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Volume 14 No. 06
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Accepted Papers

Letters to the Editor

Sleep Disorders and Attention Deficit: A Consequence of Proinflammatory State?

Mengühan Araz Altay, MD
Department of Child and Adolescent Psychiatry, Edirne Sultan 1. Murat State Hospital, Edirne, Turkey

Attention-deficit hyperactivity disorder (ADHD) is common neuropsychiatric disorder in children and adults. Sleep disorders and restless legs are related to the presence of ADHD.

Wynchank et al.1 have recently reported in the Journal of Clinical Sleep Medicine the results of a large survey of adults. The authors found that within the group with clinically relevant ADHD symptoms, 43% reported significant insomnia symptoms and 41% reported short sleep duration. A consensus group recently implicated arousal dysregulation in the pathological mechanism of attention in ADHD.2

In this context, this letter is a plea to investigators in this journal to evaluate the association between enhanced low-grade inflammation, sleep disorders, and ADHD. This mechanism has been proposed by the investigators of the Turkish Adult Risk Factor (TARF) study to underlie diverse chronic diseases,3 including type 2 diabetes, coronary heart disease, chronic kidney disease, and rheumatic diseases. It postulates that in individuals with proinflammatory state due to obesity or circulating excess oxidized phospholipid content of lipoprotein [Lp](a),4 protective plasma proteins such as adiponectin5 become converted to an inflammatory protein, with concomitant slower clearance of the protein from plasma.

Some support for this notion having a potential relevance for ADHD may be derived from Li et al.'s study that reported nondiabetic men with restless legs syndrome (RLS) have a higher risk of early death.6 Li et al. emphasized that the elevated mortality risk was not associated with the usual known risk factors but rather with endocrine, nutritional/metabolic, and immunological disorders. RLS may be another manifestation of the basic process of enhanced proinflammatory state and autoimmune activation. The TARF cohort revealed that metabolic syndrome, a constellation of proinflammatory state, was associated significantly with obstructive sleep apnea in nondiabetic individuals.7

In summary, we believe that investigations directed to proinflammatory state may be fruitful to identify mechanisms underlying sleep disorders and ADHD.


The author reports no conflicts of interest.


Araz Altay M. Sleep disorders and attention deficit: a consequence of proinflammatory state? J Clin Sleep Med. 2018;14(6):1081.



Wynchank D, ten Have M, Bijlenga D, et al. The association between insomnia and sleep duration in adults with attention-deficit hyperactivity disorder: results from a general population study. J Clin Sleep Med. 2018;14(3):349–357. [PubMed Central][PubMed]


Owens J, Gruber R, Browen T, et al. Future research directions in sleep and ADHD: report of a consensus working group. J Attent Disord. 2013;17(7):550–564.


Onat A, Can G. Enhanced proinflammatory state and autoimmune activation: a breakthrough to understanding chronic diseases. Curr Pharm Design. 2014;20(4):575–584.


Tsimikas S. A test in context: lipoprotein(a). Diagnosis, prognosis, controversies, and emerging therapies. J Am Coll Cardiol. 2017;69(6):692–711. [PubMed]


Onat A, Can G, Ayhan E, Kaya Z, Hergenç G. Impaired protection against diabetes and coronary disease by high-density lipoproteins in Turks. Metabolism. 2009;58(10):1393–1399. [PubMed]


Li Y, Wang W, Winkelman JW, Malhotra A, Ma J, Gao X. Prospective study of restless legs syndrome and mortality in men. Neurology. 2013;81(1):52–59. [PubMed Central][PubMed]


Onat A, Hergenç G, Uyarel H, et al. Obstructive sleep apnea syndrome is associated with metabolic syndrome rather than insulin resistance. Sleep Breath. 2007;11(1):23–30. [PubMed]