Skip to main navigation menu Skip to main content Skip to site footer
Brazilian Journal of Clinical Medicine and Review

Health Review

Vol. 3 No. 1 (2025): January/December - 2025

Attention-Deficit Hyperactivity Disorder (ADHD) and Sleep Disorders: What We Know Now and Where We are Headed

DOI
https://doi.org/10.52600/2965-0968.bjcmr.2025.3.1.bjcmr25
Submitted
November 24, 2024
Published
2025-01-05

Abstract

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder observed in children and adolescents, the manifestations of which affect personal, social and academic performance. The aim of this paper is to explore the relationship between sleep disorders and ADHD symptoms, highlighting the importance of investigating the bidirectional relationship between these two conditions for the management of patients with this neurodevelopmental disorder and its comorbidities. This narrative review synthesizes the current literature to elucidate the interaction between sleep and ADHD, exploring the bidirectional communication between sleep and the comorbid symptoms of ADHD. In addition, it discussed how independent drug therapy can lead to sleep problems, showing how interaction with non-drug therapy is essential for the treatment of ADHD and sleep disorders, improving patient prognosis. Some recent research has revealed a possible link between ADHD and sleep disorders, and how they have a bidirectional relationship with each other, potentially affecting the quality of life and mental health of the individual with these disorders. As we delve deeper into the bidirectional relationship between the disorders, this review provides a comprehensive overview of current knowledge and possible implications for the diagnosis, treatment and approach of ADHD when associated with sleep disorders. Addressing the comorbid conditions of ADHD, such as sleep disorders, is fundamental as a coping strategy for the treatment of this neurodevelopmental condition, which involves both non-pharmacological and pharmacological interventions.

