Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Procedure
2.3. Polysomnographic Recordings
2.4. Sleep Architecture
2.5. Sleep Stability Parameters
2.6. Cognitive Testing
2.7. Questionnaires
2.7.1. Child Behavior Checklist/4-18 (CBCL)
2.7.2. Children’s Sleep Habits Questionnaire (CSHQ)
2.8. Statistical Analysis
3. Results
3.1. Clinical Characteristics and Sleep Macroarchitecture
3.2. Sleep Stability
3.3. Association between Sleep Stability and Attention
4. Discussion
4.1. How the Present Results Fit into Existing Models of Sleep Instability in ADHD?
4.2. What Are the Potential Brain Networks Involved in Both Attention Functioning and Sleep Instability in ADHD?
4.2.1. Sleep Stage 1 to Micro-Arousal Oscillations
4.2.2. Oscillations between Sleep Stages 3 and 4
4.2.3. Oscillations between REM and NREM Sleep
4.3. What about the Brain Maturation Delay Hypothesis and Sleep Instability in ADHD?
4.4. Strengths and Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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HC | ADHD | Student-t p-Values | |
---|---|---|---|
Participants (n) | 15 | 12 | |
Age (years) | 10.7 ± 1.6 | 11.0 ± 1.2 | 0.620 |
Body mass index | 18.9 ± 5.6 | 16.7 ± 2.5 | 0.251 |
Intellectual Quotient | 111.5 ± 10.6 | 105.5 ± 15.0 | 0.233 |
CBCL | |||
Total score | 20.1 ± 15.3 | 50.3 ± 27.7 | 0.002 ** |
Anxiety/Depression score | 3.0 ± 3.4 | 7.2 ± 6.3 | 0.065 |
Attention score | 2.0 ± 1.8 | 9.9 ± 4.2 | 0.000 ** |
CPT-II | |||
Omissions | 47.3 ± 6.4 | 67.4 ± 50.3 | 0.183 |
Commissions | 49.7 ± 12.5 | 57.8 ± 5.2 | 0.061 |
Hit Reaction time | 47.9 ± 13.0 | 51.8 ± 25.7 | 0.810 |
CSHQ | |||
Total score | 37.1 ± 0.8 | 43.1 ± 0.9 | 0.002 ** |
Daytime sleepiness | 10.9 ± 2.2 | 12.1 ± 2.6 | 0.307 |
Number of children with significant sleepiness | 0 | 1 | n.a. |
HC (n = 15) | ADHD (n = 12) | Student-t p-Values | |
---|---|---|---|
Sleep Latency (min) | 15.8 ± 15.4 | 13.1 ± 11.9 | 0.517 |
TST (min) | 564.5 ± 77.2 | 541.0 ± 60.8 | 0.398 |
Sleep Efficiency (%) | 97.4 ± 2.5 | 97.4 ± 2.0 | 0.718 |
Stage 1 (%) | 3.8 ± 1.2 | 3.2 ± 1.5 | 0.241 |
Stage 2 (%) | 50.8 ± 4.3 | 52.1 ± 5.3 | 0.502 |
Stage 3 (%) | 8.8 ± 2.9 | 9.7 ± 3.0 | 0.422 |
Stage 4 (%) | 16.0 ± 4.1 | 13.7 ± 4.6 | 0.091 |
REM sleep (%) | 20.5 ± 3.9 | 21.9 ± 3.9 | 0.364 |
REM sleep latency (min) | 101.5 ± 43.1 | 81.1 ± 52.3 | 0.277 |
REM sleep duration | 132.8 ± 30.2 | 135.4 ± 30.2 | 0.820 |
REM sleep efficiency (%) | 87.7 ± 6.8 | 88.0 ± 4.9 | 0.909 |
Mean SpO2 (%) | 99.3 ± 0.5 | 99.1 ± 0.6 | 0.554 |
Minimum SpO2 (%) | 81.6 ± 9.3 | 85.0 ± 5.1 | 0.309 |
Time with SpO2 < 90% (min) | 0.96 ± 1.2 | 0.51 ± 0.74 | 0.119 |
Apnea-Hypopnea Index (no/h) | 2.8 ± 1.7 | 3.1 ± 1.4 | 0.584 |
