Cyclic Alternating Patterns in Pediatric ADHD With Sleep Disorders

Study researchers assessed sleep microstructure in children with attention deficit hyperactivity disorder.

Children with and without attention deficit hyperactivity disorder (ADHD) do not have significantly different cyclic alternating pattern (CAP) analyses and interval distributions. They present with high CAP rates, which is 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 may be considered to have sleep disorders. They conducted the analysis of the visual cyclic alternating pattern in a blinded manner.

A total of 27 children with ADHD (mean age, 10.53 years; girls, 8) and 23 controls (mean age, 10.22 years; girls, 11) underwent a full sleep investigation, which included 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), sleep onset insomnia (SOI; n=3), movement disorder (n=4), and disorder or arousal (n=1).

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

Children with ADHD were subsequently placed in 1 of 3 groups depending on their sleep phenotypes. Patients with OSA were in group 1, patients with IEDs were 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 during stage N3 compared with group 3 (P =.044) and the control cohort (P =.007).

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


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

This article originally appeared on Neurology Advisor