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. 2024 Jun 15:121:117-126.
doi: 10.1016/j.sleep.2024.06.015. Online ahead of print.

Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis

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Sleep insufficiency and bedtime irregularity in children with ADHD: A population-based analysis

Talia Y Leman et al. Sleep Med. .

Abstract

Background: Sleep is impaired in children with attention-deficit/hyperactivity disorder (ADHD). However, population-based examination of indicators of sleep insufficiency and bedtime irregularity is limited. This investigation examined associations between ADHD, weeknight sleep insufficiency, and bedtime irregularity in a nationally-representative child sample, and indicators of these sleep outcomes in ADHD.

Methods: Parents of children aged 3-17 years with ADHD (n = 7671) were surveyed through the 2020-2021 National Survey of Children's Health. Inverse probability of treatment weighting generated a weighted matched control sample (n = 51,572). Weighted generalized linear models were performed without and with age-stratification to examine associations between ADHD and sleep, adjusting for sociodemographics in the full sample, and between nineteen sociodemographic and clinical variables and sleep in ADHD.

Results: Having ADHD was associated with increased odds of sleep insufficiency and bedtime irregularity relative to controls, even after adjusting for sociodemographic variables. In ADHD, older age was associated with lower sleep insufficiency and greater bedtime irregularity. Black race, increased poverty, higher ADHD severity, depression, and increased screen time were associated with greater sleep insufficiency and bedtime irregularity. Adverse childhood experiences (ACEs) were associated with greater sleep insufficiency. Behavioral/conduct problems, female sex, and absence of both ADHD medication use and ASD diagnosis were associated with poorer bedtime irregularity. Age-stratified results are reported in text.

Conclusions: Children with ADHD face heightened risk for insufficient sleep and irregular bedtimes. Findings suggest intervention targets (e.g., Black race, poverty, depression, screen time) to improve both sleep insufficiency and bedtime irregularity. Results highlight ACEs and behavioral/conduct problems as targets to improve sleep insufficiency and bedtime regularity, respectively. Age-stratified findings are discussed.

Keywords: Adolescents; African-american; Impulsivity; Oppositional defiant disorder.

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Conflict of interest statement

Declaration of competing interest EJR reports financial support was provided in part by the National Institute of Mental HealthK23MH113884. SKL reports financial support was provided in part by the National Institute of Mental HealthR01MH126041. EJR reports grants from the American Academy of Sleep Medicine, Brain and Behavior Research Foundation, and National Institute of Mental Health, relevant to the submitted work. She also reports speaking and lecture fees from Wink Sleep. SKL reports a grant from the National Institute of Mental Health relevant to the submitted work. TYL, SB, VSS, DSJ, KAK, and JMZ declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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