Stimulant medications for ADHD linked to sleep disruption

1. A meta-analysis of recent studies revealed that stimulant use in children with attention-deficit/hyperactivity disorder (ADHD) was associated with longer sleep latency, decreased sleep efficiency, and decreased total sleep time.

2. Sleep latency was significantly increased with each additional daily dose of stimulant medication. The negative impact of sleep efficiency was lower with increased stimulant length of use.

Evidence Rating Level: 2 (Good)

Study Rundown: The prevalence of ADHD among children and adolescents is approximately 7%, with stimulant medication being the most common treatment for this disease. Despite this, there are conflicting beliefs on the effect of stimulant medication on sleep among these patients. This study therefore explored the most recent literature on the effects of stimulant medication use on sleep in children and teens with ADHD. Overall, several significant effects of stimulant medication on sleep were determined. First, stimulant medication use was associated with longer sleep latency. A significant moderator included frequency of stimulant dosage, with greater dosage frequency linked to greater sleep latency. Second, sleep efficiency was decreased in children taking stimulants for ADHD. Negative impact of sleep efficiency was decreased the longer a patient was taking the medication. Finally, stimulant medication use was associated with decreased sleep time. While these results highlight the importance of weighing risks and benefits when considering stimulant medication for children and teens with ADHD, they are limited by the small number of studies included in the meta-analysis. These findings are important for pediatricians to understand the effects of stimulant medications on sleep, so that they may treat and advise their patients with ADHD appropriately.

Click to read the study, published today in Pediatrics

Relevant Reading: Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011

Study Author, Katherine M. Kidwell, MA, talks to 2 Minute Medicine: University of Nebraska, Department of Psychology, Lincoln, Nebraska.

“A simple review of the literature is insufficient for guiding medical professionals when prescribing stimulant medications, because studies have found mixed results on whether stimulants impair or aid with sleep. In this meta-analysis, we found that stimulant medications led to shorter sleep time, worse sleep efficiency, and longer sleep latency, and we recommend that prescribers monitor sleep adverse effects and adjust dosing or medication type for individual children to improve sleep.”

In-Depth [meta-analysis]: This study included 9 randomized controlled studies from February 2014 through March 2015 that met inclusion criteria. Effect size of stimulant medications on sleep, heterogeneity, and significant effect moderators were calculated among the 9 studies. The effect of stimulant medication on sleep latency was 0.78 and significant, indicating increased sleep latency with increased use of stimulants (95% CI 0.54 to 1.02, P=.054). An I² of 67.3% indicated moderate to high heterogeneity in effect size between studies. For each additional daily dose of medication, effect size was greater by 0.42, demonstrating that sleep latency was increased with additional daily doses of medication. Overall, effect of stimulant medications on sleep efficiency was -0.39 (95% CI -0.69 to -0.08, P<.001), indicating significantly decreased sleep efficiency with use of stimulants. An I² of 83.37% indicated high levels of heterogeneity in effect size between studies. For every additional day on medication, effect size was less negative by .05, indicating a lessening effect on sleep efficiency over time. Finally, the statistically significant effect size of stimulant medication on sleep time was -0.59, highlighting the negative effect of the medication on hours of sleep (95% CI -0.84 to -0.35, P<.001). An I² of 82.67% indicated high heterogeneity in effect size between studies. No significant moderators were found for this variable.

Image: PD

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