title: Relationship between polysomnographic sleep architecture and behavior in medication-free children with TS, ADHD, TS and ADHD, and controls.
abstract: OBJECTIVE
  To describe the relationship between sleep architecture and behavioral measures in unmedicated children and adolescents with Tourette syndrome (TS), attention-deficit hyperactivity disorder (ADHD), TS and comorbid ADHD (TS + ADHD), and healthy controls. The study also set out to examine differences in sleep architecture with each diagnosis.
  
  
  METHODS
  A cross-sectional, 2-night consecutive polysomnographic sleep study was conducted in 90 children. All participants were matched for age, gender, and level of intelligence.
  
  
  RESULTS
  Scores on the Child Behavior Checklist delinquency measure were modestly but significantly correlated with the number of movements during REM sleep (r = .36, p = .003). Significant correlations were also noted among the number of total arousals and arousals from slow wave sleep (SWS), and scores on the measures of conduct disorder, hyperactivity/immaturity, and restless/disorganized behaviors. There were a few significant differences in sleep architecture among the diagnostic groups. The ADHD-only group exhibited a significantly higher number of total arousals (p < .01) and arousals from SWS (p < .01) compared with the other three study groups.
  
  
  CONCLUSIONS
  Our findings indicate that children with TS and/or ADHD and who have more arousals from sleep are significantly more likely to have issues with conduct disorder, hyperactivity/immaturity, and restless/disorganized behavior. It was also noted that having ADHD, alone or comorbid with TS, is associated with a significantly greater number of movements during both non-REM and REM sleep. This study underscores the compelling need for the diagnosis and treatment of any sleep disorders in children with TS and/or ADHD so as to facilitate better management of problem behaviors.
authors.affiliation: *Youthdale Treatment Centres, Toronto, ON, Canada; †Department of Psychiatry, University of Toronto, Toronto, ON, Canada; ‡Youthdale Child and Adolescent Sleep Centre, Toronto, ON, Canada; §Tourette's Syndrome Clinic, Toronto Western Hospital, University Health Network, Toronto, ON, Canada; ‖Department of Psychiatry, Toronto Western Hospital, University Health Network, Toronto, ON, Canada.
authors.forename: Robyn J
authors.initials: RJ
authors.lastname: Stephens
authors.forename: Sharon A
authors.initials: SA
authors.lastname: Chung
authors.forename: Dragana
authors.initials: D
authors.lastname: Jovanovic
authors.forename: Randy
authors.initials: R
authors.lastname: Guerra
authors.forename: Brandon
authors.initials: B
authors.lastname: Stephens
authors.forename: Paul
authors.initials: P
authors.lastname: Sandor
authors.forename: Colin M
authors.initials: CM
authors.lastname: Shapiro
mesh_terms: D000293:Adolescent; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography / Q000295:instrumentation / Q000379:methods*; D012893:Sleep Wake Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*; D005879:Tourette Syndrome / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology*