ADHD has been reported to be associated with sleep problems in both children and adults, including prolonged sleep latency, early/middle insomnia, dyssomnia and parasomnia (Gau et al, 2007; Hvolby et al, 2009). This study aimed to assess the prevalence and severity of sleep disorders in an adult population with a diagnosis of ADHD, and to understand whether ADHD could be considered a predictor of the severity of sleep disturbances.
Participants aged ≥18 years were recruited from two outpatient services at the Brescia Spedali Civili Hospital in Italy between November 2015 and March 2017. Adults aged ≥70 years, or with a diagnosis of intellectual disability or a mental disorder related to a general medical condition were excluded from the study. A diagnosis of adult ADHD was confirmed if patients tested positive on both the Adult ADHD Self-Report Scale (ASRS*) and the Diagnostic Interview for ADHD in Adults (DIVA 2.0†). Patients who tested negative on the ASRS, or who tested positive on the ASRS but negative on the DIVA, were included in the ‘no adult ADHD’ group. Sleep quality was assessed through the Patient-Reported Outcome Measurement Information System (PROMIS‡). Between-group comparisons were assessed using Pearson’s χ2 test, and a stepwise linear regression model was also performed to account for socio-demographic and clinical characteristics when evaluating whether ADHD alone was a predictor of sleep disturbances.
A total of 634 adults (52.8% female; mean [standard deviation (SD)] age 47.2  years) participated in this study; of these, 44 (6.9%) participants were confirmed as having ADHD. Sleep disorders were found to be more prevalent (χ2 = 83.823; p<0.001) and more severe (p<0.001) in participants with adult ADHD than in those without adult ADHD.
- Among participants with ADHD, 15 (34.1%) reported no or slight sleep disturbances, and for those reporting sleep disorders, these were mild for 9/44 (20.5%) participants, moderate for 17/44 (38.6%) and severe for 3/44 (6.8%).
- By contrast, 505 (85.6%) participants without ADHD reported no or slight sleep disturbances, while 43/590 (7.3%) reported mild sleep disorder, 37/590 (6.3%) reported moderate sleep disorder, and 5/590 (0.8%) reported severe sleep disorder.
Among the socio-demographic and clinical variables included as potential predictors of severity of sleep disturbances in the multivariate linear regression analysis, a diagnosis of ADHD was found to be an individual predictor of worse sleep disturbances (adjusted R2=0.099; β=-316; p<0.001), along with a history of suicide attempts and the presence of psychiatric comorbidity.
There were some limitations to this study, including that data on participants’ medications were not included in the analysis, and therefore the potential effects of medications on sleep disturbances were not accounted for. Additionally, this study did not investigate whether there was a relationship between the severity of sleep disorders and the severity of ADHD symptoms, or ADHD subtype. Furthermore, due to the cross-sectional design of the study, a longitudinal observation was not included, which could have provided further insight on the prevalence and severity of sleep disorders in psychiatric outpatients.
The authors concluded that in this study, sleep disorders were more frequent and more severe in adults with ADHD compared with the psychiatric outpatient population without ADHD, suggesting that such disorders may be an intrinsic feature of adult ADHD itself, rather than a result of comorbid psychiatric disorders. The authors suggested that future studies could involve longitudinal observation of sleep disorders in adults with ADHD and evaluate the impact of different ADHD symptoms and treatments on sleep disorders.
Read more about sleep disorders in adults with ADHD here
*The ASRS is an 18-item self-report screening tool that measures the frequency of symptoms of adult ADHD according to Diagnostic and Statistical Manual of Mental Disorders – 4th Edition (DSM-IV) criteria, and provides a scoring system to aid diagnosis (Kessler et al, 2005)
†The DIVA 2.0 is a structured interview for diagnosing ADHD in adults, based on DSM-IV criteria (Kooij and Francken, 2010)
‡The PROMIS Adult Sleep Disturbance Scale V1.0 Short Form is an 8-item questionnaire used to assess the severity of sleep disorders
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Hvolby A, Jørgensen J, Bilenberg N. Parental rating of sleep in children with attention deficit/hyperactivity disorder. Eur Child Adolesc Psychiatry 2009; 18: 429-438.
Kessler RC, Adler L, Ames M, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS): a short screening scale for use in general population. Psychol Med 2005; 35: 245-256.
Kooij JJS, Francken MH. Diagnostic Interview for ADHD in Adults (DIVA). 2010. Available at: https://www.advancedassessments.co.uk/resources/ADHD-Screening-Test-Adult.pdf. Accessed March 2022.
Valsecchi P, Nibbio G, Rosa J, et al. Adult ADHD and sleep disorders: prevalence, severity and predictors of sleep disorders in a sample of Italian psychiatric outpatients. Psychiatry Res 2022; 310: 114447.