Does Homeostatic Sleep Pressure Buildup Explain Objective Excessive Daytime Sleepiness in Adults With ADHD? An Exploratory Study

Stéphanie Bioulac, Patricia Sagaspe, Eléonore Tron, Antoine Benard, Christian Berthomier, Marie Brandewinder, Pierre Philip, Jacques Taillard, Stéphanie Bioulac, Patricia Sagaspe, Eléonore Tron, Antoine Benard, Christian Berthomier, Marie Brandewinder, Pierre Philip, Jacques Taillard

Abstract

Background: Excessive daytime sleepiness (EDS) is central in Attention deficit hyperactivity disorder (ADHD) but its causes remain unclear. The aim of this study was to explore objective EDS and homeostatic sleep pressure buildup, evaluated by power theta-alpha frequency (PTAF), in drug-free sleepy adults with ADHD and controls. Methods: Participants were placed during a 36-h period of extended wakefulness under constant routine protocol to strictly control sleep time, sleep duration, and circadian zeitgebers. Results: Eight drug-free sleepy patients with ADHD and 7 matched controls were included. The ADHD group had significantly shorter sleep latency on the Maintenance of Wakefulness Test (MWT) throughout extended wakefulness than the control group. There was no significant difference between the groups in PTAF evolution during extended wakefulness and in kinetic sleep pressure buildup, evaluated by the time constant of saturating exponential function. Limitations: The sample was small, so the findings cannot be generalized. Moreover, psychiatric comorbidities and circadian regulation should be taken into account in future studies. Conclusion: In very controlled conditions, mean sleep latency on the MWT during the whole extended wakefulness was significantly shorter in sleepy patients with ADHD than in control subjects. However, the difficulty to remain awake during soporific circumstances observed in these patients with ADHD cannot be explained by changes in the kinetic of sleep pressure buildup. Clinical Trials Registration: www.clinicaltrials.gov/, Identifier: NCT02217371.

Keywords: ADHD (attention deficit and hyperactivity disorder); maintenance of wakefulness test; phenotype; sleep pressure; sleepiness.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2021 Bioulac, Sagaspe, Tron, Benard, Berthomier, Brandewinder, Philip and Taillard.

Figures

Figure 1
Figure 1
Time course of sleep latency on MWT (Mean ± SE) in sleepy ADHD group and control group during 36-h of sustained wakefulness from T1 to T9.
Figure 2
Figure 2
Time course of fPTAF in sleepy ADHD group and control group during 36-h of sustained wakefulness from T1 to T9 (A) and sleep pressure buildup in sleepy ADHD and controls assessed by saturating exponential function (B).

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