Skip to main content
Log in

ADHD symptoms in adults with delayed sleep phase disorder

  • Original Article
  • Published:
Sleep and Biological Rhythms Aims and scope Submit manuscript

Abstract

The aims of the study are to investigate the prevalence of ADHD in delayed sleep phase disorder (DSPD) patients and to explore the relationship between circadian phase and ADHD symptoms, using the dim light melatonin onset (DLMO), and to compare this relationship with patients with sleep problems other than DSPD. 353 adult patients with sleep problems were assessed for self-reported ADHD symptoms using ADHD rating scale, self-reported sleep disorders using Holland Sleep Disorders Questionnaire (HSDQ), and circadian rhythmicity using salivary DLMO. From the 353 patients with sleep problems, 63 were designated as DSPD and 107 (30.3%) reported probable ADHD. Probable ADHD was reported by 47.6% of the DSPD patients and by 26.9% of the non-DSPD patients (p = 0.059). The DSPD group showed significant higher total ADHD-RS scores (p = 0.011). In the probable ADHD group more patients were designated as DSPD (28%) compared to the non-ADHD group (13.6% [χ2 = 10.402, p = 0.001]). Also 20 min later, DLMO (22:46 h) was found (p = 0.017) and more positive HSDQ scores on insomnia, parasomnia, hypersomnia, and sleep-related breathing disorders were reported in the probable ADHD group than in the non-probable ADHD group (χ2 resp. 16.07; p < 0.001, 9.245; p = 0.002, 19.391; p < 0.00 and 5.865; p = 0.059). The data suggest a high prevalence of probable ADHD in DSPD patients and increased prevalence of DSPD and other sleep disorders in patients with probable ADHD. Consequence is that awareness of these findings might help with treatment of both DSPD and ADHD.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Weitzman ED, Czeisler CA, Coleman RM, et al. Delayed sleep phase syndrome. A chronobiological disorder with sleep-onset insomnia. Arch Gen Psychiatry. 1981;38:737–46.

    Article  CAS  PubMed  Google Scholar 

  2. Pandi-Perumal SR, Trakht I, Spence DW, Srinivasan V, Dagan Y, Cardinali DP. The roles of melatonin and light in the pathophysiology and treatment of circadian rhythm sleep disorders. Nat Clin Pract Neurol. 2008;4:436–47.

    Article  CAS  PubMed  Google Scholar 

  3. Lewy AJ, Sack RL. The dim light melatonin onset as a marker for circadian phase position. Chronobiol Int. 1989;6:93–102.

    Article  CAS  PubMed  Google Scholar 

  4. Pandi-Perumal SR, Smits M, Spence W, et al. Dim light melatonin onset (DLMO): a tool for the analysis of circadian phase in human sleep and chronobiological disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2007;31:1–11.

    Article  CAS  PubMed  Google Scholar 

  5. Archer SN, Robilliard DL, Skene DJ, et al. A length polymorphism in the circadian clock gene Per3 is linked to delayed sleep phase syndrome and extreme diurnal preference. Sleep. 2003;26:413–5.

    Article  PubMed  Google Scholar 

  6. Schrader H, Bovim G, Sand T. The prevalence of delayed and advanced sleep phase syndromes. J Sleep Res. 1993;2:51–5.

    Article  CAS  PubMed  Google Scholar 

  7. Sivertsen B, Pallesen S, Stormark KM, Boe T, Lundervold AJ, Hysing M. Delayed sleep phase syndrome in adolescents: prevalence and correlates in a large population based study. BMC Public Health. 2013;13:1163.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Saxvig IW, Pallesen S, Wilhelmsen-Langeland A, Molde H, Bjorvatn B. Prevalence and correlates of delayed sleep phase in high school students. Sleep Med. 2012;13:193–9.

