Cyclic alternating patterns in pediatric ADHD with insomnia

Children with and without attention deficit hyperactivity disorder (ADHD) do not have significantly different cyclic alternating pattern (CAP) analyzes and interval distributions. They have high CAP rates, which are normal for peripubertal children, according to study results published in the Journal of Sleep Research.

A team of researchers in Switzerland and Italy conducted a study to determine CAP in children with ADHD who are believed to have insomnia. They performed the analysis of the visual cyclical change pattern in a blinded manner.

A total of 27 children with ADHD (mean age 10.53 years; girls 8) and 23 control persons (mean age 10.22 years; girls 11) underwent a complete sleep study including video polysomnography. The 27 children with ADHD were classified into the following sleep phenotypes: obstructive sleep apnea (OSA; n = 11), interictal epileptiform discharges (IEDs; n = 6), narcolepsy-like (n = 2), insomnia (SOI; n = 3), movement disorder (n = 4) and disturbance or arousal (n = 1).

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Children with ADHD and children in the normal cohort showed similar CAP parameters. They had an expected CAP rate of approximately 50% based on normative values ​​for their respective age groups.

Children with ADHD were then divided into one of 3 groups, depending on their sleep phenotypes. Patients with OSA were placed in Group 1, patients with IEDs were placed in Group 2, and patients without OSA or IEDs were placed in Group 3. Children with ADHD in group 1 had significantly higher CAP rates in stage N3 compared to group 3 (P =. 044) and the control cohort (P = 0.007).

“Future studies are needed to examine changes in sleep microstructure related to CAP parameters after treatment with stimulants in patients without IEDs compared to those with IEDs or OSA,” the study researchers noted. “A more detailed analysis of the neuropsychological profile of children with ADHD and an epileptic phenotype would also be necessary in order to identify and treat them in good time,” they concluded.


Miano S, Castelnovo A, Bruni O, Manconi M. Sleep microstructure in attention deficit hyperactivity disorder according to underlying sleep phenotypes. J sleep. Published online June 24, 2021. doi: 10.1111 / jsr.13426

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