**5. References**

28 Sleep Disorders

The 2 biological rhythms (sleep and CBT) are sometimes desynchronized with each other, e.g., when the person was completely isolated from time cues. Once the desynchronization occurred, psychosomatic symptoms, such as headache, gastrointestinal discomfort, or general fatigue. These symptoms could make the affected person unable to perform

Furthermore, our findings obtained in this study suggest that physiological homeostasis might be seriously impaired by sleep deprivation and emotional distress, as reflected clearly by depressive symptoms in these patients. Easy fatigability and disturbed learning and memorization are among the primary characteristics of sleep disturbance and chronic fatigue in adolescents (Miike et al., 2004). Fatigue and gastrointestinal discomfort were quite severe in our patients. Another feature of this illness is the individuality of symptom

It is particularly interesting that diurnal hypersecretion of glucocorticoids and altered regulation of the hypothalamo–pituitary–adrenocortical axis are known in patients with poorly controlled or uncontrolled diabetes (Archer et al., 2003; Chiodini et al., 2006; Roy, Roy, & Brown, 1998). We found no cortisol hypersecretion in the present patients, suggesting the absence of diabetic status. However, those patients with sleep disturbance had glucoregulatory dysfunction. Results of a previous study show that emotionally stressful events result in hyperglycemia in diabetic patients (Lustman, Carney, & Amado, 1981). On the other hand, sleep deficit has a harmful impact on carbohydrate metabolism and endocrine function, even in healthy subjects (Spiegel, Leproult, & Van Cauter, 1999). Abnormalities of the biological stress response (hypothalamic–pituitary–adrenal axis and autonomic nervous system) were also identified in a previous animal study, the results of which suggested that cortisol can act directly on the central nervous system (Sandoval, Ping, Neill, Morrey, & Davis, 2003). Multiple factors including autonomic nervous system dysfunction, derangement of neuropeptides in the hypothalamus, and hormonal imbalance

The biological clock (circadian clock) in human beings is formed and regulated through interrelationships of various clock genes such as *Per1, Per2, Per3*, *Bmal1*, *Clock, Cry1, Cry2, Bmal, Rev-ervA, CK1 d/e,* and *glycogen synthase kinase 3-b (GSK3ß*) (Ebisawa et al., 2001; Gietzen & Virshup, 1999; Jones et al., 1999; Takano et al., 2004; Toh et al., 2001; Vanselow et al., 2006). Currently, the markers of circadian rhythms are considered to be the profiles of plasma melatonin, cortisol, and core body temperature (Tomoda, Miike, Yonamine, Adachi, & Shiraishi, 1997). However, even if these markers show normal rhythmic patterns, certain patients suffer from circadian rhythm sleep disorders and indeterminate symptoms, suggesting that these markers may not be reliable for the diagnosis of circadian rhythm

Presumably, autonomic and metabolic dysfunction causing sleep disturbance may be related to the *hPer2* phase shift because of chronobiological abnormality. Results of a previous study indicate that such disturbances might be related closely to the desynchronization of biorhythms, particularly the circadian rhythm of body temperature and the sleep–wake rhythm (Tomoda, Jhodoi, & Miike, 2001; Tomoda et al., 2000). Previous and present results suggest that sleep deprivation may originate from a dysfunctional network of brain areas related to the circadian rhythm and peripheral nervous system involved in the autonomic nervous system including cardiac function and gastrointestinal digestion. However, dysregulation of the circadian rhythm is neither the only nor the

ordinary daily activities.

patterns and the unpredictability of symptom severity.

might also affect the glucoregulatory metabolism.

sleep disorders.


**3** 

*Italy* 

**Sleep Disorders Diagnosis and** 

*Messina Medical School, Department of Neurosciences,* 

Rosalia Silvestri and Irene Aricò

**Management in Children with Attention** 

ADHD is an increasingly prevalent developmental disorder, especially in the western world

According to both the DSM-IV and the ICD-10 it refers to three major problematic domains: attention, hyperactivity and impulsivity. Subtypes of ADHD have been coded accordingly as a predominantly hyperactive-impulsive type (H), predominantly inattentive (I) and a

Age is an important factor in the clinical/behavioral manifestations of ADHD. Symptoms, in fact, vary according to brain maturation. The hyperactive aspects, for instance, tend to subside with age, even if longitudinal research demonstrated that over 30% of children with

Gender also plays an important role in ADHD, with a 1:10 male prevalence in clinical samples (Cortese et al., 2006). It also appears to have a strong influence over behavioral

ADHD holds a high potential for psychiatric and cognitive co-morbidity (mood, anxiety, conduct disorder and learning disability), with a nearly 50% rate of oppositional defiant

Sleep disturbance is by far one of the most reported problems (>80%) especially by parents and care-takers, who commonly recount restless, inadequate and often delayed and/or

A clear distinction, however, needs to be drawn between subjective and objective sleep reports and, with respect to the latter, actigraphyc versus video-polysomnographic (vPSG) studies present a palpable difference in terms of method and quality of data accessed. Several metanalytic reviews have been published within the last ten years, dealing with many confounding factors including gender, referral source, age range, co-morbid disorders, first versus follow-up visits, medications, number of studied nights with or

They all address, through various approaches, the multilevel/dimensional relationship

symptoms and co-morbid disorders, which appear generally less disruptive in girls.

ADHD grow up to be adults with significant ADHD related problems.

without adaptation. (Owens, 2005; Cortese et al., 2006; Sadeh et al., 2006).

among sleep alterations and neurobehavioral/neurocognitive functioning.

**1. Introduction** 

combined type (C).

conduct in males.

**2. ADHD and sleep** 

fragmented sleep in their children.

where prevalence rates are estimated around 12%.

**Deficit/Hyperactivity Disorder (ADHD)** 

