CHICAGO—Sleep problems are common in children with psychiatric disorders, according to two studies by researchers at the University of Louisville. Further, children with attention-deficit/hyperactivity disorder (ADHD) and a comorbid psychiatric disorder are more prone to leg jerks and to sleep disturbances, the researchers found, while symptoms of daytime sleepiness were more prevalent among children with sleep-disordered breathing and those with a comorbid anxiety/ depression disorder. Both studies were reported at the 17th Annual Meeting of Associated Professional Sleep Societies.

SLEEP COMPLAINTS VARIED WITH PSYCHIATRIC DIAGNOSIS

In the first study, investigators compared parental records of sleep problems and polysomnographic findings in 151 children ages 3 to 12 who had been formally diagnosed with ADHD (45.7%), ADHD with other psychiatric comorbidities (19.8%), and anxiety or mood disorder (34.4%), as well as 39 children with sleep-disordered breathing but no psychiatric disorder, reported lead author V. Faye Jones, MD, of the Division of Pediatric Sleep Medicine at Kosair Children’s Hospital Research Institute at the University of Louisville. Eighty-five of the 151 children in the study groups and all of the 39 children with sleep-disordered breathing underwent overnight polysomnography.

The researchers found that “no statistically significant differences were identified between the study groups on any of the sleep architecture measures.” However, Periodic Limb Movement Index scores were significantly higher among children with ADHD, those with ADHD and comorbid psychiatric disorders, and those with anxiety or mood disorders, as compared to children with sleep-disordered breathing.

Additionally, presenting complaints of night wakings, sleep-disordered breathing, and somnolence were reported less often in the three psychiatric groups than in the sleep-disordered breathing group. Comparison between psychiatric groups found that such complaints were less frequent in parents of children with ADHD than in parents of children in the other two psychiatric groups. Reports of leg jerks were also more common in the comorbid psychiatric group than in the ADHD or anxiety/mood disorder groups, the researchers noted. Enlarged tonsils and symptoms of daytime sleepiness were more prevalent among children with sleep-disordered breathing and those with anxiety/depression.

PARENTAL COMPLAINTS

A second study, led by Anna Ivanenko, MD, PhD, used parental reports to examine sleep complaints and psychiatric symptomatology in a pediatric population. The parents of 174 children (mean age, 10.5) with ADHD, ADHD with psychiatric comorbidities (including mood and anxiety disorders), mood and anxiety disorders alone, and other psychiatric disorders completed a Behavior Assessment System for Children and a 47-item Childhood Sleep Questionnaire, Dr. Ivanenko explained.

By parental report, sleep problems “are highly prevalent among children with psychiatric disorders,” the researchers reported. In particular, nocturnal awakenings (82%), snoring (68%), restless sleep (78%), and leg jerks (74%) are more prevalent in children with ADHD and a comorbid anxiety/mood disorder than in children in the other comparison groups. Additionally, restless sleep, long sleep latency, short sleep duration, and frequent nocturnal awakenings were all “highly associated with the severity of psychiatric symptoms,” noted Dr. Ivanenko, who is also affiliated with the Division of Sleep Medicine at Kosair Children’s Hospital Research Institute.

Based on their findings, the researchers concluded that “additional objective assessments of sleep are needed to better understand the role of physiologic factors in the development of psychopathology in children and to rule out primary sleep disorders as the potential contributing factors to behavioral and emotional morbidity.”

—C. Justin Romano

Suggested Reading
Chervin RD, Archbold KH, Dillon JE, et al. Associations between symptoms of inattention, hyperactivity, restless legs, and periodic leg movements. Sleep. 2002;25:231-218.

Corkum P, Tannock R, Moldofsky H, et al. Actigraphy and parental ratings of sleep in children with attention-deficit/hyperactivity disorder (ADHD). Sleep. 2001;24:303-312.

Return to table of contents