ARTICLES
Actigraphic Monitoring During Sleep of Children With ADHD on Methylphenidate and Placebo

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ABSTRACT

Objective

Sleep disturbances appear as a comorbid condition in children with attention-deficit/hyperactivity disorder. The aim of this study was to investigate the relationship of activity levels during sleep and therapeutic response to methylphenidate (MPH).

Method

Nightly sleep actigraphic recordings during a double-blind, placebo-controlled, crossover clinical study (1-week of 0.5 mg/kg MPH; 1-week of placebo) were obtained on 44 children, 6 to 12 years old, diagnosed with attention-deficit/hyperactivity disorder (DSM-IV).

Results

Significant (p < .005) differences between the conditions were found in several software-computed parameters: sleep onset latency (MPH, 39.3 minutes; placebo, 28.2 minutes), sleep efficiency (MPH, 78.0%; placebo, 80.4%), total sleep time (MPH, 7 hours; 57 minutes; placebo, 8 hours, 16 minutes). No significant differences on any of these measures were found among the 26 subjects who showed a moderate or large global improvement on MPH over placebo compared with 18 subjects who showed mild or no clinical improvement.

Conclusions

MPH, given twice daily, induces a slight but significant sleep disturbance. Motor activity levels during sleep did not differentiate children who responded to MPH from those who did not respond. This suggests that responders to MPH treatment do not experience greater sleep disturbances than nonresponders, at least at the dose studied.

Section snippets

METHOD

Children were recruited from the Disruptive Behavior Disorders Program and from the outpatient department of Douglas Hospital in Montreal, a psychiatric university teaching hospital. Thus, the full spectrum of the disorder is represented in the study, from the mildly to the severely ill. Children who had either been diagnosed with ADHD or were referred because of possible diagnosis of ADHD were interviewed by an experienced child psychiatrist. Approximately 95% of all eligible patients who met

RESULTS

As shown in Table 2, comparing actigraphic sleep characteristics on MPH and placebo, there was a significant difference found in sleep onset latency (95% confidence interval [CI] around mean difference on MPH and placebo = 4.2–17.9 minutes), in sleep efficiency (CI = 1.2%–3.6%), and in total sleep time (CI = 6.5–31.5 minutes). The number and duration of wake and sleep bouts were similar.

As shown in Table 3, comparing 26 subjects who showed a moderate or large global improvement on MPH over

DISCUSSION

The purpose of the current study was to investigate the relationship of sleep disturbance and therapeutic response to MPH in children with ADHD. In the literature, only a few studies used both actigraphic recording and a placebo-controlled design, but to our knowledge this is the first study that addressed the question of sleep disturbance and degree of response to MPH.

Wrist activity monitoring on MPH relative to placebo showed a significant increase in activity at sleep onset and throughout

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    • Cited by (0)

    The project was supported by a grant from Le Fonds de la recherche en santé du Québec and the Canadian Institutes of Health Research. The authors thank Marina Ter-Stepanian, Nicole Pawliak, Valentin Mbekou, Johanne Bellingham, Claire Hutchinson, and Anthony Hussein for their help in this study.

    Disclosure: Dr. Joober is a Principal Investigator on a clinical trial not related to this study and that is sponsored by AstraZeneca Canada, Inc. Dr. Joober receives no direct compensation for this trial. Dr. Boivin has the following industry financial ties: The Litebook Company Ltd., Medicine Hat, Alberta, Canada, and Pulsar Informatics Inc., Vancouver, British Columbia, Canada.

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    Copyright © 2004 The American Academy of Child and Adolescent Psychiatry. Published by Elsevier Inc. All rights reserved.