الفهرس 
Introduction
Attention Deficit Hyperactivity Disorder (ADHD)Only 14 pages are availabe for public view
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Abstract
In the past two decades, Attention Deficit Hyperactivity Disorder became one of the most recognized disorders. ADHD is a mental disorder of the neurodevelopmental type. Sleep and ADHD relationship is a complex and unclear process, remains a debate point in literature, and the results of prior research were controversial. In light of this evidence, the current study investigated sleep profile differences in children with ADHD, either subjectively or objectively. Moreover, we are interested in gaining an insight into the relation of different sleep problems with symptoms of ADHD. Additionally, the current study examined the most predicting and contributing factors of different sleep parameters on different domains of quality of life and cognitive functions, especially attention and inhibitory control, after controlling the confounding factors (medication, comorbidity, IQ level). The current study was an observational case-control study, a registered clinical trial (NCT03737552) conducted at “Okasha institute of Psychiatry”, Ain shams Psychiatric institute, Neurology, and Psychiatry department, Ain shams University Hospitals, Ain Shams University, between 1st of May 2019 and 1st of September 2020. After applying inclusion and exclusion criteria, eighty-four participants were enrolled in the study, recruited from child psychiatry outpatients clinic, aged (6-12 years), divided into 2 groups; ADHD and control groups. Firstly, children were diagnosed with ADHD based on DSM-5- criteria, structural interviews with parents and children (Mini-Kids), also symptoms were quantified by (CPRS-L). Then, all participants were subjected to a full sleep study assessment subjectively (CSHQ) and objectively (PSG). After that, parents completed (PedsQL-P) to assess different domains of quality of life among their children. Finally, continuous performance task (CPT) evaluated children’s cognitive performance especially attention and inhibitory control Our major findings could be summarized into the following: Male patients were predominant 29 (69.0%), combined ADHD subtype was more prevalent 23 (54.8%). Also, most of the ADHD sample was drug naïve 32(76.2%) and free of comorbidity 30(71.4%).ADHD patients had moderate to a marked increase in different scores of Conner’s parent rating scale and also ADHD index. Regarding subjective sleep assessment, children with ADHD had significantly higher CSHQ subscales and total scores than the control group (P-value = 0.000). Also, 30 ADHD patients (71.4%) reported subjective sleep problems. Concerning PSG parameters, ADHD patients had a significantly lighter sleep in the form of (a significant shorter TST & lower sleep efficiency (%) (P-value = 0.000), and a longer WASO & sleep onset latency than the control group (P-value = 0.000), and longer REM latency (P-value = 0.000). Among sleep stages macrostructures, children with ADHD spent more time in the N1 sleep stage, with less time in REM and deep sleep stages (P-value = 0.000) compared to the control group. Also, ADHD patients had problems with sleep continuity (frequent arousal, higher arousal index, and longer waking time during sleep) (P-value = 0.000). There was no significant difference in A/H index, limb movement index, or PLMI between ADHD and control groups. Concerning the quality of life assessment, ADHD patients showed impairment in different areas of physical health, psychosocial health, and total quality of life score (P-value = 0.000) compared to healthy children. Also, children with ADHD had lower performance in the cognitive task (higher omission and commission errors, and longer response time) than the control group (P-value = 0.000). Despite that the different ADHD subtypes showed no significant difference among subjective sleep reports (P-value>0.05), PSG found that the combined ADHD subtype had shorter total sleep time and longer sleep onset latency than other subtypes (P-value = 0.03). Regarding sex differences among sleep habits, female ADHD patients had a higher sleep onset delay score on CSHQ than male patients (p-value = 0.048), while objective assessment failed to find any significant difference (P-value>0.05). Concerning the relation between sleep problems and ADHD symptoms, we found a significant positive correlation between problem of bedtime resistance and inattentive symptoms and a total ADHD index (P=0.018, r=0.365), (P=0.045, r= 0.310), respectively. Furthermore, there was a significant negative correlation between total sleep time (TST), sleep efficiency (%), and hyperactive symptoms (P= 0.027, r= -0.342), (P= 0.025, r= -0.345), respectively. Also, a significant negative correlation was found between short REM sleep duration, and inattentive symptoms and total ADHD index (P= 0.028, r= -0.340), (P= 0.040, r= -0.434), respectively. Interestingly, the current study found that sleep onset latency delay and parasomnia on CSHQ were the most important contributing factors of emotional functional impairment in ADHD patients (beta = -0.387, P-value = 0.007), (beta = -.0347, P-value= 0.014) respectively, and the two factors represent 34 % of emotional functional impairment. Also, parasomnia was the most important contributing factor of social functional impairment in ADHD patients (beta = -0.340, P-value = 0.027), it represents (11 %) of social functional impairment. Regarding the relation and effect of different PSG parameters on the physical health among ADHD patients, the results revealed a significant negative correlation between short total sleep time (TST), lower sleep efficiency, and physical function impairment (P= 0.029, r=-0.336), (P= 0.034, r=-0.328), respectively. Also, Sleep efficiency (%) is the most contributing and predicting factor of physical function (beta = -0.672, P-value =0.001) in ADHD patients, it represents 61 % of physical function contribution along with sleep onset latency and REM latency. One of the key findings in our study included that REM sleep duration is the most contributing and predicting factor of school function (beta = 0.863, P-value =0.000) in ADHD patients, and it represents 84% of school function contribution along with sleep onset latency, total sleep time, and sleep efficiency. Additionally, we found a significant relation between short total sleep time, and commission and omission errors among ADHD group (P= 0.000, r=-0.673), (P= 0.000, r= -0.449), respectively. Also, a strong significant relation between short REM sleep duration (min, %), and commission and omission errors among ADHD group (P= 0.000, r=-0.641), (P= 0.000, r= -0.606), respectively. Moreover, the current study reported that short REM sleep duration was the most contributing and predicting factor of commission and omission errors (beta = -0.852, P-value =0.000), (beta = -0.598, P-value =0.000) in ADHD patients, it represents 72 % of commission errors and 36 % omission errors contribution. In conclusion, the current findings show that there is sleep parameters differentiation among children with ADHD compared to healthy children, either subjectively or objectively. The PSG results indicate that children with ADHD have lower sleep duration, poor sleep quality, and REM sleep duration, which is the most contributor and predictor in quality-of-life domains, cognitive functions, and possibly a biomarker in ADHD. Also, the results provide the importance of subjective or objective sleep evaluation among children with ADHD and the proper treatment strategies of sleep problems with ADHD symptoms that help provide better QoL among those children. Finally, our recommendations include future studies that should focus on combined long-term subjective sleep habits, such as sleep diary and longitudinal objective sleep measures, to confirm the diversity of sleep patterns from night to another night. Finally, longitudinal studies are required to characterize the sleep habits of each different subtype of ADHD