ABSTRACT

The majority of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) have a delayed circadian rhythm that is a characteristic of Delayed Sleep Phase Syndrome (DSPS). Treatment of DSPS may improve both the circadian rhythm and ADHD symptoms. In this three-armed randomized clinical trial, 51 adults (18–55 y) with ADHD and DSPS received sleep education and 3 weeks of (1) 0.5 mg/d placebo, (2) 0.5 mg/d melatonin, or (3) 0.5 mg/d melatonin plus 30 minutes of 10,000 lux bright light therapy (BLT) between 07:00 and 08:00 h. Placebo/melatonin conditions were double-blind. Treatment took place in the participants’ naturalistic home settings. Dim-light melatonin onset (DLMO) was measured in saliva as marker of internal circadian rhythm. Melatonin or placebo administration followed individual schedules, starting 3 hours before the individual DLMO and weekly advancing by 1 h. DLMO and ADHD Rating Scale score were assessed at baseline, directly after 3-week treatment, and two weeks after the end of treatment. Results show that at baseline 77% had a DLMO after 21:00 h with an average DLMO at 23:43 h ± 1h46. Directly after treatment, melatonin had advanced DLMO by 1h28 (p = .001), and melatonin plus BLT by 1h58 (p < .001). Placebo did not affect DLMO. ADHD symptoms reduced by 14% (p = .038) directly after melatonin treatment. Placebo and melatonin plus BLT did not impact ADHD symptoms. Two weeks after end of treatment, ADHD symptoms and DLMO had returned to baseline levels. It can be concluded that low doses of melatonin advanced the circadian rhythm and reduced self-reported ADHD symptoms. Given the large number of adult ADHD patients with concurrent DSPS, treating delayed sleep with melatonin is an important component of effective ADHD treatment.

摘要

大多数患有注意力缺陷/多动障碍 (ADHD) 的成年人都有延迟的昼夜节律，这是延迟睡眠相位综合征 (DSPS) 的一个特征。DSPS 的治疗可以改善昼夜节律和 ADHD 症状。在这项三组随机临床试验中，51 名患有 ADHD 和 DSPS 的成人（18-55 岁）接受了睡眠教育和 3 周的 (1) 0.5 mg/d 安慰剂、(2) 0.5 mg/d 褪黑激素或 (3) 0.5 毫克/天褪黑激素加上 30 分钟 10,000 勒克斯强光疗法 (BLT) 在 07:00 和 08:00 之间。安慰剂/褪黑激素条件是双盲的。治疗发生在参与者的自然家庭环境中。在唾液中测量昏暗的褪黑激素起始 (DLMO) 作为内部昼夜节律的标记。褪黑激素或安慰剂的给药遵循个人时间表，在个人 DLMO 前 3 小时开始，每周提前 1 小时。DLMO 和 ADHD 评定量表评分在基线、治疗 3 周后直接和治疗结束后两周进行评估。结果显示，基线时 77% 的人在 21:00 小时后出现 DLMO，平均 DLMO 在 23:43 h ± 1h46。治疗后立即，褪黑激素在 1h28 (p = .001），褪黑激素加 BLT 到 1 小时 58 分（p < .001）。安慰剂不影响 DLMO。在褪黑激素治疗后，ADHD 症状直接减少了 14% ( p = .038)。安慰剂和褪黑激素加 BLT 不影响 ADHD 症状。治疗结束两周后，ADHD 症状和 DLMO 已恢复到基线水平。可以得出结论，低剂量的褪黑激素会促进昼夜节律并减少自我报告的 ADHD 症状。鉴于大量成人 ADHD 患者并发 DSPS，用褪黑激素治疗延迟睡眠是有效 ADHD 治疗的重要组成部分。