Here is a article about sleep. Because it has been a topic at many meetings I wanted to get it out to you all.

Medscape.com
June 14, 2010

Sleepiness Correlates With ADHD-Like Symptoms Across All Age Groups

Jim Kling

(San Antonio, Texas) – A new study shows that sleep problems in children correlate strongly with symptoms that mimic those of attention-deficit/hyperactivity disorder (ADHD). The findings were presented here SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting by Timothy Hoban, MD, clinical professor of pediatrics and neurology at the University of Michigan in Ann Arbor. Previous studies have shown an association between ADHD symptoms and sleep-related breathing disorders (SRBDs), restless leg syndrome (RLS), and periodic limb movements during sleep (PLMS). The researchers set out to determine whether these relationships are maintained across different age groups. Specifically, they sought to link parent reports of ADHD symptoms with daytime sleepiness and physical sleep disruptors in children and adolescents.

Study participants were selected from children referred to a sleep clinic. The researchers instructed parents to complete the Pediatric Sleep Questionnaire (PSQ). They then calculated an ADHD score using the sum of 6 questions on the PSQ that were derived from the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition). The researchers computed an overall SRBD score minus the ADHD items (SRDB-16), as well as validated subscales for sleepiness, RLS/PLMS, and sleep and breathing (SB).

Dr. Horgan and colleagues looked for correlations between ADHD score and subscales in 3 age groups: 3 to 6 years (n = 94), 6 to 12 years (n = 152), and 12 to 18 years (n = 118).

In each age group, ADHD correlated with sleepiness (r = 0.35, P < .002; r = 0.19, P < .03; r = 0.17, P < .07, respectively).

Sleepiness (at least 2 of 4 symptoms) occurred in each subgroup (60%, 71%, and 87%, respectively). In children ages 3 to 6 years, ADHD had a positive correlation with RLS and PLMS (r = 0.49, P < .001), but no correlation was seen in other age groups.

After adjustment for RLS and PLMS in the 3- to 6-year group, there remained a marginal correlation between sleepiness and ADHD score (r = 0.18, P < .08).

In the 6- to 12-year age category, there was an inverse correlation between ADHD score and SRBD-16 score (r = -0.23, P < .02).

In the 12- to 18-year age group (r = -0.176, P < .08), the researchers found a marginal correlation between ADHD score and SB. In the 6- to 12-year and 12- to 18-year age groups, sleepiness was correlated with ADHD after adjustment for SB (r = 0.181, P < .04, and r = 0.210, P < .04, respectively).

Children have a high prevalence of sleep problems, including insomnia, sleeplessness, sleep apnea, and periodic movement disorder, but they often are not obviously sleepy during the day. “Kids are wired in a way that [looks like] ADHD,” Dr. Horgan told Medscape Medical News.

The study shows that preschool children with RLS and periodic movement disorders are most likely to show ADHD-like symptoms. Whether sleep disorders are simply mimicking ADHD or exacerbating it is difficult to determine, Dr. Hoban said. “It can be either, and that is the challenge. But if a sleep disorder is the cause of the symptoms, it’s probably medically appropriate to treat the underlying sleep disorder as opposed to giving them stimulants to treat the symptoms and not the underlying disorder.”

The study relies on parental reporting, and that could introduce bias, cautioned William C. Kohler, MD, director of pediatric sleep services at University Hospital in Tampa, Florida, and the director of the Florida Sleep Institute in Spring Hill, in an interview after the SLEEP 2010 meeting. “It’s relying on an observation rather than any hard numbers. But it substantiates what we know, that anything that disrupts the sleep will cause adverse behavioral effects during the day,” Dr. Kohler added.

The study did not receive commercial support. Dr. Hoban and Dr. Kohler have disclosed no relevant financial relationships.

SLEEP 2010: Associated Professional Sleep Societies 24th Annual Meeting: Abstract 0949. Presented June 7, 2010.

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Reuters Health
June 15, 2010

Should adults with ADHD take stimulants?
By Lynne Peeples

NEW YORK (Reuters Health) – Ritalin is not just for kids anymore, suggests a new study. A team of Swedish psychiatrists found that stimulants relieved symptoms in 4 out of 5 adults with attention-deficit hyperactivity disorder (ADHD). Further, the long-term side effects of the drugs appeared to be few and mild.

“ADHD problems are often carried into adulthood, although they look a bit different from the outside,” lead researcher Dr. Susanne Bejerot of the Karolinska Institute in Stockholm told Reuters Health by email. “Adults with ADHD are extremely susceptible to stress, forgetfulness and restlessness. They also have low self-esteem and are often emotionally unstable.”

“Not that stimulant treatment helps with everything,” she added, “but it usually makes life a bit easier for these adults.”

Stimulant drugs, including Ritalin and Adderall, are FDA-approved for children with the disorder. However, not all of the drugs are approved for adults, as data on safety and efficacy in this age group lag behind those in children.

This is crucial hole to fill, note the researchers, especially since an estimated 3 to 4 percent of adults have ADHD — many of whom are now using the stimulants for extended periods of time.

Bejerot and her colleagues identified and followed 133 adults with ADHD who received stimulants from their Stockholm clinic between 2001 and 2008. In nearly half of the adults, the treatment was prescribed on top of existing anxiety or depression medications. Half were also too disabled to be employed or in school full-time, even though the group was of average intelligence.

By 6 to 9 months into the study, 80 percent of patients had successfully controlled their ADHD symptoms with stimulants. Side effects were not considered severe, and included a 10 beat-per-minute average increase in heart rate, decreased appetite and dry mouth.

Despite the help most patients found with the drugs, one of every two adults quit taking them within 2 years. Not surprisingly, those who experienced the greatest reductions in symptoms during the first 6 to 9 months — particularly an improvement in attention over time — were more likely to continue on treatment.

Anxiety and depression led the list of reasons for dropping out. Just 15 percent of patients blamed a lack of treatment effect.

ADHD has only become a widely recognized diagnosis in the last couple decades. So, while many of the adults followed in the study had received psychiatric help as children, only one had a childhood diagnosis of ADHD. That individual happened to be Bejerot’s son.

“In the early nineties I was able to get him into a drug trial with stimulant treatment in Sweden,” she said. “For my son, the treatment made it possible to attend a normal class and learn; it made all the difference in the world. The drug treatment still makes all the difference.”

Other treatment options do exist for adults with ADHD, including a non-stimulant medication called atomoxetine (Strattera). However, as Bejerot noted, people tend to find the drug’s side effects more bothersome than stimulants. Talk therapy and mindfulness training may also help lessen symptoms, she said.

The researchers note that the best treatment of ADHD should go beyond medications and therapies to include a team of caregivers who understand the disorder and how its very symptoms can get in the way of its treatment. The study clinic, for example, reminded forgetful patients of appointments by phone and text message.

Megan Davidson of Queen’s University in Ontario, Canada, agreed with the need for a team approach to help patients stick to their therapies and deal with the educational, occupational and marital problems that often accompany the disorder.

“Treatment of adult ADHD should not only involve psychiatrists or family physicians,” she said in an email to Reuters Health, “but also psychologists, social workers, and occupational therapists.”

SOURCE: Journal of Clinical Psychiatry, online June 1, 2010.

© Thomson Reuters 2010. All rights reserved

Web address:  http://www.reuters.com/article/idUSTRE65E5P020100615