Delayed Circadian Rhythm in Adults with Attention-Deficit/Hyperactivity Disorder and Chronic Sleep-Onset Insomnia

• Published in: Biological psychiatry (1969) 2010-06, Vol.67 (11), p.1091-1096
• Main Authors: Van Veen, Maaike M, Kooij, J.J. Sandra, Boonstra, A. Marije, Gordijn, Marijke C.M, Van Someren, Eus J.W
• Format: Article
• Language: English
• Subjects: Actigraphy; Adolescent; Adult; Attention Deficit Disorder with Hyperactivity - complications; Attention Deficit Disorder with Hyperactivity - physiopathology; Attention deficit disorders. Hyperactivity; attention-deficit/hyperactivity disorder; Biological and medical sciences; Chi-Square Distribution; Child clinical studies; circadian rhythm; Circadian Rhythm - physiology; Disorders of higher nervous function. Focal brain diseases. Central vestibular syndrome and deafness. Brain stem syndromes; Humans; insomnia; Medical sciences; melatonin; Melatonin - analysis; Middle Aged; Nervous system (semeiology, syndromes); Neurology; Psychiatry; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Saliva - chemistry; sleep; Sleep - physiology; Sleep Initiation and Maintenance Disorders - complications; Sleep Initiation and Maintenance Disorders - physiopathology; Surveys and Questionnaires
• ISSN: 0006-3223; 1873-2402
• DOI: 10.1016/j.biopsych.2009.12.032

Background Previous studies suggest circadian rhythm disturbances in children with attention-deficit/hyperactivity disorder (ADHD) and sleep-onset insomnia (SOI). We investigate here sleep and rhythms in activity and melatonin in adults with ADHD. Methods Sleep logs and actigraphy data were collected during 1 week in 40 adults with ADHD, of whom 31 reported SOI. Salivary melatonin levels were assessed during 1 night. Sleep measures, circadian activity variables, and dim light melatonin onset were compared between groups of ADHD adults with and without SOI and with matched healthy control subjects. Results Compared with control subjects, both groups of ADHD adults had longer sleep-onset latency and lower sleep efficiency. Adults with ADHD and SOI showed a delayed start and end of their sleep period and a delayed melatonin onset compared with adults with ADHD without SOI ( p = .006; p = .023; p = .02) and compared with healthy control subjects ( p = .014; p = .019; p = .000). Adults with ADHD and SOI also showed an attenuated 24-hour amplitude in their rest-activity pattern, in contrast to those without SOI, who showed a higher day-to-day stability. Conclusions These findings demonstrate diurnal rhythm deviations during everyday life in the majority of adults with ADHD that have SOI and suggest that potential benefits of rhythm-improving measures should be evaluated.