References

  1. Martins R, Scalco JC, Ferrari Junior GJ, Gerente JGDS, Costa MDL, Beltrame TS. Sleep disturbance in children with atten-tion-deficit hyperactivity disorder: A systematic review. Sleep Sci. 2019;12(4):295–301. doi:10.5935/1984-0063.20190088
  2. Chen SC, Cheng HL, Wang DD, Wang S, Yin YH, Suen LK, et al. Experience of parents in delivering pediatric tuina to children with symptoms of attention deficit hyperactivity disorder during the COVID-19 pandemic: qualitative findings from focus group interviews. BMC Complement Med Ther. 2023;23(1):53. doi:10.1186/s12906-023-03891-3
  3. Lecendreux M, Lavault S, Lopez R, Inocente CO, Konofal E, Cortese S, et al. Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms in Pediatric Narcolepsy: A Cross-Sectional Study. Sleep. 2015;38(8):1285–95. doi:10.5665/sleep.4910
  4. Arias-Mera C, Paillama-Raimán D, Lucero-González N, Leiva-Bianchi M, Avello-Sáez D. Relation between sleep disorders and attention deficit disorder with hyperactivity in children and adolescents: A systematic review. Res Dev Disabil. 2023;137:104500. doi:10.1016/j.ridd.2023.104500
  5. Rocha NS, Correa RDESA, Dias ACM, Bueno CDF. Association between sleep pattern and pharmacological treatment in children with attention deficit disorder with hyperactivity: a systematic review. Rev Paul Pediatr. 2023;41:e2022065. doi:10.1590/1984-0462/2023/41/2022065
  6. Souto-Souza D, Mourão PS, Barroso HH, Douglas-de-Oliveira DW, Ramos-Jorge ML, Falci SGM, et al. Is there an association between attention deficit hyperactivity disorder in children and adolescents and the occurrence of bruxism? A systematic review and meta-analysis. Sleep Med Rev. 2020;53:101330. doi:10.1016/j.smrv.2020.101330
  7. Keuppens L, Marten F, Baeyens D, Boyer B, Danckaerts M, van der Oord S. Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial. BMJ Open. 2023;13(4):e065355. doi:10.1136/bmjopen-2022-065355
  8. Sciberras E, Efron D, Patel P, Mulraney M, Lee KJ, Mihalopoulos C, et al. Does the treatment of anxiety in children with Attention-Deficit/Hyperactivity Disorder (ADHD) using cognitive behavioral therapy improve child and family outcomes? Protocol for a randomized controlled trial. BMC Psychiatry. 2019;19(1):359. doi:10.1186/s12888-019-2276-3
  9. Sciberras E, Hiscock H, Cortese S, Becker SP, Fernando JW, Mulraney M. Variation in sleep profiles in children with ADHD and associated clinical characteristics. J Child Psychol Psychiatry. 2023;64(10):1462–9. doi:10.1111/jcpp.13835
  10. Becker SP, Cusick CN, Sidol CA, Epstein JN, Tamm L. The impact of comorbid mental health symptoms and sex on sleep functioning in children with ADHD. Eur Child Adolesc Psychiatry. 2018;27(3):353–65. doi:10.1007/s00787-017-1055-2
  11. Loram G, Ling M, Silk T, Sciberras E. Associations Between ADHD, Sleep Problems, and Mental Health Symptoms in Ado-lescents. J Atten Disord. 2023;27(6):635–42. doi:10.1177/10870547231155871
  12. Moreau V, Rouleau N, Morin CM. Sleep of children with attention deficit hyperactivity disorder: actigraphic and parental reports. Behav Sleep Med. 2014;12(1):69–83. doi:10.1080/15402002.2013.764526
  13. Lycett K, Mensah FK, Hiscock H, Sciberras E. A prospective study of sleep problems in children with ADHD. Sleep Med. 2014;15(11):1354–61. doi:10.1016/j.sleep.2014.06.004
  14. Yıldız Miniksar D, Özdemir M. Sleep quality in children and adolescents with attention-deficit and hyperactivity disorder. Arch Pediatr. 2021;28(8):668–76. doi:10.1016/j.arcped.2021.09.017
  15. Mulas F, Rojas M, Gandía R. Sueño en los trastornos del neurodesarrollo, déficit de atención e hiperactividad y en el espectro autista. Medicina. 2019;79 Suppl 3:33–6.
  16. Miano S, Amato N, Foderaro G, Pezzoli V, Ramelli GP, Toffolet L, et al. Sleep phenotypes in attention deficit hyperactivity disorder. Sleep Med. 2019;60:123–31. doi:10.1016/j.sleep.2018.08.026
  17. Urbano GL, Tablizo BJ, Moufarrej Y, Tablizo MA, Chen ML, Witmans M. The Link between Pediatric Obstructive Sleep Apnea (OSA) and Attention Deficit Hyperactivity Disorder (ADHD). Children (Basel). 2021;8(9):824. doi:10.3390/children8090824
  18. Precenzano F, Ruberto M, Parisi L, Salerno M, Maltese A, D’alessandro I, et al. Sintomas semelhantes aos do TDAH em crianças afetadas pela síndrome da apneia obstrutiva do sono: um estudo de caso-controle. Acta Med Mediterr. 2016;32:1756–9. doi:10.19193/0393-6384_2016_6_159
  19. Craig SG, Weiss MD, Hudec KL, Gibbins C. The Functional Impact of Sleep Disorders in Children With ADHD. J Atten Disord. 2020;24(4):499–508. doi:10.1177/1087054716685840
  20. Sierra Montoya AC, Mesa Restrepo SC, Cuartas Arias JM, Cornejo Ochoa W. Prevalence and Clinical Characteristics of the Restless Legs Syndrome (RLS) in Patients Diagnosed with Attention-Deficit Hyperactivity Disorder (ADHD) in Antioquia. Int J Psychol Res. 2018;11(1):58–69. doi:10.21500/20112084.3381
  21. Kwon S, Sohn Y, Jeong SH, Chung US, Seo H. Prevalence of restless legs syndrome and sleep problems in Korean children and adolescents with attention deficit hyperactivity disorder: a single institution study. Korean J Pediatr. 2014;57(7):317–22. doi:10.3345/kjp.2014.57.7.317
