Untreated Adults With ADHD Spend Longer in Slow Wave Sleep Than Controls

The duration of slow wave sleep was longer in drug-naïve adults with ADHD than in non-ADHD controls.

A study published in the Journal of Attention Disorders found that drug-naïve adults with attention-deficit/hyperactivity disorder (ADHD) spent longer in slow wave sleep (SWS) compared with non-ADHD controls.

Investigators from Kurume University Hospital Sleep Clinic in Japan recruited patients (N=55) with untreated sleep disorders between 2015 and 2020. Participants were evaluated by multiple sleep scale instruments and underwent polysomnography (PSG) and multiple sleep latency tests following a 1-week actigraphy sleep assessment. Differences in outcomes were compared between the subset of participants with (n=28) and without (n=27) ADHD.

The ADHD group and controls had mean ages of 24.1±5.6 and 28.0±8.6 years, the female:male ratios were 15:13 and 12:15, and the most common sleep disorders were insomnia (38% vs 50%), sleep apnea (27% vs 17%), insufficient sleep syndrome (15% vs 9%), and narcolepsy (7% vs 11%), respectively. No participant had a history of mental illness or exposure to ADHD medications.

The only subjective sleep measures that differed between groups were the Japanese version of the Epworth Sleepiness Scale (ESS) scores (mean, 16 vs 13.1 points; P =.0307), Pittsburgh Sleep Quality Index (PSQI) difficulty maintaining wakefulness during day measure (mean, 2.6 vs 1.9 points; P =.0367), and Morningness-Eveningness Questionnaire Self-Assessment (MEQ-SA) scores (mean, 39.6 vs 44.9 points; P =.0457) among the ADHD and control groups, respectively.

Sleep structure problems may provide powerful insights for understanding the pathogenesis of ADHD.

During PSG, the ADHD group had a significantly shorter time to wake after sleep onset (mean, 38.4 min) compared with controls (mean, 64.4 min; P =.0127) and the ADHD group spent longer in sleep stage 3 (mean, 42.2 vs 24.8 min; P =.0005) and SWS (mean, 68.3 vs 43.4 min; P =.0065) compared with controls, respectively.

Significant correlations between SWS time and PSQI sleep quality (r, 0.5073; P =.0224), PSG sleep quality (r, 0.7885; P=.0014), and the Japanese version of the ESS scores (r, 0.4324; P =.0348) were observed among the ADHD group.

The limitations of this study included the small sample size and the pooling of data from patients with differing sleep disorders.

These data indicated that adults with sleep problems spent longer in SWS if they had untreated ADHD. “Sleep structure problems may provide powerful insights for understanding the pathogenesis of ADHD. The increased amount of SWS in untreated adult patients with ADHD identified in this study may suggest the immaturity of the central nervous system in ADHD. In the future, we believe that a longitudinal study of SWS in untreated patients, especially focusing on stage [3], could contribute to a better understanding of the pathogenesis of ADHD,” concluded the study authors.


Kato T, Ozone M, Kotorii N, et al. Sleep structure in untreated adults with ADHD: a retrospective study. J Atten Disord. 2023;27(5):488-498. doi:10.1177/10870547231154898