    Article  PubMed  Google Scholar 

  9. Reid KJ, Jaksa AA, Eisengart JB, et al. Systematic evaluation of Axis-I DSM diagnoses in delayed sleep phase disorder and evening-type circadian preference. Sleep Med. 2012;13:1171–7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Sivertsen B, Harvey AG, Pallesen S, Hysing M. Mental health problems in adolescents with delayed sleep phase: results from a large population-based study in Norway. J Sleep Res. 2015;24:11–8.

    Article  PubMed  Google Scholar 

  11. Zhu L, Zee PC. Circadian rhythm sleep disorders. Neurol Clin. 2012;30:1167–91.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Kooij JJ, Bijlenga D. The circadian rhythm in adult attention-deficit/hyperactivity disorder: current state of affairs. Expert Rev Neurother. 2013;13:1107–16.

    Article  CAS  PubMed  Google Scholar 

  13. Snitselaar MA, Smits MG, van der Heijden KB, Spijker J. Sleep and circadian rhythmicity in adult ADHD and the effect of stimulants: a review of the current literature. J Atten Disord. 2013;21:14–26

    Article  Google Scholar 

  14. van der Heijden KB, Smits MG, van Someren EJ, Gunning WB. Idiopathic chronic sleep onset insomnia in attention-deficit/hyperactivity disorder: a circadian rhythm sleep disorder. Chronobiol Int. 2005;22:559–70.

    Article  PubMed  Google Scholar 

  15. Barkley RA, Fischer M, Smallish L, Fletcher K. The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. J Abnorm Psychol. 2002;111:279–89.

    Article  PubMed  Google Scholar 

  16. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163:716–23.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Bae SM, Park JE, Lee YJ, et al. Gender difference in the association between adult attention deficit hyperactivity disorder symptoms and morningness–eveningness. Psychiatry Clin Neurosci. 2010;64:649–51.

    Article  PubMed  Google Scholar 

  18. Voinescu BI, Szentagotai A, David D. Sleep disturbance, circadian preference and symptoms of adult attention deficit hyperactivity disorder (ADHD). J Neural Transm. 2012;119:1195–204.

    Article  PubMed  Google Scholar 

  19. Caci H, Bouchez J, Bayle FJ. Inattentive symptoms of ADHD are related to evening orientation. J Atten Disord. 2009;13:36–41.

    Article  PubMed  Google Scholar 

  20. Caci H, Robert P, Boyer P. Novelty seekers and impulsive subjects are low in morningness. Eur Psychiatry. 2004;19:79–84.

    Article  PubMed  Google Scholar 

  21. Baird AL, Coogan AN, Siddiqui A, Donev RM, Thome J. Adult attention-deficit hyperactivity disorder is associated with alterations in circadian rhythms at the behavioural, endocrine and molecular levels. Mol Psychiatry. 2012;17:988–95.

    Article  CAS  PubMed  Google Scholar 

  22. Bijlenga D, van der Heijden KB, Breuk M, et al. Associations between sleep characteristics, seasonal depressive symptoms, lifestyle, and ADHD symptoms in adults. J Atten Disord. 2013;17:261–75.

    Article  PubMed  Google Scholar 

  23. Rybak YE, McNeely HE, Mackenzie BE, Jain UR, Levitan RD. Seasonality and circadian preference in adult attention-deficit/hyperactivity disorder: clinical and neuropsychological correlates. Compr Psychiatry. 2007;48:562–71.

    Article  PubMed  Google Scholar 

  24. Van Veen MM, Kooij JJ, Boonstra AM, Gordijn MC, van Someren EJ. Delayed circadian rhythm in adults with attention-deficit/hyperactivity disorder and chronic sleep-onset insomnia. Biol Psychiatry. 2010;67:1091–6.

    Article  PubMed  Google Scholar 

  25. Fargason RE, Fobian AD, Hablitz LM, et al. Correcting delayed circadian phase with bright light therapy predicts improvement in ADHD symptoms: a pilot study. J Psychiatr Res. 2017;91:105–10.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Rybak YE, McNeely HE, Mackenzie BE, Jain UR, Levitan RD. An open trial of light therapy in adult attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006;67:1527–35.

