Sleep for attention by attention to sleep

Rationale: Attention-deficit/hyperactivity disorder (ADHD) is highly associated with a delayed circadian rhythm, which is prevalent in 73-78% of children and adults with ADHD. Also sleep disorders such as restless legs syndrome, sleep-disordered breathing, and insomnia are increased in ADHD. The persistence of ADHD symptoms from childhood into adulthood is even predicted by sleep problems. Sleep problems are currently seldom diagnosed and treated in psychiatry. Sleep problems increase cognitive symptoms of ADHD. Treating sleep problems is hypothesized to decrease the severity of ADHD.
Objective: To investigate the effect of sleep treatment on ADHD, mood and sleep quality.
Study design: Open-label randomized controlled trial
Study population: N=60 adults with ADHD who screen positive for a sleep disorder.
Intervention (if applicable): Participants will have a sleep screening using the HSDQ, clinical assessment and polysomnography (PSG) at home. Then, they are randomized for a 12-week intervention of (1) a protocolled sleep treatment for their sleep disorder; (2) treatment as usual (TAU) for ADHD; or (3) a combined treatment of sleep and TAU. At three time points the ADHD symptoms, sleep and mood are evaluated objectively and subjectively.
Main study parameters/endpoints: Each intervention is evaluated for its effect on the reduction of self-reported and objective ADHD symptoms, mood symptoms, and sleep quality. Treatment of sleep is hypothesized to lead to a reduction of ADHD symptoms. The combined treatment of sleep and ADHD is expected to have the highest effect on ADHD. The data will give insight into any treatment effect on the objective PSG signals, and also a cluster analysis for sleep and ADHD will be possible in order to examine if sleep parameters are related to behavioural or psychiatric aspects in ADHD.

(1) The stand-alone treatment of sleep problems will have a clinically significant effect on the reduction of ADHD symptoms in adults with ADHD.
(2) The concurrent treatment of sleep problems and usual care is more effective than usual care to treat ADHD in adults with ADHD.
(3) The concurrent treatment of sleep problems and usual care is more effective than the stand-alone treatment of sleep problems to reduce ADHD symptoms in adults aith ADHD.

The study is 14 weeks in total.
T0: baseline measurements at week 1. Then, the 12-week interventions start.
T1: a mid-term evaluation of the ADHD and mood symptoms at week 7.
T2: the final week of the study period, at week 14.

A 12-week intervention of: (1) a protocolled sleep treatment for their sleep disorder; (2) treatment as usual (TAU) for ADHD; or (3) a combined treatment of sleep and TAU.