Sleep Dysfunction and Neurocognitive Outcomes in Adolescent ADHD

摘要 这个K23指导的以患者为导向的研究职业发展奖的目标是扩大 候选人在睡眠障碍和神经认知方面的专业知识， 缺陷/多动障碍（ADHD）。青春期的ADHD经常预示着有害的学业 和社会成果。在某种程度上，功能不良可能是由于在ADHD中观察到的神经认知缺陷; 然而，这些缺陷的程度是可变的，导致更大损害的机制是， 有些人而不是另一些人知之甚少。睡眠障碍是一个潜在的因素 注意力缺陷多动障碍的青少年中观察到的神经认知异常。具体来说，睡眠障碍是 在ADHD中普遍存在，并且核心ADHD特征和神经认知功能之间存在相当大的重叠。 睡眠障碍的相关因素。然而，睡眠生理学和可变的临床和 ADHD青少年的神经认知结果还有待研究。拟议K23的培训目标 将包括获得先进的实验室管理，评分和分析的专业知识， 多导睡眠图数据，评估ADHD患者睡眠障碍的神经认知和临床相关性， 并增强了对典型发展中和ADHD患者睡眠功能发展轨迹的理解 青少年。这些目标将通过指导，研究和课程来实现，这将导致一个 一项独立资助的研究计划，旨在阐明睡眠问题背后的生物机制 和神经认知障碍，并开发创新的基于睡眠的干预措施， 这个人群的症状。Scott Kollins博士是本申请的主要导师，他在以下方面有着良好的记录： 评估ADHD临床和神经认知结果的临床研究。他是一个建立在 申请人将接受培训的研究培训地点。研究计划包括使用多导睡眠图， 评估ADHD青少年和健康对照组（HC）的睡眠障碍和神经认知结果。 主要假设预测，患有ADHD的青少年将表现出持续时间缩短，潜伏期增加， 与HC相比，增加了夜间觉醒，降低了Delta功率，并扰乱了睡眠纺锤波。 预测组内的变异性，我们将探讨是否有不同的亚组， ADHD组的睡眠问题。此外，睡眠障碍预计与较差的 ADHD青少年的神经认知和临床表现。如果这些假设得到支持， 可能代表ADHD表型亚型的生物标志物。此外，检查这个结构 可能会为预防和干预策略的制定提供信息，这些策略可能会影响睡眠 注意力缺陷多动障碍的核心症状。

ABSTRACT The goal of this K23 Mentored Patient-Oriented Research Career Development Award is to broaden the candidate’s expertise in sleep disturbance and neurocognition in adolescents with Attention- Deficit/Hyperactivity Disorder (ADHD). ADHD in adolescence is frequently predictive of detrimental academic and social outcomes. In part, poor functioning may be due to neurocognitive deficits observed in ADHD; however, the extent of these deficits is variable and the mechanisms contributing to greater impairment in some individuals and not others are poorly understood. Sleep disturbance represents one potential contributor to the neurocognitive abnormalities observed in a subset of youth with ADHD. Specifically, disturbed sleep is prevalent in ADHD and there is considerable overlap between core ADHD features and the neurocognitive correlates of sleep impairment. However, associations between sleep physiology and variable clinical and neurocognitive outcomes in ADHD youth have yet to be investigated. Training objectives for the proposed K23 will include gaining expertise in advanced laboratory-based administration, scoring, and analysis of polysomnographic data, assessment of neurocognitive and clinical correlates of sleep impairment in ADHD, and enhanced understanding of developmental trajectories of sleep function in typically developing and ADHD adolescents. These objectives will be met through mentoring, research, and coursework, which will result in an independently funded program of research to elucidate the biological mechanisms underlying sleep problems and neurocognitive impairment in ADHD and develop innovative sleep-based interventions targeting core symptoms in this population. Dr. Scott Kollins, the primary mentor for this application, has a strong record of clinical research assessing clinical and neurocognitive outcomes in ADHD. He is the director of the established research training site where the applicant will be trained. The research plan involves using polysomnography to assess sleep disturbance and neurocognitive outcomes in adolescents with ADHD and healthy controls (HC). The primary hypothesis predicts that adolescents with ADHD will display reduced duration, increased latency, increased nocturnal awakenings, reduced delta power, and disrupted sleep spindles compared to HC. Variability within groups is predicted, and we will explore whether there are distinct subgroups with and without sleep problems within the ADHD group. In addition, sleep disturbance is predicted to be associated with poorer neurocognitive and clinical presentations in ADHD adolescents. If these hypotheses are supported, sleep disturbance may represent a biomarker for phenotypic subtypes of ADHD. In addition, examining this construct may inform development of prevention and intervention strategies with the potential to impact sleep disturbance as well as core symptoms of ADHD in adolescents.