Lockdowns due to the COVID-19 pandemic exacerbated maladaptive sleep-wake rhythms and increased screen time exposure of many Italian children with attention deficit hyperactivity disorder (ADHD), according to research published in the Journal of Clinical Sleep Medicine.
Prior studies indicated changes in sleep patterns and increased screen exposure among the general population during lockdown restrictions. Study researchers specifically studied the impact on children with ADHD, who are often intolerant of forced restrictions and may be at higher risk of unhealthy changes.
Parents of children and adolescents with ADHD completed an anonymous survey in June 2020 regarding the lockdown’s impact on their children’s sleep patterns and disturbances and use of social media and daily screen exposure, excluding hours spent participating in online lessons. Questions for the survey came from the Sleep Disturbance Scale for Children.
Survey responses represented 528 children (boys, 441; girls; 87; age range, 5 to 11.11 years; mean age 9.1 years, standard deviation [SD], 1.63 years) and 464 adolescents (boys, 406; girls, 58; age range, 12 to 17.1 years; mean age 14.3 years, SD: 1.92 years).
Bedtimes were delayed in 59.3% of children and 69.4% of adolescents, but 4 adolescents had earlier bedtimes and the rest of the group maintained their bedtimes. Bedtimes of 11 PM or later increased for children (12 before lockdown increased to 177 during) and adolescents (71 to 279 during).
Sleep duration decreased in 19.9% of children and increased in 21.4% of children. Among adolescents, 22% had decreased sleep duration while 27.4% had increased sleep duration.
Bedtime delays and decreased sleep duration were associated with increased screen time exposure. The study researchers found that 64.2% of children and 72% of adolescents spent half or most of the time or day in front of a screen. Children watched more TV while the adolescents spent more time with internet and mobile phone.
Parents reported that children experienced increased nightmares, anxiety at bedtime, and bruxism and that adolescents’ daytime sleepiness had increased.
Delaying bedtime, compared with maintained bedtime, was associated with daytime sleepiness among children (60/313 [19.2%] vs 26/215 [12.1%]; χ² =4.681; P =.031) and adolescents (113/322 [35.1%] vs 27/138 [19.6%]; χ² =15.934; P <.001). Reduced sleep duration also was associated with increased daytime sleepiness in children (29/105 [27.6%] vs 39/310 [12.6%], respectively; χ² =1.066; P =.004) and adolescents (44/102 [43.1%] vs 48/235 [20.4%], respectively; χ² =15.934; P <.001) compared with those who maintained the same sleep duration. Adolescents who increased their sleep duration also had higher daytime sleepiness than those who maintained it.
Limitations of the study included no specific evaluation of the influence of psychiatric comorbidity and possible memory bias of parents.
The association of increased sleep duration with adolescents’ increase in daytime sleepiness was “alarming” since in Italy, “regular academic activities at school have been interrupted for adolescents and the persistence of this condition could represent a risk factor of stabilization of disrupted sleep patterns and screen addiction,” the study authors concluded. They added that assessing whether ADHD patients will experience “long-term disrupted sleep habits” will be a significant challenge following the pandemic.
Bruni O, Giallonardo M, Sacco R, Ferri R, Melegari MG. The impact of lockdown on sleep patterns of children and adolescents with ADHD. J Clin Sleep Med. Published online April 1, 2021. doi:10.5664/jcsm.9296