  22. Takahashi N, Nishimura T, Harada T, Okumura A, Choi D, Iwabuchi T, et al. Polygenic risk score analysis revealed shared genetic background in attention deficit hyperactivity disorder and narcolepsy. Transl Psychiatry. 2020;10(1):284. doi:10.1038/s41398-020-00971-7
  23. Wilenius L, Partinen M. Attention-Deficit/Hyperactivity Disorder Patients May Have Undiagnosed Narcolepsy. Cureus. 2020;12(6):e8436. doi:10.7759/cureus.8436
  24. Saulue P, Carra MC, Laluque JF, d’Incau E. Understanding bruxism in children and adolescents. Int Orthod. 2015;13(4):489–506. doi:10.1016/j.ortho.2015.09.001
  25. Wynchank D, Bijlenga D, Beekman AT, Kooij JJS, Penninx BW. Adult Attention-Deficit/Hyperactivity Disorder (ADHD) and Insomnia: an Update of the Literature. Curr Psychiatry Rep. 2017;19(12):98. doi:10.1007/s11920-017-0860-0
  26. Ren J, Zhao X, Su C, Li X, Zhou J. ADHD in narcolepsy: A closer look at prevalence and ties. Neurosci Biobehav Rev. 2024;156:105471. doi:10.1016/j.neubiorev.2023.105471
  27. Alessandri-Bonetti A, Guglielmi F, Deledda G, Sangalli L, Brogna C, Gallenzi P. Malocclusions, Sleep Bruxism, and Obstructive Sleep Apnea Risk in Pediatric ADHD Patients: A Prospective Study. J Atten Disord. 2024;28(6):1017–23. doi:10.1177/10870547231226139
  28. Sciberras E, Mulraney M, Heussler H, Rinehart N, Schuster T, Gold L, et al. Does a brief, behavioural intervention, delivered by paediatricians or psychologists improve sleep problems for children with ADHD? Protocol for a cluster-randomised, trans-lational trial. BMJ Open. 2017;7(4):e014158. doi:10.1136/bmjopen-2016-014158
  29. Hiscock H, Sciberras E, Mensah F, Gerner B, Efron D, Khano S, et al. Impact of a behavioural sleep intervention on symptoms and sleep in children with attention deficit hyperactivity disorder, and parental mental health: randomised controlled trial. BMJ. 2015;350:h68. doi:10.1136/bmj.h68
  30. Rzepka-Migut B, Paprocka J. Efficacy and Safety of Melatonin Treatment in Children with Autism Spectrum Disorder and Attention-Deficit/Hyperactivity Disorder-A Review of the Literature. Brain Sci. 2020;10(4):219. doi:10.3390/brainsci10040219
  31. Moon E, Kim K, Partonen T, Linnaranta O. Role of Melatonin in the Management of Sleep and Circadian Disorders in the Context of Psychiatric Illness. Curr Psychiatry Rep. 2022;24(11):623–34. doi:10.1007/s11920-022-01369-6
  32. Yuge K, Nagamitsu S, Ishikawa Y, Hamada I, Takahashi H, Sugioka H, et al. Long-term melatonin treatment for the sleep problems and aberrant behaviors of children with neurodevelopmental disorders. BMC Psychiatry. 2020;20(1):445. doi:10.1186/s12888-020-02847-y
  33. Lopez PL, Torrente FM, Ciapponi A, Lischinsky AG, Cetkovich-Bakmas M, Rojas JI, et al. Cognitive-behavioural interventions for attention deficit hyperactivity disorder (ADHD) in adults. Cochrane Database Syst Rev. 2018;3(3):CD010840. doi:10.1002/14651858.CD010840.pub2
  34. Dittner AJ, Hodsoll J, Rimes KA, Russell AJ, Chalder T. Cognitive-behavioural therapy for adult attention-deficit hyperac-tivity disorder: a proof of concept randomised controlled trial. Acta Psychiatr Scand. 2018;137(2):125–37. doi:10.1111/acps.12836
  35. Stein MA, Zulauf-McCurdy C, DelRosso LM. Attention Deficit Hyperactivity Disorder Medications and Sleep. Child Adolesc Psychiatr Clin N Am. 2022;31(3):499–514. doi:10.1016/j.chc.2022.03.006
  36. Briars L, Todd T. A Review of Pharmacological Management of Attention-Deficit/Hyperactivity Disorder. J Pediatr Pharmacol Ther. 2016;21(3):192–206. doi:10.5863/1551-6776-21.3.192
  37. Honorio Neto F, Camargo AP, Polanczyk G, Adamis D, McNicholas F. A mixed methods study of clinician reported challenges in the assessment of ADHD and treatment decisions for children with ADHD in Brazil. Clin Child Psychol Psychiatry. 2021;26(2):505–17. doi:10.1177/1359104521994634
  38. Becker SP. ADHD and sleep: recent advances and future directions. Curr Opin Psychol. 2020;34:50–6. doi:10.1016/j.copsyc.2019.09.006
  39. Hvolby A. Associations of sleep disturbance with ADHD: implications for treatment. Atten Defic Hyperact Disord. 2015;7(1):1–18. doi:10.1007/s12402-014-0151-0
  40. Martin CA, Hiscock H, Rinehart N, Heussler HS, Hyde C, Fuller-Tyszkiewicz M, et al. Associations Between Sleep Hygiene and Sleep Problems in Adolescents With ADHD: A Cross-Sectional Study. J Atten Disord. 2020;24(4):545–54. doi:10.1177/1087054718762513
  41. Gupta CC, Sprajcer M, Johnston-Devin C, Ferguson SA. Sleep hygiene strategies for individuals with chronic pain: a scoping review. BMJ Open. 2023;13(2):e060401. doi:10.1136/bmjopen-2021-060401
  42. Morash-Conway J, Gendron M, Corkum P. The role of sleep quality and quantity in moderating the effectiveness of medi-cation in the treatment of children with ADHD. Atten Defic Hyperact Disord. 2017;9(1):31–8. doi:10.1007/s12402-016-0204-7
  43. Grünwald J, Schlarb AA. Relationship between subtypes and symptoms of ADHD, insomnia, and nightmares in connection with quality of life in children. Neuropsychiatr Dis Treat. 2017;13:2341–50. doi:10.2147/NDT.S118076

Most read articles by the same author(s)

1 2 > >>