    Article  PubMed  Google Scholar 

  27. DuPaul GJ, Power TJ, Anastopoulos AD, Reid R. ADHD rating scale-IV: checklists, norms and clinical interpretation. New York: Guilford; 1998.

    Google Scholar 

  28. Sack RL, Auckley D, Auger RR, et al. Circadian rhythm sleep disorders: part II, advanced sleep phase disorder, delayed sleep phase disorder, free-running disorder, and irregular sleep-wake rhythm. An American Academy of Sleep Medicine review. Sleep. 2007;30:1484–501.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Ptacek R, Kuzelova H, Stefano GB, et al. Disruptive patterns of eating behaviors and associated lifestyles in males with ADHD. Med Sci Monit. 2014;20:608–13.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Vogel SW, Bijlenga D, Tanke M, et al. Circadian rhythm disruption as a link between attention-deficit/hyperactivity disorder and obesity? J Psychosom Res. 2015;79:443–50.

    Article  PubMed  Google Scholar 

  31. Kerkhof GA, Geuke ME, Brouwer A, Rijsman RM, Schimsheimer RJ, Van Kasteel V. Holland sleep disorders questionnaire: a new sleep disorders questionnaire based on the International Classification of Sleep Disorders-2. J Sleep Res. 2013;22:104–7.

    Article  PubMed  Google Scholar 

  32. American Academy of Sleep Medicine. International classification of sleep disorders: diagnostic and coding manual (ICSD-2). 2nd edn. Chicago: American Academy of Sleep Medicine; 2005.

    Google Scholar 

  33. Keijzer H, Smits MG, Duffy JF, Curfs LM. Why the dim light melatonin onset (DLMO) should be measured before treatment of patients with circadian rhythm sleep disorders. Sleep Med Rev. 2014;18:333–9.

    Article  PubMed  Google Scholar 

  34. Redlin U. Neural basis and biological function of masking by light in mammals: suppression of melatonin and locomotor activity. Chronobiol Int. 2001;18:737–58.

    Article  CAS  PubMed  Google Scholar 

  35. Zeitzer JM, Dijk DJ, Kronauer R, Brown E, Czeisler C. Sensitivity of the human circadian pacemaker to nocturnal light: melatonin phase resetting and suppression. J Physiol. 2000;526(Pt 3):695–702.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  36. Nagtegaal E, Peeters T, Swart W, Smits M, Kerkhof G, van der Meer G. Correlation between concentrations of melatonin in saliva and serum in patients with delayed sleep phase syndrome. Ther Drug Monit. 1998;20:181–3.

    Article  CAS  PubMed  Google Scholar 

  37. Rahman SA, Kayumov L, Tchmoutina EA, Shapiro CM. Clinical efficacy of dim light melatonin onset testing in diagnosing delayed sleep phase syndrome. Sleep Med. 2009;10:549–55.

    Article  PubMed  Google Scholar 

  38. Lack LC, Wright HR. Clinical management of delayed sleep phase disorder. Behav Sleep Med. 2007;5:57–76.

    Article  PubMed  Google Scholar 

  39. Spencer T, Biederman J, Wilens T, et al. A large, double-blind, randomized clinical trial of methylphenidate in the treatment of adults with attention-deficit/hyperactivity disorder. Biol Psychiatry. 2005;57:456–63.

    Article  CAS  PubMed  Google Scholar 

  40. Bioulac S, Chaufton C, Taillard J, et al. Excessive daytime sleepiness in adult patients with ADHD as measured by the Maintenance of Wakefulness Test, an electrophysiologic measure. J Clin Psychiatry. 2015;76:943–948

    Article  PubMed  Google Scholar 

  41. Modestino EJ, Winchester J. A retrospective survey of childhood ADHD symptomatology among adult narcoleptics. J Atten Disord. 2013;17:574–82.

