Poor sleep quality and increased sleepiness associated with ADHD children can be due to either periodic leg movements of sleep or sleep-disordered breathing.68,69

Habitual snoring is more common in ADHD children (33%) compared with 11% in a psychiatry clinic and 9% in a general clinical trial pediatric clinic.70 Another cross-sectional study of 45 ADHD children reported that only the HI subtype of ADHD Inhibitors,research,lifescience,medical correlated with chronic snoring.71 In a cross-sectional survey of 866 children aged 2.0 to 13.9 years (mean 6.8±3.2 years), the OR between HI>60 and a 1-SD Increase In the overall sleep disordered breathing score was 1.7.68,69 In two other studies, sleep-disordered breathing occurred In 50% (17/34) to 76% (67/88) of ADHD children, and periodic limb movements of sleep were reported In 10% (9/88) to 15% (5/34).72,73 Polysomnographic recordings of ADHD children compared with normal controls demonstrate an Increase In the percentage of phase 3 of sleep.74 Epileptic paroxysms have Inhibitors,research,lifescience,medical also been reported In 16.7% of ADHD children.74

In addition to behavioral measures, medications have been utilized in ADHD; like other psychotropic medications, these can also affect sleep. Sleep effects of medications and substances of abuse Sleep architecture can be affected by acute or chronic Ingestion of medications or substances of abuse, as well as by abrupt withdrawal of these agents. Antidepressant drugs consist of tricyclic antidepressants Inhibitors,research,lifescience,medical (TCAs), selective serotonin reuptake Inhibitors (SSRIs), monoamine oxidase inhibitors (MAOIs), and noradrenaline reuptake Inhibitors (NARIs). Acute Intake of TCAs, except trimIpramine, decreases WASO, Increases stage 2 nrem Inhibitors,research,lifescience,medical sleep, increases delta sleep, and reduces REM sleep with varying

degrees of residual daytime sedation. During withdrawal, WASO Is Increased and REM sleep rebound occurs. Trimlpramine Ingestion Increases SWS, but has no effect on REM sleep. MAOIs, such as moclobemide, phenelzine, and trancylpromine, Increase sleep continuity, Increase REM sleep latency, and reduce REM sleep amount, Inhibitors,research,lifescience,medical but do not affect SWS. However, moclobemide can result in Insomnia.75,76 Acute ingestion of SSRIs may cause insomnia or hypersomnia. WASO may be normal or Increased, but SWS Is not affected. REM latency Is Increased and REM sleep Is reduced. SSRI agents, such as fluoxetine, sertraline, and paroxetine, may Induce sleep bruxism, which may improve with buspirone.75,77-79 Acute Ingestion of trazodone decreases WASO, Increases before or has no effect on SWS, and decreases or has no effect on REM sleep. Buproprion reduces REM latency, Increases REM sleep, and normalizes a propensity for sleep-onset REM periods on multiple sleep latency testing.75 MIrtazapine Increases SWS, but does not affect stage 2 NREM sleep, nor does It affect REM latency or REM percentage of total sleep. NARIs Increase the duration of stage 2 NREM sleep, lengthen REM latency, and shorten REM sleep.