A study published in the Journal of Attention Disorders found that drug-naive adults with attention-deficit/hyperactivity disorder (ADHD) spent more time in slow wave sleep compared with non-ADHD controls.

Investigators from Kurume University Hospital Sleep Clinic in Japan recruited patients (N=55) with untreated sleep disorders between 2015 and 2020. Participants were evaluated by multiple sleep scale instruments and underwent polysomnography and multiple sleep latency tests following a 1-week actigraphy sleep assessment. Differences in outcomes were compared between the subset of participants with (n=28) and without (n=27) ADHD.

The ADHD group and controls had mean ages of 24.1±5.6 and 28.0±8.6 years, the female:male ratios were 15:13 and 12:15, and the most common sleep disorders were insomnia (38% vs 50%), sleep apnea (27% vs 17%), insufficient sleep syndrome (15% vs 9%), and narcolepsy (7% vs 11%), respectively. No participant had a history of mental illness or exposure to ADHD medications.

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The only subjective sleep measures that differed between groups were the Japanese version of the Epworth Sleepiness Scale (ESS) scores (mean, 16 vs 13.1 points; P =.0307), Pittsburgh Sleep Quality Index (PSQI) difficulty maintaining wakefulness during day measure (mean, 2.6 vs 1.9 points; P =.0367), and Morningness-Eveningness Questionnaire Self-Assessment (MEQ-SA) scores (mean, 39.6 vs 44.9 points; P =.0457) among the ADHD and control groups, respectively.

During polysomnography, the ADHD group had a significantly shorter time to wake after sleep onset (mean, 38.4 min) compared with controls (mean, 64.4 min; P =.0127), and the ADHD group spent more time in sleep stage 3 (mean, 42.2 vs 24.8 min; P =.0005) and slow wave sleep (mean, 68.3 vs 43.4 min; P =.0065) compared with controls, respectively.

Significant correlations between time in slow wave sleep and PSQI sleep quality (r, 0.5073; P =.0224), polysomnography sleep quality (r, 0.7885; P=.0014), and the Japanese version of the ESS scores (r, 0.4324; P =.0348) were observed among the ADHD group.

Limitations of this study include its small sample size and the pooling of data from patients with differing sleep disorders.

These data indicated that adults with sleep problems spent more time in slow wave sleep if they had untreated ADHD. “Sleep structure problems may provide powerful insights for understanding the pathogenesis of ADHD. The increased amount of SWS in untreated adult patients with ADHD identified in this study may suggest the immaturity of the central nervous system in ADHD. In the future, we believe that a longitudinal study of [slow wave sleep] in untreated patients, especially focusing on stage [3], could contribute to a better understanding of the pathogenesis of ADHD,” concluded the study authors.


Kato T, Ozone M, Kotorii N, et al. Sleep structure in untreated adults with ADHD: a retrospective studyJ Atten Disord. 2023;27(5):488-498. doi:10.1177/10870547231154898

This article originally appeared on Psychiatry Advisor