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    1 Comment for this article
    Cohort data that possibly shed light on connection of ADHD and sleep disorders
    Eike Ahlers, MD | Charite Univercity Medicine Berlin, Campus Benjamin Franklin, Dept. of Psychiatry, Berlin, Germany.
    I find the presented cohort data very adding to the psychiatric field, especially because of the thorough assessment with actual interviews and objective sleep measures (and not primarily self-rated questionnaires as often applied in cohort studies in attention deficit/ hyperactivity disorder (ADHD) research) and like to comment on implications for ADHD.
    Sleep problems are very frequently reported in children (and adults) with ADHD on a rater based level. It is strongly debated if this reflects ADHD inherent sleep symptoms, closely connected mechanisms (like circadian rhythm delay) or rather an ADHD phenotype during the day in sequel of sleep disorders.
    Objective (a. e. polysomnography) data do not coherently demonstrate systematic sleep impairment in ADHD, some studies do not find altered sleep at all. On the other hand, sleep disorders mistaken for ADHD (esp. breathing problems) are described (1,2,3).
    The authors conclude that impaired sleep duration may somewhat forecast behavioral conditions in child (boys) development. ADHD is among the “behavioral” conditions measured and known to be more often diagnosed in boys. Very interestingly behavioral (or emotional conditions) did not precede shortened sleep duration in the presented cohort. I would like to cautiously discuss these findings in favor of the idea that sleep conditions beginning in childhood might lead to an ADHD diagnosis in a relevant number of boys and second that a shortened sleep duration is not systematically inherent to conditions like ADHD the other way round. I wonder if light can be shed on this hen egg dilemma via subgroup analyses of the ADHD cases of the cohort only.

    1. https:// doi:10.1037/bul0000053
    2. https://doi.org/10.1016/j.smrv.2011.07.001
    3. https://doi.org/10.1016/j.bj.2018.10.004
    CONFLICT OF INTEREST: Participation 2019: Advisory Board Shire/ Takeda.
    Original Investigation
    December 27, 2019

    Association Between Objectively Measured Sleep Duration and Symptoms of Psychiatric Disorders in Middle Childhood

    Author Affiliations
    • 1Department of Psychology, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
    • 2Department of Child and Adolescent Psychiatry, St Olavs Hospital, Trondheim, Norway
    • 3NTNU Social Research, Human Development Department, Trondheim, Norway
    • 4Department of Psychosocial Science, University of Bergen, Bergen, Norway
    • 5Norwegian Competence Center for Sleep Disorders, Haukeland University Hospital, Bergen, Norway
    JAMA Netw Open. 2019;2(12):e1918281. doi:10.1001/jamanetworkopen.2019.18281
    Key Points español 中文 (chinese)

    Question  What is the long-term and bidirectional association between sleep duration and symptoms of psychiatric disorders in school-aged children?

    Findings  In this population-based cohort study of 799 Norwegian children participating in the Trondheim Early Secure Study, when all time-invariant confounders and baseline levels of study variables were accounted for, short sleep duration was prospectively associated with symptoms of psychiatric disorders at younger but not older ages. No evidence was found for the opposite direction of association.

    Meaning  This study found that short sleep duration was associated with the development of symptoms of psychiatric disorders, but symptoms of psychiatric disorders were not associated with reduced sleep.


    Importance  The long-term association between sleep duration and mental health in children is currently unknown.

    Objective  To investigate the prospective associations between sleep duration and symptoms of emotional and behavioral disorders at ages 6, 8, 10, and 12 years.

    Design, Setting, and Participants  This population-based cohort study obtained data from the Trondheim Early Secure Study in Trondheim, Norway. A representative, stratified random sample of children born between January 1, 2003, and December 31, 2004, were invited to participate. Participants were followed up biennially from age 4 years (2007-2008) to 12 years (2013-2014). Data analysis was conducted from January 2, 2019, to May 28, 2019.

    Main Outcomes and Measures  Sleep duration was assessed with 1 week of continuous use of a triaxial accelerometer. Symptoms of emotional (anxiety and depression) and behavioral (oppositional defiant, conduct, and attention-deficit/hyperactivity) disorders were measured by semistructured clinical interviews (using the Preschool Age Psychiatric Assessment and the Child and Adolescent Psychiatric Assessment) with parents (at all ages) and children (from age 8 years).

    Results  The analytical sample comprised 799 children (mean [SD] age at time point 2, 6.0 [0.2] years; 405 [50.7%] boys; and 771 [96.5%] Norwegian). Shorter sleep duration at age 6 years (β [unstandardized regression coefficient] = −0.44; 95% CI, −0.80 to −0.08; P = .02) and 8 years (β = −0.47; 95% CI, −0.83 to −0.11; P = .01) forecasted symptoms of emotional disorders 2 years later. Comparatively short sleep duration at age 8 years (β = −0.65; 95% CI, −1.22 to −0.08; P = .03) and 10 years (β = −0.58; 95% CI, −1.07 to −0.08; P = .02) was associated with symptoms of behavioral disorders 2 years later among boys but not among girls at age 8 years (β = −0.14; 95% CI,− 0.52 to 0.24; P = .48) or 10 years (β = −0.05; 95% CI, = −0.49 to 0.40; P = .84). These associations were statistically significant among boys compared with girls at age 8 years (Δχ21 = 13.26; P < .001) and 10 years (Δχ21 = 10.25; P = .001). Symptoms of psychiatric disorders did not forecast sleep duration at any age.

    Conclusions and Relevance  This study found an association between short sleep duration and increased risk of future occurrence of emotional disorder symptoms in both boys and girls and between reduced sleep and behavioral disorder symptoms in boys. These results suggest that improving sleep in children may help protect against the development of symptoms of common psychiatric disorders and may be advantageous in the treatment of such disorders.