TY - JOUR
T1 - The role of inflammation in the prospective associations between early childhood sleep problems and ADHD at 10 years
T2 - findings from a UK birth cohort study
AU - Morales-Muñoz, Isabel
AU - Upthegrove, Rachel
AU - Lawrence, Kate
AU - Thayakaran, Rasiah
AU - Kooij, Sandra
AU - Gregory, Alice M.
AU - Marwaha, Steven
N1 - Funding Information: This work was supported by The UK Medical Research Council and Wellcome (Grant: 217065/Z/19/Z) and the University of Bristol. I.M.-M., S.M., R.U., A.G. and K.L. designed the study. I.M.-M. was primarily responsible for data analysis and writing of the article. R.T. contributed substantially to the data analysis. S.M., R.U., S.K., R.T., A.G. and K.L. reviewed and contributed critically to the writing of the article. The authors have declared that they have no competing or potential conflicts of interest.Key points There is recent evidence to support the potential role of inflammatory processes in the association between sleep and ADHD in children; however, so far, no research has specifically investigated the prospective association between inflammation, sleep and ADHD. Several sleep problems in early childhood, including shorter nighttime sleep duration, higher night awakening and more irregular sleep routines, constituted a risk factor for probable ADHD diagnosis at 10 years. IL-6 at 9 years, but not CRP at 9 years mediated the associations between early sleep problems and probable ADHD diagnosis at 10 years. These results open a new research vista to the pathophysiology of ADHD and highlight the potential of future preventative interventions in ADHD. There is recent evidence to support the potential role of inflammatory processes in the association between sleep and ADHD in children; however, so far, no research has specifically investigated the prospective association between inflammation, sleep and ADHD. Several sleep problems in early childhood, including shorter nighttime sleep duration, higher night awakening and more irregular sleep routines, constituted a risk factor for probable ADHD diagnosis at 10 years. IL-6 at 9 years, but not CRP at 9 years mediated the associations between early sleep problems and probable ADHD diagnosis at 10 years. These results open a new research vista to the pathophysiology of ADHD and highlight the potential of future preventative interventions in ADHD. Funding Information: This work was supported by The UK Medical Research Council and Wellcome (Grant: 217065/Z/19/Z) and the University of Bristol. I.M.‐M., S.M., R.U., A.G. and K.L. designed the study. I.M.‐M. was primarily responsible for data analysis and writing of the article. R.T. contributed substantially to the data analysis. S.M., R.U., S.K., R.T., A.G. and K.L. reviewed and contributed critically to the writing of the article. The authors have declared that they have no competing or potential conflicts of interest. Key points Publisher Copyright: © 2023 The Authors. Journal of Child Psychology and Psychiatry published by John Wiley & Sons Ltd on behalf of Association for Child and Adolescent Mental Health.
PY - 2023/6
Y1 - 2023/6
N2 - Background: Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. Methods: Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. Results: Less regular sleep routines (OR = 0.51, 95% CI = 0.28–0.93, p =.029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56–0.89, p =.004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06–1.52, p =.009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, −0.002; p =.005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p =.003). Conclusions: Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.
AB - Background: Several underlying mechanisms potentially account for the link between sleep and attention deficit and hyperactivity disorder (ADHD), including inflammation. However, studies so far have been cross sectional. We investigate (a) the association between early childhood sleep and probable ADHD diagnosis in childhood and (b) whether childhood circulating inflammatory markers mediate these prospective associations. Methods: Data from the Avon Longitudinal Study of Parents and Children were available for 7,658 10-year-old children. Parent-reported sleep duration, night awakening frequency and regular sleep routines were collected at 3.5 years. The Development and Wellbeing Assessment was administered to capture children with clinically relevant ADHD symptoms, or probable ADHD diagnosis. Blood samples were collected at 9 years, from which two inflammatory markers were obtained [interleukin-6 (IL-6) and C-reactive protein (CRP)]. Logistic regression analyses were applied to investigate the associations between sleep variables at 3.5 years and probable ADHD diagnosis at 10 years. Further, path analysis was applied to examine the potential mediating role of inflammation at 9 years (as measured by CRP and IL-6) in the associations between early sleep and ADHD at 10 years. Results: Less regular sleep routines (OR = 0.51, 95% CI = 0.28–0.93, p =.029), shorter nighttime sleep (OR = 0.70, 95% CI = 0.56–0.89, p =.004) and higher night awakening frequency (OR = 1.27, 95% CI = 1.06–1.52, p =.009) at 3.5 years were associated with higher odds of ADHD at 10 years. Further, IL-6 at 9 years, but not CRP, mediated the association between irregular sleep routines and ADHD (bias-corrected estimate, −0.002; p =.005) and between night awakening and ADHD (bias-corrected estimate, 0.002; p =.003). Conclusions: Several sleep problems in early childhood constitute a risk factor for probable ADHD diagnosis at 10 years. Further, these associations are partially mediated by IL-6 at 9 years. These results open a new research vista to the pathophysiology of ADHD and highlight sleep and inflammation as potential preventative targets for ADHD.
KW - ADHD
KW - ALSPAC
KW - Sleep
KW - inflammatory markers
KW - longitudinal
UR - http://www.scopus.com/inward/record.url?scp=85145503325&partnerID=8YFLogxK
U2 - https://doi.org/10.1111/jcpp.13755
DO - https://doi.org/10.1111/jcpp.13755
M3 - Article
C2 - 36597271
SN - 0021-9630
VL - 64
SP - 930
EP - 940
JO - Journal of Child Psychology and Psychiatry and Allied Disciplines
JF - Journal of Child Psychology and Psychiatry and Allied Disciplines
IS - 6
ER -