Association between attention-deficit/hyperactivity disorder and sleep impairment in adulthood: evidence from a large controlled study.
OBJECTIVE
To examine whether sleep impairment is associated with attention-deficit/hyperactivity disorder (ADHD) in adults.


METHODS
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.


CONCLUSIONS
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.
Surman
Craig B H
CB
Clinical and Research Program in Pediatric Psychopharmacology and Adult ADHD, Massachusetts General Hospital, Cambridge, MA 02138, USA. csurman@partners.org
Adamson
Joel J
JJ
Petty
Carter
C
Biederman
Joseph
J
Kenealy
Deborah C
DC
Levine
Madeleine
M
Mick
Eric
E
Faraone
Stephen V
SV
D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology*; D015897:Comorbidity; D039721:Diagnostic and Statistical Manual of Mental Disorders; D004325:Dreams / Q000187:drug effects / Q000523:psychology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology; D008774:Methylphenidate / Q000009:adverse effects / Q000627:therapeutic use; D008875:Middle Aged; D011569:Psychiatric Status Rating Scales; D012893:Sleep Wake Disorders / Q000139:chemically induced / Q000175:diagnosis* / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013624:Taiwan / Q000453:epidemiology
D008774:Methylphenidate