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Good morning.

Did you know restless sleep might be more than just an ADHD symptom? It could be a key player.

This issue uncovers the sleep-ADHD link and how it could transform educating your patients.

In Today’s Edition:

• The Sleep-ADHD Connection

• Industry Events

5-minute read👇

Clinical Corner

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Key Takeaways🔑

The Sleep-ADHD Connection: New Insights for Dental Sleep Professionals

The Hidden Link: Sleep Quality and ADHD

Recent research has uncovered a critical connection between sleep quality and Attention-Deficit/Hyperactivity Disorder (ADHD). This link has significant implications for dental sleep practice. Let's dive into the latest findings and their potential impact on patient care.

The Genetic Puzzle of ADHD

ADHD isn't just about behavior – it's in the genes:

• Multiple genes contribute to ADHD, each with small effects [1]

• Environmental factors, including sleep, can modify genetic expression [2]

Implication: Family history may be relevant when assessing patients with sleep issues or ADHD symptoms.

Sleep and ADHD: A Two-Way Street

Poor sleep doesn't just make kids cranky – it can mimic or exacerbate ADHD:

• Insufficient sleep leads to attention problems in both ADHD and non-ADHD children [3]

• Improving sleep can significantly reduce ADHD symptoms [4]

Key point: Screening for sleep problems in patients with attention issues, regardless of ADHD diagnosis, may be beneficial.

Breaking News: Genetics, Sleep, and ADHD Severity

A groundbreaking study by Morales-Muñoz et al. [5] revealed:

• Genetic risk for ADHD (measured by polygenic risk scores) correlates with symptom severity

• Short sleep duration amplifies the effect of genetic risk on ADHD symptoms

Insight: The interaction between genetic predisposition and sleep patterns is crucial in understanding ADHD symptom expression.

Beyond Hours: The Quality Question

Sleep quality trumps quantity when it comes to ADHD:

• 55% of children with ADHD have sleep alterations [6, 7]

• Top complaints: restless sleep, early awakening, and difficulty falling asleep

Consideration: Assessing sleep quality, not just duration, may provide more comprehensive insights into patient sleep patterns.

Sleep Architecture: The ADHD Difference

Polysomnographic studies show distinct patterns in ADHD sleep:

• Increased body movements during sleep [8, 9]

• 81.1% of ADHD children have restless sleep [9]

• 9.1% meet criteria for restless sleep disorder [9]

• Altered sleep microarchitecture, affecting sleep quality [10, 11]

Observation: Excessive movement during sleep could be an indicator of underlying ADHD or sleep disorders.

The Bottom Line

The connection between sleep quality and ADHD opens new avenues for understanding and potentially managing ADHD symptoms. By recognizing the intricate relationship between sleep patterns, genetic predisposition, and ADHD, dental sleep professionals can contribute valuable insights to the broader picture of patient care.

As research in this field progresses, staying informed about the latest findings on sleep quality and ADHD can enhance the depth and efficacy of sleep assessments. This knowledge not only enriches our understanding of sleep disorders but also highlights the far-reaching impacts of quality sleep on neurodevelopmental conditions like ADHD.

Remember: Every improvement in sleep quality could potentially lead to better daytime functioning for individuals struggling with ADHD symptoms. This underscores the critical role of comprehensive sleep care in overall health and well-being.

1. Paclt I, et al. Biochemical markers and genetic research of ADHD. Neuro Endocrinol Lett. 2005;26(4):423–430.

2. Banerjee TD, et al. Environmental risk factors for attention-deficit hyperactivity disorder. Acta Paediatr. 2007;96(9):1269–1274. https://doi.org/10.1111/j.1651-2227.2007.00430.x

3. Li Y, et al. Deficits in attention performance are associated with insufficiency of slow-wave sleep in insomnia. Sleep Med. 2016;24:124–130. https://doi.org/10.1016/j.sleep.2016.07.017

4. Biggs SN, et al. Long-term cognitive and behavioral outcomes following resolution of sleep disordered breathing in preschool children. PLoS One. 2015;10(9):e0139142. https://doi.org/10.1371/journal.pone.0139142

5. Morales-Muñoz I, et al. Genetic background to ADHD and ADHD symptoms at the age of five years: the role of sleep duration. Sleep. 2023;46(7):zsad047. https://doi.org/10.1093/sleep/zsad047

6. Greenhill L, et al. Sleep architecture and REM sleep measures in prepubertal children with ADHD. Sleep. 1983;6(2):91–101. https://doi.org/10.1093/sleep/6.2.91

7. Silvestri R, et al. Sleep disorders in children with ADHD recorded overnight by video-polysomnography. Sleep Med. 2009;10(10):1132–1138. https://doi.org/10.1016/j.sleep.2009.04.003

8. DelRosso LM, et al.; International Restless Legs Syndrome Study Group (IRLSSG). Restless sleep in children: a systematic review. Sleep Med Rev. 2021;56:101406. https://doi.org/10.1016/j.smrv.2020.101406

9. Kapoor V, et al. Restless sleep disorder in children with ADHD. J Clin Sleep Med. 2021;17(4):639–643. https://doi.org/10.5664/jcsm.8984

10. Scarpelli S, et al. Advances in understanding the relationship between sleep and ADHD. J Clin Med. 2019;8(10):1737. https://doi.org/10.3390/jcm8101737

11. Parrino L, et al. Cyclic alternating pattern (CAP): the marker of sleep instability. Sleep Med Rev. 2012;16(1):27–45. https://doi.org/10.1016/j.smrv.2011.02.003

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