Cognitive and Behavioral Effects of Sleep Restriction in Adolescents with ADHD

 描述（由申请人提供）：注意力缺陷/多动障碍（ADHD）青少年的睡眠时间比同龄人少，高达75%的ADHD青少年睡眠不足。这是值得注意的，因为睡眠不足与典型发育中的青少年的许多负面结果有关，包括学业成绩不佳，情绪失调和心理健康问题-所有这些结果在患有ADHD的青少年中发生率较高。我们的试点工作表明，睡眠不足与患有ADHD的青少年的抑郁症，行为问题和学业障碍有关，睡眠不足显然与典型青少年的注意力问题有关。然而，没有实验研究已经检查了睡眠时间是否与被诊断患有ADHD的青少年的注意力，行为，情绪和学业障碍有因果关系。如果睡眠问题导致ADHD青少年的功能障碍，那么它们代表了一个被忽视的治疗目标。实验研究提供了最强有力的因果关系检验，在没有多动症的青少年中使用家庭睡眠限制协议的研究显示，睡眠时间缩短与损害之间存在因果关系。然而，对于患有ADHD的青少年来说，管理家庭睡眠限制协议可能特别具有挑战性，因为他们很难组织睡前和唤醒活动，以及与健康青少年在生物昼夜节律偏好方面的差异。因此，研究睡眠与疾病之间的因果关系， 对患有多动症的青少年进行的一项研究记录了在这一人群中使用家庭睡眠限制协议的可行性。我们建议（1）评估在ADHD青少年中使用家庭睡眠限制方案的可行性，以及（2）收集初步数据，检查缩短的睡眠时间是否与ADHD青少年的注意力，行为，情绪和学业障碍有因果关系。这些目标将通过招募54名患有ADHD的青少年来实现，他们将接受为期三周的睡眠操纵协议。具体而言，将使用交叉设计，包括一周的典型睡眠，随后是数周的睡眠限制或睡眠延长。在这三周内，将通过每日睡眠日记和客观睡眠测量（即，活动记录法）。在每一个睡眠条件后，青少年和他们的父母将完成注意力，行为，情绪和学业的主观和客观测量。这项研究的结果将使我们能够识别和解决对患有ADHD的青少年实施在家睡眠限制和延长协议的障碍，并进行更大规模的实验研究，研究睡眠问题与损害的因果关系。这项研究具有临床意义，因为患有ADHD的青少年经常会经历一系列的障碍，这些障碍一直延伸到成年。如果睡眠时间短导致ADHD青少年的功能障碍，那么睡眠代表了一个可修改和被忽视的治疗目标。这项研究计划的长期目标是确定睡眠问题是否以及如何导致损害，并成为ADHD青少年的重要治疗目标。

 DESCRIPTION (provided by applicant): Teens with attention-deficit/hyperactivity disorder (ADHD) obtain less sleep than their peers, with up to 75% of youth with ADHD obtaining insufficient sleep. This is noteworthy since insufficient sleep is associated with a multitude of negative outcomes in typically developing teens, including academic underachievement, emotion dysregulation, and mental health problems - all outcomes that occur at higher rates among teens with ADHD. Our pilot work demonstrates that insufficient sleep is correlated with depression, behavior problems, and academic impairment in teens with ADHD specifically and insufficient sleep is clearly associated with greater attentional problems in typical teens. However, no experimental study has examined whether sleep duration is causally linked to attentional, behavioral, emotional, and academic impairments in teens diagnosed with ADHD. If sleep problems contribute to functional impairments in teens with ADHD, then they represent an overlooked treatment target. Experimental studies provide the strongest test of causality, and studies using at- home sleep restriction protocols in teens without ADHD show a causal link between shortened sleep duration and impairment. However, administering an at-home sleep restriction protocol may be especially challenging for teens with ADHD due to their difficulties with organizing bedtime and wake activities, as well as differences from healthy teens in biological circadian preference. Thus, a critical first step in examining sleep as causally related to impairment in teens with ADHD is documenting the feasibility of using an at-home sleep restriction protocol with this population. We propose to (1) evaluate the feasibility of using an a-home sleep restriction protocol in teens with ADHD, and (2) collect preliminary data examining whether shortened sleep duration is causally linked to attentional, behavioral, emotional, and academic impairment in teens with ADHD. These goals will be accomplished by recruiting 54 teens with ADHD who will undergo a three-week sleep manipulation protocol. Specifically, a cross-over design will be used that includes a week of typical sleep followed by weeks of sleep restriction or sleep extension. Sleep functioning will be assessed during these three weeks with daily sleep diary and objective sleep measurement (i.e., actigraphy). After each sleep condition, teens and their parents will complete subjective and objective measures of attention, behavior, mood, and academics. Findings from this study will allow us to identify and address barriers to administering an at-home sleep restriction and extension protocol to teens with ADHD and pursue larger-scale experimental research examining sleep problems as causally linked to impairment. This research is clinically significant since teens with ADHD frequently experience a range of impairments that extend well into adulthood. If short sleep duration contributes to functional impairments in teens with ADHD, then sleep represents a modifiable and overlooked treatment target. The long-term goal of this research program is to identify whether and how sleep problems contribute to impairment and are an important treatment target in teens with ADHD.