Does excessive daytime sleepiness contribute to explaining the association between obesity and ADHD symptoms?
Introduction
Attention-deficit/hyperactivity disorder (ADHD) is one of the most common and impairing childhood psychiatric conditions, estimated to affect 5–10% of school-aged children [1]. According to the Diagnostic and Statistical Manual of Mental Disorders-4th edition (DSM-IV) [2], ADHD is characterized by pervasive and developmentally inappropriate symptoms of inattention and/or impulsivity-hyperactivity. Impairing symptoms of ADHD may persist into adulthood in up to 60% of cases [3]. ADHD is frequently associated with psychiatric and developmental disorders such as oppositional defiant disorder, conduct disorder, anxiety disorders, depressive disorders, speech and learning disorders [4], [5].
Although overlooked in the past, a significant association between ADHD/ADHD traits and obesity has been suggested by recent empirically based evidence, both from clinical [6], [7], [8], [9], [10], [11] and epidemiological studies [12], [13]. The factors underlying this newly described comorbidity are still unclear and unexplored. In a previous paper published in this Journal, Bazar et al. [14] suggested that an excess of exogenously supplied information predisposes to both obesity and ADHD. In the present article, we propose another hypothesis, i.e., that excessive daytime sleepiness (EDS) contributes to explaining the association between ADHD and obesity.
Section snippets
ADHD and EDS
In recent years there has been a growing interest in the relationship between EDS and ADHD behaviors. EDS has been assessed both with “subjective measures”, i.e., questionnaires on sleep and alertness, and “objective methods”, i.e., polysomnographic measures provided by the multiple sleep latency test (MSLT). (The MSLT consists of four or five 20–30 min nap opportunities given at 2 h intervals during the day; the basic parameters measured are latency to sleep onset and latency to rapid eye
The hypothesis
Given the association between EDS and ADHD behaviors, we hypothesize that the higher than expected rates of EDS in obese individuals contribute to explaining the comorbidity between obesity and ADHD traits (i.e., inattention, hyperactivity, and impulsivity). To our knowledge, currently, no studies have explored this hypothesis. Therefore, we believe that studies assessing the relationship between EDS and ADHD behaviours in obese subjects using both subjective and objective measures of EDS
Implications
Our hypothesis generates potentially relevant clinical and therapeutic implications for the management of ADHD and obesity when coexisting.
Conclusion
In light of the personal and social burden that comorbid ADHD adds to obesity and considering that the treatment of ADHD might actually improve the management of obesity itself, we think that further studies on this comorbidity are necessary. Research on the role of EDS might allow advancements in this field. Studies assessing the relationship between EDS (measured both with subjective and objective methods) and ADHD in obese subjects as well as investigations in the potential molecular
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Sleep and ADHD: What we know and what we do not know
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