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Prevalence of sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD across the lifespan: a Swedish nationwide register-based study
Örebro University, School of Medical Sciences.ORCID iD: 0000-0003-4206-8401
Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.ORCID iD: 0000-0002-4811-2330
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
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2023 (English)In: BMJ Mental Health, E-ISSN 2755-9734, Vol. 26, no 1, article id e300809Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Consistent evidence suggests a strong association between attention-deficit/hyperactivity disorder (ADHD) and subjectively reported sleep problems. However, the prevalence of clinically ascertained sleep disorder diagnoses and sleep medication prescriptions in individuals with ADHD remains unclear.

OBJECTIVE: To determine the rates of sleep disorder diagnoses and sleep medication prescriptions in children, adolescents and adults with ADHD.

METHODS: We linked Swedish national registers to create a cohort of individuals born 1945-2008. We estimated the absolute and relative risks (using logistic regression models) of different sleep disorder diagnoses and medication prescriptions in individuals with and without ADHD. The analyses were performed across five different age groups: children (5-11 years), adolescents (12-17 years), young adults (18-30 years), middle-aged adults (31-45 years) and older adults (46-60 years).

FINDINGS: Among individuals with ADHD (N=145 490, 2.25% of the cohort), 7.5% had a sleep disorder diagnosis and 47.5% had been prescribed sleep medication. Individuals with ADHD, across all age groups, had a statistically significantly increased risk of having any sleep disorder diagnosis (ORrange=6.4-16.1) and any sleep medication prescription (ORrange=12.0-129.4) compared with individuals without ADHD. While rates of sleep disorders were highest in older adults, the relative risks were highest in youth.

CONCLUSIONS: Individuals with ADHD have a substantially increased risk of sleep disorder diagnoses and sleep medication prescriptions, from childhood into older adulthood.

CLINICAL IMPLICATIONS: More clinical efforts are needed to tackle impairing sleep problems in individuals with ADHD via systematic sleep assessment, appropriate diagnosis, and pharmacological and non-pharmacological interventions. Sleep medication use should be informed by sleep disorder diagnosis.

Place, publisher, year, edition, pages
BMJ Publishing Group Ltd, 2023. Vol. 26, no 1, article id e300809
Keywords [en]
Adult psychiatry, Child & adolescent psychiatry
National Category
Psychiatry
Identifiers
URN: urn:nbn:se:oru:diva-108032DOI: 10.1136/bmjment-2023-300809ISI: 001062126100001PubMedID: 37657817Scopus ID: 2-s2.0-85169514679OAI: oai:DiVA.org:oru-108032DiVA, id: diva2:1793897
Funder
Swedish Research Council, 2018-02599 2022-01119 2017-00788The Swedish Brain Foundation, FO2021-0115 FO2022-0327Forte, Swedish Research Council for Health, Working Life and Welfare, 2022-00126Stiftelsen Söderström - Königska sjukhemmet, SLS-969059Region Stockholm, 2018-0718Swedish Society for Medical Research (SSMF), PD20-0036
Note

Funding agency:

Ingrid Thurings Stiftelse 2021-0063

The Strategic Research Area in Epidemiology and Biostatistics (SFOepi)

European Research Agency 101095568 -HORIZON-HLTH-2022-DISEASE-07-03

National Institute for Health and Care Research NIHR203684 NIHR203035 NIHR130077 NIHR128472 RP-PG-0618-20003

Available from: 2023-09-04 Created: 2023-09-04 Last updated: 2025-02-12Bibliographically approved
In thesis
1. The extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why?
Open this publication in new window or tab >>The extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why?
2025 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism (ASD) are two neurodevelopmental conditions with early onset in the developmental period, high heritability and relatively high stability through the lifespan. The evi-dence base for these findings is considerable. Less researched, however, is the extent to which neurodevelopmental conditions are associated with func-tional and physical outcomes. The impact of ADHD/ASD on physical out-comes like height, obesity, and real-life functional outcomes such as relational instability, job shifting, and residential moves remain unclear. There is also a knowledge gap to what extent there is sex differences in these associations and if the associations are present through the life span. And lastly, a detailed un-derstanding about why these associations is present is also lacking. The overarching goal of this thesis was therefore to advance the understanding of the extent to which neurodevelopmental disorders are associated with functional and physical outcomes, and why. In study I-IV, we used data from Swedish population registers. We found that individuals with ASD and their relatives are at increased risk for obesity, and that the risk is partly familial in nature (study I). Further, our findings suggest that ADHD, rather than ADHD medication, is associated with shorter height and that the association between ADHD and shorter height is partly due to a shared familial liability (study II). We also found that both men and women (from young to older adulthood) with ADHD have a higher rate of residential moves, relational instability and job shifting (study III). Finally, we found that individuals with ADHD have an increased risk of sleeping disorders, from childhood to older adulthood (study IV).

The findings from this thesis highlight the importance of a life-span per-spective of neurodevelopmental disorders, and importantly - a focus that ex-tends beyond the core ADHD symptoms to include psychiatric and physical comorbidity as well as real-life functional outcomes. Thus, our findings also point to the need for integrated care between psychiatric and physical care and helping people with neurodevelopmental conditions to navigate across health care and social systems for their functional and physical problems.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2025. p. 76
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 314
Keywords
ADHD, Autism, Functional impairments, Somatic problems
National Category
General Practice
Identifiers
urn:nbn:se:oru:diva-117316 (URN)9789175296289 (ISBN)9789175296296 (ISBN)
Public defence
2025-03-06, Örebro universitet, Campus USÖ, hörsal X1, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2024-11-13 Created: 2024-11-13 Last updated: 2025-03-06Bibliographically approved

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Ahlberg, RickardGarcia-Argibay, MiguelLarsson, Henrik

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