Children taking stimulants for attention-deficit/hyperactivity disorder (ADHD) had worse sleep than those not taking such medications, according to a meta-analysis of nine randomized, controlled studies that used objective measures of sleep.
“Whenever we don’t have sleep then we … have a harder time paying attention the next day, kids are more impulsive the next day,” said Katherine M. Kidwell, M.A., clinical psychology graduate student at the University of Nebraska-Lincoln and lead author of the report. “So some of those problems that we would hope stimulant medications would help with, if it’s impacting their sleep, then those problems might get worse over time so it’s something for pediatricians to monitor.”
Roughly 7% of children and adolescents have ADHD, and many are treated with stimulant medications. However, opinions differ as to whether such medications improve or impair children’s sleep, according to the report Stimulant Medications and Sleep for Youth with ADHD: A Meta-Analysis (Kidwell HM, et al. Pediatrics. Nov. 23, 2015, www.pediatrics.org/cgi/doi/10.1542/peds.2015-1708).
Hoping to reach a more clear understanding of the impact of stimulants, researchers conducted a meta-analysis of randomized controlled trials that looked at sleep latency, sleep efficiency and/or total sleep time in children and adolescents diagnosed with ADHD. Studies included a total of 246 subjects and used actigraphy or polysomnography to assess sleep.
They found stimulant medications were associated with taking longer to fall asleep, especially with more frequent doses during the day. Extended-release formulas had less of an effect on sleep latency.
Stimulants also were associated with shorter total sleep time as well as poorer sleep efficiency. Sleep efficiency problems were seen more in boys than in girls, but there wasn’t as much of an effect when youths were on the medication for longer.
The analysis did have several limitations, including publication bias, a small number of studies, inconsistent reporting of similar variables and different doses of stimulant medications.
However, the authors said the analysis was strengthened by using randomized controlled trials and studies looking specifically at sleep outcomes. They also conducted publication bias analyses.
The team recommends pediatricians monitor patients with ADHD for sleep problems and consider adjusting the dose of stimulants or switching to extended-release medications. They also may consider referring patients to a behavioral psychologist.
