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Attention-Deficit/Hyperactivity Disorder and Delayed Sleep Phase Syndrome in Adults: A Randomized Clinical Trial on the Effects of Chronotherapy on Sleep.

Journal of biological rhythms
December 1, 2022
Emma van Andel et al. (5 authors)
Randomized Controlled TrialJournal ArticleResearch Support, Non-U.S. Gov'tHuman StudyClinical
Study Details

Study Goal

The researchers aimed to determine whether melatonin (with or without bright light therapy) advanced sleep times and improved sleep quality in adults with ADHD and delayed sleep phase syndrome (DSPS), potentially explaining the reduction in ADHD symptoms.

Results Summary

Melatonin advanced the dim-light melatonin onset (DLMO) but did not advance sleep times or improve sleep quality. Combining melatonin with bright light therapy further advanced DLMO but also did not affect ADHD symptoms or sleep timing.

Population

Adults (18-55 years) with ADHD and delayed sleep phase syndrome (DSPS).

Effective Dosage

0.5 mg/day melatonin, with or without 30 minutes of bright light therapy (BLT) between 0700 and 0800 h.

Duration

3 weeks of treatment, with follow-up 2 weeks post-treatment.

Interactions

None mentioned

Extracted Claims (7)
InterventionDirectionEndpointPopulationDosageImpactClaim #
chronotherapy with melatonin
increase
dim-light melatonin onset (DLMO)
adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS)
1.5 h
effectively advanced
#1
chronotherapy with melatonin
decrease
ADHD symptoms
adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS)
14%
reduced
#2
Melatonin combined with bright light therapy (BLT)
increase
DLMO
adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS)
2 h
advanced
#3
Melatonin combined with bright light therapy (BLT)
no change
ADHD symptoms
adults with attention-deficit/hyperactivity disorder (ADHD) and delayed sleep phase syndrome (DSPS)
no significant change
did not affect
#4
Melatonin with or without BLT
no change
sleep times
49 adults (18-55 years) with ADHD and DSPS
-
did not advance
#5
Melatonin with or without BLT
no change
sleep in general
49 adults (18-55 years) with ADHD and DSPS
-
did not improve
#6
Melatonin with or without BLT
no change
wake-activity rhythms
49 adults (18-55 years) with ADHD and DSPS
-
did not strengthen
#7
Abstract

Delayed sleep phase syndrome (DSPS) is the most common sleep disturbance in adults with attention-deficit/hyperactivity disorder (ADHD). We previously showed that chronotherapy with melatonin effectively advanced the dim-light melatonin onset (DLMO), a biomarker for the internal circadian rhythm, by 1.5 h and reduced ADHD symptoms by 14%. Melatonin combined with bright light therapy (BLT) advanced the DLMO by 2 h, but did not affect ADHD symptoms. This article explores whether sleep times advanced along with DLMO, leading to longer sleep duration and better sleep in general, which might explain the working mechanism behind the reduction in ADHD symptoms after treatment with melatonin. This article presents exploratory secondary analysis on objective and self-reported sleep characteristics from a three-armed double-blind randomized placebo-controlled clinical trial (RCT), which included 49 adults (18-55 years) with ADHD and DSPS. Participants were randomized to receive sleep education and 3 weeks of (1) 0.5 mg/day placebo, (2) 0.5 mg/day melatonin, or (3) 0.5 mg/day melatonin plus 30 min of bright light therapy (BLT) between 0700 and 0800 h. Sleep was assessed at baseline, directly after treatment, and 2 weeks after the end of treatment. Objective measures were obtained by actigraphy, self-reported measures by various sleep questionnaires and a sleep diary. Melatonin with or without BLT did not advance sleep times, improve sleep in general, or strengthen wake-activity rhythms. So even though the DLMO had advanced, sleep timing did not follow. Adding extensive behavioral coaching to chronotherapy is necessary for advancing sleep times along with DLMO and to further alleviate ADHD symptoms.

Medical Subject Headings (MeSH)
AdultHumansAttention Deficit Disorder with HyperactivitySleep Disorders, Circadian RhythmMelatoninCircadian RhythmSleepChronotherapy
Study Links
Quality Scores
SafetyNot Assessed
Efficacy60/10
Quality85/10
Citation Metrics
Total Citations6
Citations/Year2.0
Relative Citation Ratio1.03
NIH Percentile51.2%
Research Impact Scores
APT Score0.25
Weight Score2.64
Normalized Score0.61
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