This article is more than 5 years old. Information may no longer be current.

Stimulants worsen sleep outcomes among youth with ADHD

Results from a meta-analysis show stimulant medication led to longer sleep latency, worse sleep efficiency and shorter sleep duration among youth with attention-deficit/hyperactivity disorder.

“Experts disagree about the effects of stimulant medications on the sleep of youth with ADHD. Some researchers have suggested that stimulants impair child sleep, citing evidence of objectively measured deficits in sleep quantity and quality, as well as parent reports of child insomnia, as common adverse effects of stimulant medications,” Katherine M. Kidwell, MA, University of Nebraska-Lincoln, and colleagues wrote. “Conversely, some researchers have argued that stimulants may actually improve a child’s sleep, noting that these medications are generally well tolerated and are effective in reducing the core symptoms of ADHD, and these positive effects may generalize to sleep problems as well.”

To assess the effect of stimulant medications on sleep, researchers analyzed nine studies published through March 2015, which included 246 children with ADHD randomly assigned to stimulants whose sleep was objectively measured.

Researchers found that stimulants produced longer sleep latencies, with a significant adjusted effect size of 0.54.

Stimulants worsened sleep efficiency, with a significant effect size of –0.32, and led to shorter sleep duration, with a significant effect size of –0.59.

Length of time on medication, number of assessed nights of sleep, polysomnography/actigraphy and gender were significant moderators.

Medication effects were less evident the longer participants were taking medication.

“The results of the present meta-analysis highlight the importance of carefully weighing the potential benefits and adverse effects of stimulant medications when prescribing to children. Sleep impairment is related to many cognitive (eg, inattention) and emotional/behavioral (eg, defiance, anger) consequences, and sleep adverse effects could undermine the benefits of stimulant medications in some cases. Pediatricians are advised to frequently monitor the effects of stimulant medications, including potential adverse effects such as sleep disturbance,” Kidwell and colleagues wrote. “A wide range of medication options are currently available for treating ADHD, and pediatricians should carefully consider the medication dosage, release type (eg, immediate release vs. extended release), and frequency to minimize potential sleep problems while effectively treating ADHD symptoms.” – by Amanda Oldt

Disclosure: The researchers report no relevant financial disclosures.