Abstract
BACKGROUND: Attention Deficit Hyperactivity Disorder (ADHD) in adults is characterized by cognitive, behavioral and affective symptoms. Emotion dysregulation (ED), psychiatric comorbidities, and disturbances in sleep and circadian rhythms frequently co-occur with ADHD, yet their relationships have rarely been investigated using objective measures and are overlooked in therapeutic approaches. This study aimed to compare sleep and rest-activity rhythm parameters between adults with ADHD and control subjects and to examine their associations with cognitive and emotional symptoms in adults with ADHD. METHODS: Fifty-four adults with ADHD completed self-report questionnaires assessing inattention, hyperactivity/impulsivity, and emotional symptoms of ADHD, along with a neuropsychological evaluation of attentional and executive functions. Sleep patterns and rest-activity rhythm were monitored using actigraphy over a 10-days period and compared to data from 47 control participants without psychiatric or neurodevelopmental disorders, adjusting for age and sex. Relationships between ADHD symptoms, neuropsychological test results, sleep and rest-activity rhythm parameters were examined using correlation analyses. RESULTS: Adults with ADHD exhibited a more unstable and delayed rhythm compared to controls. Sleep and rest-activity rhythm disturbances were significantly associated with cognitive and behavioral symptoms, particularly hyperactivity. Longer sleep latency was associated with poorer selective attention, while shorter total sleep time was linked to deficits in inhibitory control. However, no significant associations were found between sleep, circadian rhythms, and ED symptoms and the majority of observed correlations were no longer significant after correction for multiple comparisons. CONCLUSIONS: These findings highlight the intricate interplay between sleep and circadian rhythm disturbances and the core symptoms of ADHD, emphasizing the need to consider sleep and circadian rhythms interventions in the management of core ADHD symptoms in adults. TRIAL REGISTRATION: The study involving adults with ADHD, Emotional Dysregulation and Cyclothymia in Adult Patients With ADHD (EMO-TDA), was registered at ClinicalTrials.gov (Identifier: NCT03494478) on April 11, 2018. The study involving control participants, Influence of Light on Sleep, Awakening, Electroencephalogram (EEG) and Cognitive Performances, and Medical Technology Assessment for Registration and Long-term EEG Analysis (CHRONOSOMNO), was registered at ClinicalTrials.gov (Identifier: NCT02858765) on August 8, 2016.