MINERVA MEDICA COPYRIGHT ® MINERVA PEDIATR 2004;56:585-601 Sleep in children with attention deficit/hyperactivity disorder L. M. O’BRIEN, D. GOZAL Department of Pediatrics, Kosair Children’s Hospital Sleep Medicine and Apnea Center University of Louisville School of Medicine Louisville, KY, USA Attention-deficit hyperactivity disorder (AD- HD) is one of the most common psychologi- cal disorders in children. Sleep disturbances are also very prevalent among the pediatric age range and can lead to substantial behav- ioral and cognitive consequences that may mimic ADHD. Conversely, children with AD- HD may suffer from significant sleep distur- bances that may originate in the biochemical disturbances that underlie their deficits in ex- ecutive function and attention. This review ad- dresses both these issues and provides a con- cise yet timely assessment of the potential links between sleep disorders and ADHD. Key words: Child - Sleep - Attention deficit dis- order with hyperactivity. A ttention-deficit hyperactivity disorder (ADHD) is among the most common psychological disorders in children with prevalence estimates ranging from 4-12% 1, 2 and is more frequent in males. Three sub- types of ADHD have been proposed, name- ly predominantly inattentive (ADHD-I), pre- dominantly hyperactive/impulsive (ADHD- HI), and a combination of both (ADHD-C). 3 Since the cardinal features of ADHD (i.e. inat- tention, impulsiveness, and restlessness) are also characteristic of sleep deprivation and disruption, the role of sleep in ADHD is the focus of a growing number of studies. Both parents of children with ADHD and children themselves commonly report sleep distur- bance, 4-11 and these sleep disturbances were so widely presumed to be an intrinsic part of the clinical phenotype of ADHD that they were included as one of the previous DSM- III diagnostic criteria for ADHD. 12 However, none of the more recent diagnostic manuals 3, 13 have included sleep disturbance as a symptomatic criterion for ADHD now that it is realized that they are neither specific nor necessary for a diagnosis. Thus, since parental perception of sleep disturbance helped to define ADHD previously, it is not surprising that studies using earlier diagnostic criteria found a significant association between AD- HD and sleep problems. Although the pathophysiology of ADHD is not well understood, dopamine pathways in the brain are hypothesized to play an im- portant role 14 with glutaminergic and other The authors are supported by NIH grants HL-65270, HL- 69932, and HL-63912, Department of Education Grant H324E011001, Centers for Disease Control grant E11/CCE 422081-01, and The Commonwealth of Kentucky Research Challenge Trust Fund. Address reprint request to: D. Gozal, MD, Professor and Director, Kosair Children’s Hospital Research Institute, Departments of Pediatrics, Pharmacology and Toxicology, University of Louisville School of Medicine, 570 S. Preston Street, Ste. 321, Louisville, KY 40202. Vol. 56, N. 6 MINERVA PEDIATRICA 585