Periodic leg movement index (no/h) | 8.7 ± 5.0 | 10.4 ± 8.0 | 0.501 |
HC (n = 15) | ADHD (n = 12) | Student-t p-Values | |
---|---|---|---|
Awakenings | |||
Number | 15.7 ± 7.0 | 15.4 ± 9.9 | 0.939 |
Minutes | 14.3 ± 12.3 | 14.6 ± 12.8 | 0.884 |
Microarousal index (no/h) | |||
Total | 4.6 ± 2.0 | 5.3 ± 2.0 | 0.333 |
Stage 1 | 12.9 ± 8.0 | 25.4 ± 19.5 | 0.034 * |
Stage 2 | 5.9 ± 2.9 | 6.5 ± 2.6 | 0.594 |
Stage 3 | 6.9 ± 4.3 | 4.8 ± 3.1 | 0.159 |
Stage 4 | 1.5 ± 1.5 | 1.8 ± 2.0 | 0.668 |
REM sleep | 1.2 ± 1.5 | 2.1 ± 1.9 | 0.191 |
Transitions towards deeper sleep stages | |||
Wake to Stage 1 | 16.7 ± 6.0 | 16.5 ± 9.4 | 0.938 |
Wake to Stage 2 | 0.7 ± 1.5 | 0.8 ± 1.2 | 0.665 |
Stage 1 to Stage 2 | 15.2 ± 6.7 | 14.1 ± 5.9 | 0.653 |
Stage 1 to Stage 3 | 0.1 ± 0.4 | 0.0 ± 0.0 | 0.203 |
Stage 2 to Stage 3 | 52.7 ± 31.9 | 43.7 ± 13.3 | 0.599 |
Stage 2 to Stage 4 | 1.1 ± 1.1 | 0.4 ± 0.5 | 0.04 * |
Stage 3 to Stage 4 | 20.5 ± 7.3 | 29.3 ± 13.2 | 0.064 |
Transitions to lighter sleep stages | |||
Stage 1 to Wake | 5.9 ± 3.4 | 6.3 ± 4.5 | 0.937 |
Stage 2 to Wake | 8.7 ± 5.5 | 8.0 ± 5.2 | 0.683 |
Stage 2 to Stage 1 | 2.9 ± 2.3 | 2.9 ± 2.6 | 0.986 |
Stage 3 to Awake | 0.5 ± 0.6 | 0.2 ± 0.4 | 0.179 |
Stage 3 to Stage 2 | 51.1 ± 31.5 | 42.8 ± 13.4 | 0.652 |
Stage 4 to Stage 2 | 2.1 ± 1.8 | 0.9 ± 0.8 | 0.046 * |
Stage 4 to Stage 3 | 19.6 ± 6.7 | 28.7 ± 13.2 | 0.048 * |
REM Sleep Transitions | |||
Stage 1 to REM sleep | 11.4 ± 6.5 | 9.0 ± 4.4 | 0.268 |
Stage 2 to REM sleep | 9.9 ± 2.7 | 13.1 ± 5.0 | 0.044 * |
Stage 3 to REM sleep | 0.3 ± 0.6 | 0.3 ± 0.5 | 0.699 |
Stage 4 to REM sleep | 0.0 ± 0.0 | 0.01 ± 0.3 | 0.272 |
REM sleep to Wake | 2.4 ± 1.8 | 2.9 ± 3.1 | 0.591 |
REM sleep to Stage 1 | 12.9 ± 6.3 | 9.8 ± 5.4 | 0.191 |
REM sleep to Stage 2 | 6.3 ± 2.8 | 9.5 ± 5.0 | 0.047 * |
REM sleep to Stage 3 | 0.0 ± 0.0 | 0.1 ± 0.3 | 0.272 |
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Gagnon, K.; Labrosse, M.; Gingras, M.-A.; Godbout, R. Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder. Brain Sci. 2021, 11, 1425. https://doi.org/10.3390/brainsci11111425
Gagnon K, Labrosse M, Gingras M-A, Godbout R. Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder. Brain Sciences. 2021; 11(11):1425. https://doi.org/10.3390/brainsci11111425
Chicago/Turabian StyleGagnon, Katia, Mélanie Labrosse, Marc-André Gingras, and Roger Godbout. 2021. "Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder" Brain Sciences 11, no. 11: 1425. https://doi.org/10.3390/brainsci11111425
APA StyleGagnon, K., Labrosse, M., Gingras, M.-A., & Godbout, R. (2021). Sleep Instability Correlates with Attentional Impairment in Boys with Attention Deficit Hyperactivity Disorder. Brain Sciences, 11(11), 1425. https://doi.org/10.3390/brainsci11111425