Sleep Disroders and their Link to Pharmacotherapy in Children with ADHD: A Systematic Review

Trabajo Fin de Grado curso 2022/23[ES] Introducción: El Trastorno por Déficit de Atención e Hiperactividad (TDAH) se ha vinculado tradicionalmente con las alteraciones del sueño. Algunos autores lo estudian como una comorbilidad, mientras que otros lo investigan como un efecto adverso de la terapia farmacológica del TDAH. Sin embargo, existe cierta controversia al respecto. Por ello, se precisa profundizar más en las investigaciones. Objetivos: En la presente revisión sistemática se realiza un análisis de calidad de los estudios con los que se trabajó, se estudia la presencia de las alteraciones del sueño en el desarrollo de la sintomatología del TDAH y su relación con la farmacoterapia para el TDAH en investigaciones de las dos últimas décadas. Método: Para ello, se han seleccionado 30 estudios empíricos de las bases de datos PubMed y Web of Science. Resultados: Los estudios muestran una vinculación entre algunos trastornos del sueño y la sintomatología del TDAH, en concreto, la presencia de disomnias (insomnio, apnea del sueño e hipersomnia) y parasomnias (pesadillas, terrores nocturnos y bruxismo). Los estudios que investigaron su relación con la farmacoterapia del TDAH en infantes obtuvieron hallazgos discrepantes. Parte de la literatura apunta a la presencia de alteraciones del sueño (insomnio), otra a la mejora de alteraciones preexistentes. No obstante, la mayoría de los estudios no encontró efectos adversos significativos. [EN] Introduction: Attention Deficit Hyperactivity Disorder (ADHD) has traditionally been linked to sleep disturbances. Some authors study it as a comorbidity, while others investigate it as an adverse effect of ADHD drug therapy. However, there is some controversy about it. Therefore, more in-depth research is needed. Objectives: In this systematic review, a quality analysis of the studies with which we worked is carried out, the presence of sleep disturbances in the development of ADHD symptoms and its relationship with pharmacotherapy for ADHD in research is studied. of the last two decades. Method: For this, 30 empirical studies have been selected from the PubMed and Web of Science databases. Results: Studies show a link between some sleep disorders and ADHD symptoms, specifically, the presence of dyssomnias (insomnia, sleep apnea and hypersomnia) and parasomnias (nightmares, night terrors and bruxism). Studies investigating its relationship to ADHD pharmacotherapy in infants have had conflicting findings. Part of the literature points to the presence of sleep disorders (insomnia), another part to the improvement of pre-existing disorders. However, most studies found no significant adverse effects

Prevalence and Clinical Characteristics of the Restless Legs Syndrome (RLS) in Patients Diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) in Antioquia

Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is the most common behavioral issue for children. One of the sleeping disorders most frequently related to ADHD is the Restless Legs Syndrome (RLS), characterized by an irresistible urge to move the legs, something that is generally associated with paresthesias and motor restlessness. The prevalence rate of RLS in children diagnosed with ADHD is close to 18%, but in Colombia, these cases have been hardly studied. Objective: To determine the frequency of RLS, in children with ADHD. Methods: A cross-sectional study, filled out by parents of children diagnosed with ADHD, were analyzed. This questionnaire contained clinical criteria for classifying ADHD according to the DSM-IV, as well as diagnostic criteria for RLS by the National Institutes of Health (2003). Results: A predominance rate of 65.6% in combined ADHD was observed in children with RLS criteria. Upon carrying out an exploratory data analysis, it was found that having a family history of RLS and belonging to the middle or low socioeconomic strata are conditions associated with the presence of RLS in children with ADHD, with a significant p (p < 0.000) and a PR of 4.47 (3.16-6.32). Conclusions: The prevalence of RLS was similar to the findings of other clinical investigations. However, it highlights new prevalence values in relation to the comorbidity between ADHD and RLS, suggesting the need for new clinical and therapeutic alternatives amidst the presence of both syndromes.Introducción: El trastorno de hiperactividad con déficit de atención (TDAH) es el problema de comportamiento más común en la infancia. Uno de los trastornos de sueño que más se ha relacionado el TDAH es el síndrome de piernas inquietas (SPI) el cual conlleva un deseo irresistible de mover las piernas que, en general, se asocia con parestesias e inquietud motora. La prevalencia del SPI en la población infantil diagnosticada con TDAH es de cerca del 18 %. Sin embargo, en Colombia han sido escasamente estudiados. Objetivo: Determinar la frecuencia de SPI en niños con TDAH. Método: se realizó un estudio de corte transversal, con el uso de cuestionarios diligenciados por los padres de niños con diagnóstico de TDAH. Dicho cuestionario contenía criterios clínicos para la clasificación del TDAH según el DSM-IV, y criterios diagnósticos para SPI del National Institutes of Health pediatric restless legs syndrome (2003). Resultados: Los niños con criterios de SPI tuvieron predominio del TDAH combinado en un 65.6%. Al realizar el análisis exploratorio se encontró que tener historia familiar de SPI y estrato medio o bajo se asocian con la presencia del SPI en niños con TDAH, con una p significativa (p < 0.000) y una RP de 4.47 (3.16-6.32). Conclusiones: La prevalencia de SPI fue similar a los hallazgos de otras investigaciones clínicas, sin embargo, resalta nuevos valores de prevalencia en relación a la comorbilidad entre el TDAH y el SPI, sugiriendo la necesidad de habilitar nuevas alternativas clínicas y terapéuticas en la presencia de ambos síndromes

A Systematic Review and Meta-Analysis of the Incidence of Injury in Professional Female Soccer

The epidemiology of injury in male professional football is well documented and has been used as a basis to monitor injury trends and implement injury prevention strategies. There are no systematic reviews that have investigated injury incidence in women’s professional football. Therefore, the extent of injury burden in women’s professional football remains unknown. PURPOSE: The primary aim of this study was to calculate an overall incidence rate of injury in senior female professional soccer. The secondary aims were to provide an incidence rate for training and match play. METHODS: PubMed, Discover, EBSCO, Embase and ScienceDirect electronic databases were searched from inception to September 2018. Two reviewers independently assessed study quality using the Strengthening the Reporting of Observational Studies in Epidemiology statement using a 22-item STROBE checklist. Seven prospective studies (n=1137 professional players) were combined in a pooled analysis of injury incidence using a mixed effects model. Heterogeneity was evaluated using the Cochrane Q statistic and I2. RESULTS: The epidemiological incidence proportion over one season was 0.62 (95% CI 0.59 - 0.64). Mean total incidence of injury was 3.15 (95% CI 1.54 - 4.75) injuries per 1000 hours. The mean incidence of injury during match play was 10.72 (95% CI 9.11 - 12.33) and during training was 2.21 (95% CI 0.96 - 3.45). Data analysis found a significant level of heterogeneity (total Incidence, X2 = 16.57 P < 0.05; I2 = 63.8%) and during subsequent sub group analyses in those studies reviewed (match incidence, X2 = 76.4 (d.f. = 7), P <0.05; I2 = 90.8%, training incidence, X2 = 16.97 (d.f. = 7), P < 0.05; I2 = 58.8%). Appraisal of the study methodologies revealed inconsistency in the use of injury terminology, data collection procedures and calculation of exposure by researchers. Such inconsistencies likely contribute to the large variance in the incidence and prevalence of injury reported. CONCLUSIONS: The estimated risk of sustaining at least one injury over one football season is 62%. Continued reporting of heterogeneous results in population samples limits meaningful comparison of studies. Standardising the criteria used to attribute injury and activity coupled with more accurate methods of calculating exposure will overcome such limitations