Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety

Apr 30, 2016Journal of affective disorders

ADHD Symptoms Increase Risk of Sleep-Wake Cycle Problems in Depression and Anxiety

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Abstract

12% of individuals with high ADHD symptoms reported extremely late chronotype compared to 5% in those with depression and/or anxiety disorders and 3% in healthy controls.

Individuals with both high ADHD symptoms and depression/anxiety disorders had the least favorable sleep characteristics.
Sleep duration of less than 6 hours was reported by 15% of the LDA+ADHD group, compared to 5% of the LDA group and 4% of healthy controls.
An indication of Delayed Sleep Phase Syndrome was observed in 16% of the LDA+ADHD group, versus 8% of the LDA group and 5% of healthy controls.
After adjusting for other factors, ADHD symptoms were associated with increased odds of late chronotype (OR=2.6), DSPS (OR=2.4), and short sleep duration (OR=2.7).
Circadian rhythm sleep disturbances in individuals with ADHD symptoms are not solely attributed to comorbid depression and anxiety disorders.

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BACKGROUND: Comorbid ADHD symptoms may partly account for circadian rhythm disturbances in depression and anxiety disorders.

METHODS: Self-reported sleep characteristics of 2090 participants in the Netherlands Study of Depression and Anxiety were assessed using the Munich Chronotype Questionnaire. We defined 3 groups: healthy controls (HC), persons with lifetime depression and/or anxiety disorders (LDA), and those with both LDA and high ADHD symptoms (LDA+ADHD), using the Conner's Adult ADHD Rating Scale.

RESULTS: Sleep characteristics were least favorable in the LDA+ADHD group. Important group differences between LDA+ADHD, LDA and HC were found for extremely late chronotype (12% vs. 5% vs. 3%; p<.001), sleep duration <6h (15% vs. 5% vs. 4%; p<.001), and for an indication of the Delayed Sleep Phase Syndrome (DSPS; 16% vs. 8% vs. 5%; p<.001). After adjustment for covariates, including depression and anxiety, presence of ADHD symptoms increased the odds ratio for late chronotype (OR=2.6; p=.003), indication of DSPS (OR=2.4; p=.002), and sleep duration <6h (OR=2.7; p=.007).

LIMITATIONS: ADHD conceptually overlaps with symptom presentation of depression and anxiety. We used a cross-sectional study design, and used self reported sleep characteristics.

CONCLUSIONS: High ADHD symptoms were associated with an increased rate of circadian rhythm sleep disturbances in an already at-risk population of people with depression and/or anxiety disorders. Circadian rhythm sleep disorders, as often seen in ADHD are not entirely due to any comorbid depression and/or anxiety disorder. Adequate treatment of such sleep problems is needed and may prevent serious health conditions in the long term.

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Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety

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