    Article  PubMed  Google Scholar 

  42. Oosterloo M, Lammers GJ, Overeem S, de NI, Kooij. JJ. Possible confusion between primary hypersomnia and adult attention-deficit/hyperactivity disorder. Psychiatry Res. 2006;143:293–7.

    Article  PubMed  Google Scholar 

  43. Crowley SJ, Van RE, LeBourgeois MK, et al. A longitudinal assessment of sleep timing, circadian phase, and phase angle of entrainment across human adolescence. PLoS One. 2014;9:e112199.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  44. Snitselaar MA, Smits M, van der Heijden KB, Smit A, Spijker J. Influence of methyphenidate on circadian rhythmicity and sleep in adult attention-deficit/hyperactivity disorder. Sleep Biol Rhythms. 2013;11:282–5.

    Article  Google Scholar 

  45. Hallam KT, Begg DP, Olver JS, Norman TR. An investigation of the effect of immediate and extended release venlafaxine on nocturnal melatonin and cortisol release in healthy adult volunteers. Hum Psychopharmacol. 2008;23:129–37.

    Article  CAS  PubMed  Google Scholar 

  46. Snitselaar MA, Smits MG, Spijker J. Prevalence of restless legs syndrome in adult ADHD and its subtypes. Behav Sleep Med. 2016;14:480–8.

    Article  PubMed  Google Scholar 

  47. Biederman J, Mick E, Faraone SV. Age-dependent decline of symptoms of attention deficit hyperactivity disorder: impact of remission definition and symptom type. Am J Psychiatry. 2000;157:816–8.

    Article  CAS  PubMed  Google Scholar 

  48. Bron TI, Bijlenga D, Kooij JJ, et al. Attention-deficit hyperactivity disorder symptoms add risk to circadian rhythm sleep problems in depression and anxiety. J Affect Disord. 2016;200:74–81.

    Article  CAS  PubMed  Google Scholar 

  49. Coogan AN, Baird AL, Popa-Wagner A, Thome J. Circadian rhythms and attention deficit hyperactivity disorder: the what, the when and the why. Prog Neuropsychopharmacol Biol Psychiatry. 2016;67:74–81.

    Article  PubMed  Google Scholar 

  50. Antle MC, van Diepen HC, Deboer T, Pedram P, Pereira RR, Meijer JH. Methylphenidate modifies the motion of the circadian clock. Neuropsychopharmacology. 2012;37:2446–55.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Gannon RL, Millan MJ. Evaluation of serotonin, noradrenaline and dopamine reuptake inhibitors on light-induced phase advances in hamster circadian activity rhythms. Psychopharmacology. 2007;195:325–32.

    Article  CAS  PubMed  Google Scholar 

  52. Sprouse J, Braselton J, Reynolds L. Fluoxetine modulates the circadian biological clock via phase advances of suprachiasmatic nucleus neuronal firing. Biol Psychiatry. 2006;60:896–9.

    Article  CAS  PubMed  Google Scholar 

  53. Schaufler J, Ronovsky M, Savalli G, et al. Fluoxetine normalizes disrupted light-induced entrainment, fragmented ultradian rhythms and altered hippocampal clock gene expression in an animal model of high trait anxiety- and depression-related behavior. Ann Med. 2016;48:17–27.

    Article  CAS  PubMed  Google Scholar 

Download references

Funding

The authors received no financial support for the research, authorship, and/or publication of this article. Also no off-label or investigational use.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mark A. Snitselaar.

Ethics declarations

Conflict of interest

The authors declare no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Ethical approval

The study protocol was approved by the local ethics committee of St. Radboud University Nijmegen. No clinical trial registration number available.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Snitselaar, M.A., Smits, M.G. & Spijker, J. ADHD symptoms in adults with delayed sleep phase disorder. Sleep Biol. Rhythms 17, 11–18 (2019). https://doi.org/10.1007/s41105-018-0188-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s41105-018-0188-0

Keywords

Navigation