interview for DSM-IV and with modules from the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Epidemiologic Version. Sleep problems were characterized by self-report. We separately accounted for the contribution of age at ADHD onset, ADHD pharmacotherapy, lifetime bipolar disorder, and the following lifetime and current comorbidities: depression, generalized anxiety, substance abuse, and multiple anxiety disorders. RESULTS: Adults with ADHD went to bed later than control subjects and had a wider range of bedtimes (mean +/- SD = 18 +/- 92 min vs 54 +/- 69 min before midnight; P < .001), were more likely to take over an hour to fall asleep (OR = 5.22, P = .001), and were more likely (P < .003) to experience difficulty going to bed, going to sleep, sleeping restfully, or waking in the morning. Adults with ADHD experienced daytime sleepiness more often (OR = 2.23, P = .003) and reported more sleep problems (mean +/- SD = 6.7 +/- 2.5 vs 4.3 +/- 2.2; P < .001) than controls. All sleep impairments were significantly associated with ADHD independent of contributions to sleep disruption from ADHD pharmacotherapy, comorbidities likely to contribute to sleep disturbance, and age at ADHD onset. CONCLUSION: Sleep disturbances that are not attributable to comorbid mental health conditions or ADHD pharmacotherapy are associated with ADHD in adulthood. Clinicians and researchers should consider the potential contribution of sleep disruption to the clinical presentation of adults with ADHD. SN - 1555-2101 UR - https://www.unboundmedicine.com/medline/citation/19646365/Association_between_attention_deficit/hyperactivity_disorder_and_sleep_impairment_in_adulthood:_evidence_from_a_large_controlled_study_ L2 - http://www.psychiatrist.com/jcp/article/pages/2009/v70n11/v70n1106.aspx DB - PRIME DP - Unbound Medicine ER -