Association between sleep duration and attention-deficit hyperactivity disorder: A systematic review and meta-analysis of observational studies✰.


Department of Family Medicine, Myongji Hospital, Hanyang University College of Medicine, Goyang, Gyeonggi Province, Republic of Korea. Electronic address: [Email]


BACKGROUND : Several previous meta-analyses have investigated the association between sleep quality and attention-deficit/hyperactivity disorder (ADHD). To examine the relationship between short or long sleep duration and ADHD, a meta-analysis of observational studies was conducted.
METHODS : The PubMed, EMBASE, and Cochrane Library databases were systematically searched in March 2019 to retrieve observational studies. A random-effects model was used to analyze meta-estimates of sleep duration. Three evaluators independently reviewed and selected the articles based on pre-determined selection criteria.
RESULTS : Of 1466 articles retrieved, 10 observational epidemiological studies, comprising six case-control studies and four prospective cohort studies, were included in the final analysis. Short sleep duration was significantly linked to ADHD compared with average sleep duration (odds ratio [OR] or relative risk [RR] 1.28 [95% confidence interval (CI) 1.16-1.41]), and especially with hyperactivity (OR/RR 1.60 [95% CI 1.18-2.17]). Subgroup meta-analyses according to various factors, such as study design, number of participants, methodological quality, and adjustment for smoking status and education, yielded consistent results. A significant association between long sleep duration and ADHD was not observed.
CONCLUSIONS : Publication bias and substantial heterogeneity due to the diverse measurement tools used to determine ADHD were observed. Lack of prospective cohort studies was another limitation.
CONCLUSIONS : Short sleep duration was associated with ADHD in the current meta-analysis. Clinicians may need to be more aware of this association.


Attention-deficit/hyperactivity disorder,Long sleep duration,Meta-analysis,Observational study,Short sleep duration,

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