Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Gamble, Karen L.; May, Roberta S.; Besing, Rachel C.; Tankersly, Amelia P.; Fargason, Rachel E.

doi:10.3109/07420528.2012.754454

Cited by 64Sleep and related disordersAttention Deficit Hyperactivity DisorderCircadian rhythm and melatonin

Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

Gamble, Karen L., May, Roberta S., Besing, Rachel C., Tankersly, Amelia P., Fargason, Rachel E.·2013·Chronobiology International

DOI 10.3109/07420528.2012.754454

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Abstract

Patients with attention-deficit/hyperactivity disorder (ADHD) often exhibit disrupted sleep and circadian rhythms. Determination of whether sleep disturbance and/or circadian disruption are differentially associated with symptom severity is necessary to guide development of future treatment strategies. Therefore, we measured sleep and ADHD symptoms in participants aged 19-65 who met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision) criteria for ADHD and insomnia without psychiatric comorbidities by monitoring actigraphy and daily sleep logs for 2 wks, as well as the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), the ADHD Rating Scale (ADHD-RS), and a clinic-designed sleep behavior questionnaire. Principal components analysis identified correlated circadian- and sleep-related variables in all participants with ADHD who completed the study (n = 24). The identified components were entered into a backwards stepwise linear regression analysis, which indicated that delayed sleep timing and increased sleepiness (ESS) (but not sleep duration or sleep efficiency) significantly predicted greater severity of both hyperactive-impulsive and inattentive ADHD symptoms (p < .05 for partial regression coefficients). In addition, combined subtypes had the most impaired age-adjusted sleep quality (PSQI scores; p < .05 compared with healthy controls; n = 13), and 91.7% of them reported going to bed late due to being "not tired/too keyed up to sleep" compared with 57.2% and 50% of inattentive and symptom-controlled participants, respectively (p < .05). In conclusion, the results of this study suggest that ADHD symptom severity correlates with delayed sleep timing and daytime sleepiness, suggesting that treatment interventions aimed at advancing circadian phase may improve daytime sleepiness. In addition, ADHD adults with combined hyperactive-impulsive and inattentive symptoms have decreased sleep quality as well as the delayed sleep timing of predominately inattentive subtypes.

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In 24 adults with ADHD, the rest/activity cycle was delayed.
“Gamble et al. report (2013) in 24 adults with ADHD that the rest/activity cycle was delayed and that this delay was correlated positively to the severity of the ADHD symptoms.”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Gamble et al. (2013)
In 24 adults with ADHD, the delay in rest/activity cycle was correlated positively to the severity of ADHD symptoms.
“Gamble et al. report (2013) in 24 adults with ADHD that the rest/activity cycle was delayed and that this delay was correlated positively to the severity of the ADHD symptoms.”
From A systematic review of circadian function, chronotype and chronotherapy in attention deficit hyperactivity disorder (2017) · cites this paper as Gamble et al. (2013)

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Authors: Gamble, K. L., May, R. S., Besing, R. C., Tankersly, A. P., & Fargason, R. E.
Affiliations: University of Alabama at Birmingham (US)
Corresponding author: Fargason, Rachel E.
ORCID: Gamble, Karen L.
Venue: Chronobiology International
Publisher: Informa UK Limited
Published: 2013-02-27
Volume: 30
Issue: 4
Pages: 598-606
ISSN: 0742-0528 (ISSN-L)
1525-6073
DOI: 10.3109/07420528.2012.754454
OpenAlex: W2075126198
Cited by: 64
References: 32
Citations by year: 2026: 2 · 2025: 2 · 2024: 5 · 2023: 2 · 2022: 6 · 2021: 6 · 2020: 8 · 2019: 7 · 2018: 4 · 2017: 4 · 2016: 7 · 2015: 2 · 2014: 7 · 2013: 2
FWCI: 8.13
Type: journal article
Language: en
Open access: closed
Locations: Chronobiology International (publishedVersion)
PubMed (publishedVersion)
Funders: Takeda Pharmaceuticals North America
Topics: Social Sciences › Psychology › Experimental and Cognitive Psychology › Sleep and related disorders
Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
Life Sciences › Neuroscience › Endocrine and Autonomic Systems › Circadian rhythm and melatonin
Keywords: attention deficit hyperactivity disorder, circadian rhythm disruption, sleep disorders, daytime sleepiness, sleep quality, hyperactive-impulsive symptoms, inattentive symptoms, adult ADHD, actigraphy, Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale
MeSH terms: Adult, Central Nervous System Stimulants, Attention Deficit Disorder with Hyperactivity, Double-Blind Method, Humans, Indenes, Sleep, Sleep Wake Disorders

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Delayed Sleep Timing and Symptoms in Adults With Attention-Deficit/Hyperactivity Disorder: A Controlled Actigraphy Study

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