The management of sleep disturbances in children with attention-deficit/hyperactivity disorder (ADHD): an update of the literature

Sleep disorders represent an important comorbidity in individuals with ADHD. While the links between ADHD and sleep disturbances have been extensively investigated, research on the management of sleep disorders in individuals with ADHD is relatively limited, albeit expanding. The authors searched PubMed, Medline, PsycInfo, Embase+Embase Classic, Web of Sciences databases, and clinicaltrials.gov up to 4 January 2024, for randomized controlled trials (RCTs) of any intervention for sleep disorders associated with ADHD. They retained 16 RCTs (eight on pharmacological and eight on non-pharmacological interventions), supporting behavioral intervention and melatonin, and nine ongoing RCTs registered on clinicaltrials.gov. The pool of RCTs testing interventions for sleep disorders in individuals with ADHD is expanding. However, to inform clinical guidelines, there is a need for additional research in several areas, including 1) RCTs based on a precise phenotyping of sleep disorders; 2) pragmatic RCTs recruiting neurodevelopmental populations representative of those seen in clinical services; 3) trials testing alternative interventions (e.g. suvorexant or light therapy) or ways to deliver them (e.g. online); 4) sequential and longer-term RCTs; 5) studies testing the impact of sleep interventions on outcomes other than sleep; 6) and implementation of advanced evidence synthesis and precision medicine approaches.

睡眠障碍是注意缺陷多动障碍（Attention Deficit Hyperactivity Disorder, ADHD）患者的重要共病。尽管学界已对ADHD与睡眠障碍之间的关联开展了大量研究，但针对ADHD患者睡眠障碍管理的相关研究虽呈扩张趋势，整体仍相对有限。作者检索了截至2024年1月4日的PubMed、Medline、PsycInfo、Embase+Embase Classic、Web of Science数据库以及ClinicalTrials.gov平台，搜集所有针对ADHD相关睡眠障碍干预措施的随机对照试验（Randomized Controlled Trial, RCTs）。最终纳入16项RCTs（其中8项针对药物干预，8项针对非药物干预），研究结果支持行为干预与褪黑素的应用；同时在ClinicalTrials.gov平台上另有9项正在进行的RCTs注册信息。针对ADHD患者睡眠障碍干预措施的RCTs研究正不断扩充。然而，若要为临床指南提供循证依据，仍需在多个领域开展进一步研究，包括：1）基于睡眠障碍精准表型分型的RCTs；2）招募符合临床服务中常见神经发育群体的实用型RCTs；3）测试替代干预措施（如苏沃雷生或光疗）或其实施方式（如线上干预）的试验；4）序贯性及长期随访的RCTs；5）评估睡眠干预对睡眠以外其他结局指标影响的研究；6）先进证据综合与精准医学方法的落地应用。