The Effect of Stimulants on Nocturnal Motor Activity and Sleep Quality in Adults With ADHD: An Open-Label Case-Control Study
J Clin Psychiatry 2001;62:952-956
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: Sleep disturbances are common in adults with attention-deficit/hyperactivity
disorder (ADHD). In a case-control study, adult ADHD was associated with increased
nocturnal motor activity and reduced self-perceived quality of sleep.
Method: Eight adults with DSM-IV-diagnosed ADHD (combined type,
N = 7; inattentive type, N = 1) were treated with stimulants in open-label form
at 8:00 a.m., 12:00 noon, and 4:00 p.m. The mean daily dose was 51 mg of methylphenidate
(range, 30-90 mg) in 7 subjects and 30 mg of dextroamphetamine in 1 subject.
Actimeters were used to assess nocturnal motor activity during 6 consecutive
nights both at baseline and after 3 weeks of treatment. The data were compared
with those of 8 matched normal controls.
Results: ADHD patients slept worse and showed significantly higher
nocturnal motor activity at baseline compared with controls. No baseline differences
between patients and controls were found in sleep latency, number of awakenings,
and total time in bed. Changes from baseline to week 3 within the ADHD patients
indicated improvement of sleep quality (p = .05) and reduction of Activity Level
(p = .10) and Movement Index (p = .07) scores. When within-group changes were
compared between ADHD subjects and controls, treatment with stimulants tended
to be associated with a reduction of Activity Level (p < .01) and Movement
Index (p = .04) scores and improved sleep quality (p = .02) in ADHD patients.
Sleep latency, number of awakenings, and total time in bed were unaffected in
within-group and between-group analyses.
Conclusion: The results should be interpreted cautiously given
the open-label design and small sample size. Further study is warranted into
the influence of stimulants on sleep in larger samples of ADHD patients by using
controlled designs, multiple dose levels, and polysomnographic measures.