(PS11-A17) Examining the Association Between Daily Stimulant Medication Use and Sleep in Adolescents with ADHD

Previous research has documented stimulant medication use to be associated with longer sleep onset latency (SOL) and shorter total sleep time (TST) in youth with attention-deficit/hyperactivity disorder (ADHD), over and above baseline sleep difficulties associated with ADHD symptoms. Stimulant-related sleep disturbances are more likely to occur following medication initiation or an increase in dose, improving as individuals adjust to the new medication/dosage. However, some studies have found no differences in sleep between medicated and unmedicated youth with ADHD, and less is known about the impact of medication use among individuals on stable medication doses. No study has used daily medication use and daily sleep measures to examine associations between stimulant use and sleep. Accordingly, the present study examined sleep differences in adolescents with ADHD using stimulant medication with varied treatment adherence over a two-week period. We also examined sleep differences by general receipt of stimulant treatment, as adolescents receiving treatment may have disrupted sleep for reasons (e.g., ADHD severity) that are not attributable to the medication itself.

Caregivers and adolescents (N=159, ages 13-14, diagnosed with ADHD) completed baseline clinical interviews along with daily diaries over two weeks following their baseline visit. Diaries assessed adolescent-reported stimulant use, daytime sleepiness severity, bedtime, SOL, and TST, as well as adolescent- and caregiver-reported difficulty waking the following morning. Measures of sleep onset time, TST, and sleep efficiency (SE; defined by TST/total time in bed) were also collected via actigraphy over the two-week period. 92 (57.86%) adolescents were receiving stimulant treatment (N=47 amphetamines, N=45 methylphenidate). Average age of medication initiation was 8 years old (range: 3-13 years, median: 8 years). We used Dynamic Structural Equation Modeling to handle within-subjects repeated measurement. Because within-individual estimation uses each person as their own control, time-invariant confounds (e.g., sex) are inherently adjusted for.  We adjusted for day of the week (school nights/non-school nights), as medication use and sleep often differ on school nights vs. non-school nights.

Sleep outcomes did not differ between adolescents with ADHD who were or were not prescribed stimulant medication. Among adolescents taking stimulant medication, shorter TST was observed on medicated compared to unmedicated days, with findings consistent across adolescent-reported (b=-0.198, p=.011) and actigraphy-measured (b=-12.716, p=.006) TST. We did not observe statistically significant differences for other sleep outcomes as a function of daily medication use.

Findings suggest that stimulant medication use may impact TST even among adolescents with ADHD who may have been receiving stable stimulant treatment for long periods of time (e.g., years). We did not observe statistically significant differences for other important sleep indices, such as SOL, SE, and difficulty waking the next morning. Our findings support recommendations to monitor sleep among youth with ADHD.