title: Excessive daytime sleepiness in adult patients with ADHD as measured by the Maintenance of Wakefulness Test, an electrophysiologic measure.
abstract: OBJECTIVE
  To quantify the objective level of sleepiness in adult attention-deficit/hyperactivity disorder (ADHD) patients and to determine the relationship between excessive daytime sleepiness and simulated driving performance.
  
  
  METHODS
  Forty adult ADHD patients (DSM-IV criteria) and 19 matched healthy control subjects were included between June 30, 2010, and June 19, 2013. All participants completed the Epworth Sleepiness Scale and the Manchester Driving Behavior Questionnaire. After nocturnal polysomnography, they performed 2 neuropsychological tests, a 4 × 40-minute Maintenance of Wakefulness Test, and a 1-hour driving session. The primary outcome measure was the mean sleep latency on the Maintenance of Wakefulness Test. ADHD patients were divided into 3 groups defined by their Maintenance of Wakefulness Test scores. Participants (patients and control subjects) were allocated as follows: sleepy ADHD (0-19 min), intermediate ADHD (20-33 min), alert ADHD (34-40 min), and control group (34-40 min). The driving performance outcome was the mean standard deviation of lateral position of the vehicle during the simulated session.
  
  
  RESULTS
  The group mean (SD) Epworth Sleepiness Scale score was higher in ADHD patients (12.1 [4.4]) than in controls (6.0 [2.7]) (P < .001). On the basis of the Maintenance of Wakefulness Test scores, 14 patients (35%) were in the sleepy group, 20 (50%) were in the intermediate group, and only 6 (15%) were in the alert group. Sleepy ADHD patients exhibited significantly deteriorated driving performance compared to the other 3 groups (P < .01).
  
  
  CONCLUSIONS
  Our study shows that a significant proportion of adult ADHD patients exhibit an objective excessive daytime sleepiness, which, in addition, has an impact on simulated driving performance. Excessive daytime sleepiness, therefore, may be a key element needed to better evaluate these ADHD patients.
  
  
  BACKGROUND
  ClinicalTrials.gov identifier: NCT01160874.
authors.affiliation: USR CNRS 3413 SANPSY, Pellegrin University Hospital, 13ème étage, Place Amélie Raba Léon, F-33076 Bordeaux Cedex, France stephaniebioulac@hotmail.com.
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Bioulac
authors.forename: Cyril
authors.initials: C
authors.lastname: Chaufton
authors.forename: Jacques
authors.initials: J
authors.lastname: Taillard
authors.forename: Astrid
authors.initials: A
authors.lastname: Claret
authors.forename: Patricia
authors.initials: P
authors.lastname: Sagaspe
authors.forename: Colette
authors.initials: C
authors.lastname: Fabrigoule
authors.forename: Manuel P
authors.initials: MP
authors.lastname: Bouvard
authors.forename: Pierre
authors.initials: P
authors.lastname: Philip
mesh_terms: D000328:Adult; D001289:Attention Deficit Disorder with Hyperactivity / Q000150:complications / Q000503:physiopathology*; D001334:Automobile Driving; D006970:Disorders of Excessive Somnolence / Q000209:etiology / Q000503:physiopathology*; D004569:Electroencephalography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017286:Polysomnography; D011597:Psychomotor Performance / Q000502:physiology*; D014851:Wakefulness / Q000502:physiology*; D055815:Young Adult