Effects of atomoxetine and methylphenidate on sleep in children with ADHD.
OBJECTIVE
This study compared the effects of atomoxetine and methylphenidate on the sleep of children with attention-deficit/hyperactivity disorder (ADHD). This study also compared the efficacy of these medications for treating ADHD in these children.


METHODS
Randomized, double-blind, crossover trial.


METHODS
Two sleep disorders centers in the United States; 1 in a private-practice setting and 1 in a hospital setting.


METHODS
85 children diagnosed with ADHD.


METHODS
Twice-daily atomoxetine and thrice-daily methylphenidate, each for approximately 7 weeks.


RESULTS
Relative to baseline, the actigraphy data indicated that methylphenidate increased sleep-onset latency significantly more than did atomoxetine (39.2 vs 12.1 minutes, p < .001). These results were consistent with the polysomnography data. Child diaries indicated that it was easier to get up in the morning, it took less time to fall asleep, and the children slept better with atomoxetine, compared with methylphenidate. Parents reported that it was less difficult getting their children up and getting them ready in the morning and that the children were less irritable, had less difficulty getting ready for bed, and had less difficulty falling asleep with atomoxetine, compared with methylphenidate. There were no significant differences between medications using the main measures of efficacy for ADHD treatment. Atomoxetine was superior on some secondary ADHD treatment-efficacy measures, based on parent reports. The only significant differences in treatment-emergent adverse events were greater incidence of decreased appetite and greater incidence of insomnia with methylphenidate.


CONCLUSIONS
Patients receiving twice-daily atomoxetine had shorter sleep-onset latencies, relative to thrice-daily methylphenidate, based on objective actigraphy and polysomnography data. Although both medications decreased nighttime awakenings, the decrease was greater for methylphenidate.
Sangal
R Bart
RB
Clinical Neurophysiology Services, PC, Troy, MI, USA.
Owens
Judith
J
Allen
Albert J
AJ
Sutton
Virginia
V
Schuh
Kory
K
Kelsey
Douglas
D
D000293:Adolescent; D018759:Adrenergic Uptake Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use*; D000069445:Atomoxetine Hydrochloride; D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy*; D000697:Central Nervous System Stimulants / Q000494:pharmacology* / Q000627:therapeutic use*; D002648:Child; D018592:Cross-Over Studies; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004594:Electrophysiology / Q000295:instrumentation; D005260:Female; D006801:Humans; D008297:Male; D008774:Methylphenidate / Q000494:pharmacology* / Q000627:therapeutic use*; D011437:Propylamines / Q000494:pharmacology* / Q000627:therapeutic use*; D012895:Sleep, REM / Q000187:drug effects*
D018759:Adrenergic Uptake Inhibitors; D000697:Central Nervous System Stimulants; D011437:Propylamines; D008774:Methylphenidate; D000069445:Atomoxetine Hydrochloride